Clomid is a widely used drug for fertility treatments. It is a very old drug discovered back in the 1960’s and acts as a selective estrogen receptor modulator. This means, that it attaches to receptors normally reserved for estrogen. The main effect is to naturally increase Follicle Stimulating Hormone (FSH) levels. The increased FSH levels directly stimulate the ovary to mature eggs.
Women with ovulatory dysfunction are ideal candidates for Clomid therapy. These are women who do experience irregular periods. Some of the women experience no menstrual periods for months. Most of these women suffer from Polycystic Ovarian Syndrome (PCOS). Clomid success rates are highest when used to restore ovulation in PCOS patients. When applied correctly, it is an extremely rewarding fertility drug that is simple, inexpensive and effective.
No, the problem is that Clomid is often prescribed because it is readily available and inexpensive. Some physicians prescribe Clomid without considering individual circumstances of each patient. Some women will benefit from such random administration, but many will take Clomid and only experience side effects. Clomid is quite inefficient in women who otherwise have regular periods. The only benefit of Clomid in such situations is if it is given at a higher dose (100-150mg daily). When given at higher dose, Clomid can help the ovary to mature 2 to 3 eggs in one month. In such months, the woman is more fertile since she matures more eggs than in a natural cycle. Higher doses of Clomid can only be administered when the response to it is monitored by ultrasound. Unfortunately, many general practitioners do not perform ultrasound monitoring and only prescribe Clomid at the very low dose.
Some women experience thinning of the endometrial lining during therapy with Clomid. This can become a problem once the embryo is ready to implant into the endometrial lining. Therefore, it is important to monitor Clomid treatments with an ultrasound and measure the endometrial thickness. If the endometrial lining is found to be thinned out, we recommend to avoid using Clomid. In some cases, additional vaginal estradiol can help restore the endometrial thickness.
In our practice, we frequently see women who were administered low doses of Clomid that do not induce growth of multiple eggs but thinned out the endometrial lining. In such cases the woman that was administered Clomid is actually worse off than in a natural cycle. She did not gain any additional eggs and has only thinned out the endometrial lining. Some patients who are not monitored with an ultrasound might not be aware of this. Therefore, every serious reproductive endocrinology clinic will always monitor patients that were administered Clomid. We always want to find out how many follicles developed and how thick is the endometrial lining.
Another side effect is that Clomid can induce ovarian cysts that can occur weeks after treatment. The cysts are often discovered once we see the patient for another treatment cycle start. The reason behind this is that Clomid may remain active in the woman’s body for several weeks. The ovaries remain stimulated and Clomid induces development of eggs at random times in a menstrual cycle.
Yes. We see very strong responses to Clomid and we have had patients that will develop seven or eight eggs on Clomid alone. Usually these patients have high AMH levels. Some patients with very severe PCOS show resistance to Clomid. While Clomid is very effective in patients with ovulatory dysfunction, some patients show no response because their condition is too severe. Another frequently used term is "Clomid resistant".These patients usually include PCOS patients with very high AMH levels. In such cases we need to use injectable gonadotropins to restore the ovulatory cycle.
A woman can start Clomid between cycle day 3 and cycle day 5. Each tablet of Clomid contains 50mg of Clomiphene Citrate. Typically patients take 1-3 tablets daily for a total of five days. The Clomid remains effective in the body even after all tablets are taken, since the half life is very long. In some cases when used as an adjunct to mini-IVF it can be given over a longer period of time.
Yes, there are other oral medications that can stimulate the ovaries. Some of them are Letrozole and Tamoxifen. They can be sometimes utilized instead of Clomid. A more potent alternative to stimulating with oral medication are injectable fertility drugs.
Your Clomid will be prescribed by your gynecologist or reproductive endocrinologist. Sometimes a general health practitioner can also provide you a prescription. We recommend to see a fertility specialist whenever possible. Their expertise can ensure that Clomid is the appropriate treatment for your condition. Fertility clinics are the best places to obtain and monitor the Clomid treatment.
Clomid is still considered an entry level basic fertility treatment and is typically a covered benefit by any major health insurance including HMO plans like Kaiser Permanente. Kaiser patients with infertility issues can read more about the Kaiser Permanente fertility treatment options here. Patients that pay Clomid out of pocket typically spend about $50 or less .
Transvaginal ultrasound monitoring is the best way to fully evaluate the effects of Clomid therapy. In limited circumstances a diagnosis of ovulatory dysfunction can be made by patient history and presenting symptoms in a remote consultation. Laboratory testing can confirm this diagnosis and Clomid therapy can be started remotely. Monitoring ovulation at home might be a challenge, since a great majority of patients with ovulatory dysfunction suffers from PCOS and might have increased baseline Luteinizing Hormone (LH) levels. Thus, detecting ovulation becomes somewhat tricky, but a patient can be guided how to correctly interpret the results and in some cases use diluted urine specimens to improve the specificity of urine strip ovulatory tests. Modern urinary fertility monitors further detect Estrone-3-glucuronide and this can alert the Clomid user of a developing follicle, detecting that Clomid induced ovarian response. However no home monitor can provide information on the number of developing follicles or thickness of the uterine lining.
In general, unmonitored Clomid therapy might only be justified with patients with irregular or absent periods. Patients with regular periods seeking Clomid therapy are strongly encouraged to have monitored cycles only!
Clomid will only be successful if it can properly address the underlying infertility problem. If used properly, particularly in patients with absent or irregular periods, Clomid therapy can be greatly rewarding. If used randomly with no clear rationale, it might induce ovarian cysts and further complicate fertility treatments. Timing the ovulation with either ovulatory predictor kits (OPK) or artificial ovulation trigger in combination with timed intercourse or intrauterine insemination can further improve the treatment success rates. It is best to contact an experienced reproductive endocrinologist who can provide you with guidance and proper assessment and ensure your Clomid Therapy Success.