Fertility Treatments with Clomid (Clomiphene Citrate)

What is Clomid?

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 increase follicle stimulating hormone levels (FSH). The increased FSH levels directly stimulate the ovary to mature eggs.

Who is the best candidate for Clomid?

The most effective approach is to use Clomid for women with ovulatory dysfunction. These are women who do not experience periods on a monthly basis. Some of these women have no menstrual periods for several months. Most of these women suffer from polycystic ovarian syndrome (PCOS). Clomid success rates are best when used to restore ovulation in PCOS patients. It is been an extremely rewarding fertility drug that is simple, inexpensive and widely used.

Does everybody benefit from Clomid?

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.

Are they any side effects of Clomid affecting fertility?

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.

Does everybody respond the same to Clomid?

No. 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 are resistant to it. 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.

How to take Clomid?

A woman can start Clomid between cycle day 3 and cycle day 5. The clomid is typically given for 5 days, although when used as an adjunct to mini-IVF it can be given over a longer period of time.

Are there any alternatives to Clomid?

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.