Clomid- Clomiphene Citrate
Clomid for Ovulation Induction
Clomid (Clomiphene Citrate) is a fertility drug used for the treatment of ovulation disorders. Clomid may be used to treat women with complete failure to ovulate or for the treatment of luteal phase defect. Clomid acts by causing the pituitary gland to produce a higher level of the hormones (FSH and LH) that control ovulation.
Clomid is taken in pill form from the 5th through the 9th day of the menstrual cycle - day 1 is the first day of full menstrual flow. The dose of Clomid may vary from 1 to 4 tablets per day depending on individual patient response. The usual starting dose is 1 tablet per day. Clomid may be taken at any time of day and if more than 1 pill is prescribed, the total dose may be taken all at the same time.
As Clomid treatment is started we will often see you for a “mid cycle scan.” At that appointment we will perform a sonogram to see how your ovaries are responding to the drug – how many eggs have developed. In a small percentage of patients, Clomid interferes with endometrial development (the uterine lining) or with cervical mucous development. We will check those things as well.
Clomid may delay ovulation by 1-3 days – relative to your usual cycle.
At mid cycle you may be given human chorionic gonadotropin (hCG). hCG is a hormone, given by injection, that mimics the pituitary gland message to the ovary to release the egg. It is helpful in timing intercourse or artificial insemination. It also has a beneficial effect on hormone production during the luteal phase (the second half of the ovarian cycle).
Occasionally, women taking Clomid have side effects. Common side effects include: headache, abdominal fullness or bloating, hot flashes, blurred vision. These side effects are usually temporary and are mild. There are several case reports of persistent blurred vision after clomiphene treatment. Occasionally Clomid causes moodiness or even mild depression.
Clomid is highly effective in stimulating ovulation. Approximately 80% of women who are treated with clomiphene will ovulate. Pregnancy rates vary depending on other factors - sperm count, etc. Many clomiphene pregnancies occur within 3 or 4 treatment cycles.
There are two recognized risks of Clomid treatment: multiple pregnancy and ovarian cyst formation. Approximately 8% of Clomid conceptions are multiple - twins or more. This may occur even on the lowest dose of Clomid. Approximately 10% of women who are treated with clomiphene will develop an ovarian cyst. For this reason, a pelvic examination is performed at the end of each treatment cycle - around the time of your menstrual period. If an ovarian cyst is detected, clomiphene treatment is withheld during the following cycle. The ovarian cyst usually resolves without further treatment.
Clomid has been in clinical use for over 30 years. There is a large amount of data that suggests that babies born as a product of clomiphene treatment have a normal risk of congenital anomalies - not higher and not lower. Clomid is widely used and is generally accepted as a safe drug in this regard.
There have been a variety of serious illnesses reported in association with Clomiphene treatment. Their frequency is rare or extremely rare and in some cases a proven link to Clomiphene treatment as the cause is not clear.
There have been at least two publications suggesting there may be a link between Clomid treatment and increased risk of ovarian tumors. The first publication was in 1993 and noted that women who took " fertility drugs” seemed to be at increased risk of developing ovarian cancer -particularly if they never conceived a pregnancy. A second study was published in 1994 with long-term follow-up of a large number of infertility patients. This study showed an increased risk of ovarian cancer in women using clomiphene citrate for treatment of ovulation.
The increased risk was noted only in women using the drug for 12 or more treatment cycles (that is - 12 total cycles not necessarily consecutive). Since these initial publications, there have been several larger studies of this issue, which have concluded that there is not a link between Clomid (or any other fertility drug) and an increased risk of ovarian cancer.
Making Clomid follow up appointments: a follow up to check for ovarian enlargement is performed either a week before the period is due (allowing for a blood test to check progesterone level) or at the end of the cycle. We call these appointments “ovary checks.” Your fertility specialist will tell you what to schedule.
Key Points About Clomid in Summary:
- Cycle day 1 is the first day of full menstrual flow.
- Intercourse on the day of ovulation predictor kit change and/or the following day or every other day 10 through 20.
- Pelvic exam/”ovary check” at the end of the cycle or one week after ovulation if a blood test for progesterone is planned.