Clomiphene Citrate (Brand names Serophene, Clomid)

How Does Clomid Work?

Clomiphene citrate is used to treat infertile women who have ovulation dysfunction. The drug works by improving the function of the pituitary gland (located at the base of the brain), the gland that controls ovulation. This drug medication is usually prescribed to those patients who have been found to have an abnormality with their cycle. On occasion, it is used in women who have been diagnosed with “unexplained infertility”. In both cases Clomid therapy has been shown to increase the odds of pregnancy.

The woman’s response to Clomid therapy is assessed using ultrasound and blood work. In many instances Clomid is effective in inducing growth of the follicles but does not trigger the LH surge. In these cases an injection of a second drug (hCG) serves as an artificial trigger.

Monitoring improves the effectiveness of therapy and also is instrumental in reducing the risk of multiple pregnancy. If during the cycle it becomes clear that the number of eggs that are developing exceeds the number that is deemed “safe” the cycle can be canceled.

How Is Clomid Given?

Clomiphene is often referred to as the “fertility pill”. It is prescribed for five days each cycle, usually beginning on day three and continuing through day seven. The usual initial dose for Clomiphene is 100 mg, two tablets daily. We generally do not increase the dose above 100 mg. If the response to this dose is not optimal, a second drug is often added.

How Successful is the Clomid Therapy?

Normal ovulation will be restored in 50–60% of women treated with Clomid.
However, only half of those women who ovulate will become pregnant. It is suspected that the reason for this discrepancy is related to other factors, which may be contributing to the fertility problem. The chance of conception with each cycle of Clomid is 20–25% for the first three cycles and drops precipitously thereafter.

Most of the pregnancies following Clomid therapy occur within the first 3 cycles of therapy. If unsuccessful within this time period, other treatment options are discussed. If the response to Clomid is not optimal a different treatment regimen may be recommended at any time.

What to Expect

Some 10% to 20% of women taking Clomiphene will experience side effects. By far, most of these are minor and temporary in nature. They include hot flashes, blurred vision, nausea, bloating sensation, and headache. Serious side effects are rarely seen with this medication. There are several side effects associated with Clomiphene therapy that warrant specific discussion, multiple pregnancy, ovarian cysts, visual changes, hot flashes, and mood changes.

1. Multiple Pregnancy: The risk of multiple pregnancy correlates with the number of eggs that develop following Clomid therapy. Typically 2–3 eggs will develop. The frequency of twins occurring under these circumstances is 4–5%.
   Monitoring the effect of Clomid using ultrasound and blood work allows us to better control the risk of multiple pregnancy. When the number of eggs observed exceed the safe number, the cycle is canceled. Using this strategy the risk of triplets is less than 1%.The pregnancies that follow Clomid therapy are not different from naturally occurring pregnancies. There is no increase in the risk of pregnancy loss (miscarriage) or birth defects.
2. Ovarian Cysts: Clomiphene has also been associated with the occasional development of ovarian cysts. These cysts are not true growths of the ovary and within a few weeks will resolve without treatment. Rarely these cysts may rupture and cause pain and discomfort.
3. Visual changes: Not a common side effects, visual changes with Clomid may present in a variety of forms. Most commonly women report a “halo” effect with moving objects. Visual changes should be evaluated immediately and in most cases Clomid therapy discontinues.
4. Hot Flashes: a common but rarely significant side effect. The hot flashes are results of the Clomid’s anti-estrogen properties. These are often transient and generally do not require the medication to be discontinued.
5. Mood Changes: vary from one individual to the next and often difficult to separate from the stress associated with fertility therapy. Mood changes should be reported and their severity discussed. In extreme cases Clomoid therapy is discontinued and ovulation therapy is conducted with gonadotropin drugs (injectable), which do not cause the same emotional side effects.