All About Clomid (Clomiphene Citrate)
About 25 percent of the time a couple is having trouble getting pregnant, it is because of anovulation. Anovulation means that a woman’s ovaries do not release eggs regularly. Normally one or sometimes two eggs are released a month. Pregnancy is obviously not possible without both egg and sperm.
Women are born with all their eggs. No more are made after birth. The existing eggs will start to mature during puberty. A complex sequence of hormonal signals between parts of the brain and the ovaries results in the release of an egg once a month. Sometimes one or more of the signals is absent or does not occur at the right time and an egg is not released. Medication can then be useful to coax the ovaries to release eggs.
Clomiphene citrate, or Clomid, is a medication taken by mouth that can cause a woman’s ovaries to release eggs. It is the easiest drug to take for this purpose because it is taken by mouth and not given by injection. It is also the mildest in terms of stimulating the ovaries.
Sometimes Clomid will be used to check and see if a woman has enough eggs. This is done by giving 100 milligrams of the medication on days five through nine of a menstrual cycle. The first day of a menstrual period is day one. A blood test for FSH (follicle stimulating hormone) will be done on day three, before Clomid, and on day ten, after Clomid is finished. An adequate FSH response indicates that a woman has enough eggs.
Women who are not ovulating regularly and have no other specific problem causing infertility may be given Clomid. It will not work for women who have a limited amount of eggs, or specific kinds of problems with the hormonal signals coming from certain parts of the brain. It acts on an area of the brain that then sends a message to the pituitary gland, which then releases FSH and LH (luteinizing hormone) in such a way as to cause ovulation. FSH is the hormone that stimulates egg-containing follicles to mature. LH causes one such follicle to release an egg and prepare for pregnancy by becoming what is called a corpus luteum.
To cause ovulation, Clomid can be started between the third and fifth day of the menstrual cycle. 50 milligrams is given for 5 days. Ovulation can be checked in a number of ways. The level of the hormone progesterone in the blood can be measured on approximately day 21 of the menstrual cycle, and LH can be measured in the urine with one of the many fertility kits that can be bought over the counter. The tests are designed to show when ovulation has occurred.
If ovulation does not occur at the 50 milligram dose, it can be raised to 100 mg, and higher doses may be used by fertility specialists. Clomid will cause about 80% of women who are not ovulating regularly but have enough eggs to ovulate.
In some cases, Clomid can be used without any other type of infertility treatment. However, it is often used in cases of male infertility along with intrauterine insemination (IUI), which is also called artificial insemination. The man’s sperm can be concentrated and treated to make them more likely to be able to fertilize an egg. When this is done, it is a good idea to make sure there is an egg to fertilize and that the sperm and the egg get together.
Clomid is used to make sure there is an egg, and IUI is used to introduce the sperm directly into the uterus through the vagina and cervix. In cases of unexplained infertility, Clomid used to stimulate the ovaries along with IUI may result in a successful pregnancy. In other cases, assisted reproductive technology, or ART is needed (see articles on ART and hi-tech babies).
Clomid is usually well tolerated. While the chance of twins increases with its use, higher multiple pregnancies occur very rarely. Side effects are usually mild and short-lived, disappearing when Clomid is discontinued. Looking at a group of studies, the most common side effects reported are:
- Enlargement of the ovaries (13.6% of patients)
- Abdominal bloating and abdominal and pelvic discomfort (5.5%)
- Nausea and vomiting (2.1%)
- Hormone related symptoms including flushes (10.4%) and breast discomfort (2.1%) as well as abnormal vaginal bleeding (1.3%)
- Visual problems including, among other symptoms, blurred vision, flashing lights, floaters, photophobia (eye pain in light), diplopia (double vision), scotomata (areas missing in the visual fields) (1.5%)
- Headache (1.3%)
While enlargement of the ovaries can occur, the ovarian hyperstimulation syndrome (OHSS) rarely happens as the result of taking Clomid. If too many follicles are stimulated and the level of estrogen is very high, the ovaries can swell too much and fluid can accumulate around the ovaries in the abdomen and also in the chest. This can feel like bloating with some minor pain and an increase in weight. These symptoms begin after ovulation and before menstruation or pregnancy.
If these symptoms become severe, if there is a large weight gain, severe pain and/or swelling, along with shortness of breath, this is a very serious case of OHSS which must be monitored and treated in the hospital. However, this is not likely to occur with Clomid. Anyone taking Clomid who experiences distressing or severe symptoms of OHSS or anything else that seems out of the ordinary should consult their physician immediately.
Overall, Clomid is a safe and effective treatment for anovulation without a specific cause and also for unexplained infertility. If pregnancy does not occur after Clomid and IUI, ART is the next logical step.