Clomid is a fertility drug used for the treatment of infertility,or ovulation disorders. Clomid may be used to treat women with complete failure to ovulate, irregular ovulation, or for the treatment of a luteal phase defect. Clomid acts by causing the pituitary gland to produce higher levels of the hormones (FSH and LH) that control ovulation. Clomid is sometimes administered in a "combined drug protocol" with FSH.
The fertility drug Clomid is taken in pill form usually from the 5th through the 9th day of the menstrual cycle - day 1 is the first day of full menstrual flow. Clomid’s dose may vary from 1 to 4 tablets per day depending on individual patient response. The usual starting dose of Clomid 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.
After Clomid treatment is started, we will often schedule patients for a “mid cycle scan.” At that appointment we will perform a sonogram to see how the ovaries are responding to the fertility 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. These potential fertility drug side effects are ruled out using the appropriate fertility tests.
At mid cycle, many patients are given the fertility drug human chorionic gonadotropin (hCG, Pregnyl, Ovidrel). hCG is a hormone, given by injection, that mimics the pituitary glands message to the ovary to release the egg(s). It is helpful in timing intercourse and when performing artificial insemination (IUI). hCG also has a beneficial effect on hormone production during the luteal phase (the second half of the ovarian cycle).
Clomid can sometimes produce side effects. Common side effects of Clomid include: headache; abdominal fullness or bloating; hot flashes; and blurred vision. These side effects are usually temporary and mild. However, there are several case reports of persistent blurred vision after Clomid treatment. Occasionally Clomid causes moodiness or even mild depression.
Clomid is a highly effective fertility drug for stimulating ovulation. Approximately 80% of women who are treated with Clomid will ovulate. Pregnancy rates vary depending on other factors - sperm count, etc. Most Clomid pregnancies occur within the first 3 or 4 treatment cycles.
Clomid has two clearly recognized treatment risks; 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 Clomid will develop an ovarian cyst. For this reason, a pelvic examination is performed at the end of each treatment cycle, around the time of the menstrual period. If an ovarian cyst is detected, Clomid 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 Clomid treatment have a normal risk of congenital anomalies - not higher and not lower. Clomid is widely used and is generally accepted as a safe fertility drug in this regard.
Clomid treatment has been connected to two potentially serious clinical events. Their frequency is rare, or extremely rare, and in some cases a proven link to Clomid treatment as the cause is not clear. There have been at least two publications suggesting there may be a link between the fertility drug clomiphene citrate (Clomid) 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 Clomid for ovulation induction. The increased risk was noted only in women using the fertility 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 on Clomid therapy 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 doctor will tell you what to schedule.
Key Points in Summary:
- Cycle day one is the first day of full flow bleeding. The fertility drug Clomid is taken days 5 thru 9 of your cycle.
- Intercourse on the day of ovulation predictor kit change and/or the following day or every other day 10 thru 20.
- Pelvic exam/”ovary check” at the end of the cycle or on day 21, 22, 23, or 24 if a blood test for progesterone is planned
