Need to Know Facts About Using Clomid

Clomiphene citrate has been on the front lines of fertility for over 50 years, but, unlike the more advanced fertility technologies, pregnancy rates with clomiphene citrate have varied very little over time. Many patients are aware of clomiphene as a low tech and lower cost option than IVF and are happy to learn they can embark on this level of fertility treatment with their existing OB/GYN or primary care physician. Some patients find success with clomiphene citrate, but for those who don’t, the decision about when to move on to more advanced treatment can be unclear. A brief review of pregnancy rates with clomiphene citrate may shed more light on this issue.

Success Rates with Clomiphene Citrate

Clomiphene citrate is most successful as the first line of treatment for women who experience irregular or absent menstrual cycles resulting in a 15-20% pregnancy rate per attempt. Patients who do not ovulate due to low weight amenorrhea or hypothalamic amenorrhea rarely respond to clomiphene citrate.

Clomiphene citrate is also routinely prescribed by primary care physicians for women who ovulate normally but who have otherwise unexplained infertility. But, as the table below demonstrates, using clomiphene citrate for other diagnoses is less effective and results in a less than 10% pregnancy rate per cycle even when combined with Intrauterine Insemination (IUI).

The goal of treatment is to normalize or induce ovulation by taking a 50mg dose of clomiphene citrate on day 3-7 of the menstrual cycle. Interestingly, 80% of women taking clomiphene citrate will successfully ovulate but fewer than 50% of patients will conceive. This could be due to some of the side effects of clomiphene citrate. Though it is generally well tolerated, it can lead to cervical mucus changes and have endometrial effects that could negatively impact success rates. There is no evidence that empirically increasing the dosage of Clomid will increase pregnancy rates. Increased dosages may actually even exacerbate the side effects.

Another factor limiting the success of clomiphene citrate is that many patients have secondary infertility factors. One study showed that 87% of the women who ovulated but failed to conceive with clomiphene citrate had an additional cause of infertility such as pelvic lesions, tubal disease, endometriosis, male factor infertility, or a combination of these. Diagnostic tests such as a hysterosalpingogram (HSG), semen analysis, and ultrasound should be performed early in the treatment phase to rule out other fertility factors.

It is most important to note that the woman’s age plays a major role in pregnancy rate outcomes regardless of her diagnosis. Patients over age 35 may want to consider more advanced therapies sooner.

Recommendations for Moving to Advanced Treatment

It is typically recommended that women attempt no more than 4-6 cycles of clomiphene citrate before additional testing or advancement to another level of treatment occurs. Every patient’s treatment plan recommendation is unique and the level of care they begin with or move into is based on age and diagnosis. In general, the levels of treatment are:

Clomiphene citrate combined with IUI
Clomiphene citrate combined with gonadotropins and IUI
Gonadotropins combined with IUI
IVF
Donor Egg

Age and Diagnosis Play an Important Role in Success

There are two categories of patients for whom more advanced treatment should be considered even sooner, after only three cycles of clomiphene citrate: those with unexplained infertility and patients over 35.

For patients with unexplained infertility who are using clomiphene citrate, the success rates are less than 15% per cycle even when combined with IUI. A recent study used a randomized clinical trial to evaluate optimal treatment for unexplained infertility. The fast track and standard treatment trial (FASTT) clearly demonstrated that it was more cost effective to proceed to IVF after three cycles of clomiphene citrate /IUI, than to continue with clomiphene citrate /IUI or gonadotropins and IUI.

Age matters when in comes to achieving a pregnancy. Even in the normal, non-infertility population the percentage of women who are able to conceive diminishes with age, with the most noticeable decreases occurring after the age 35. As a result, the success rates with clomiphene citrate /IUI cycle are even lower for older patients. Considering this, it may be more advantageous for women over the age of 35 to do fewer cycles of clomiphene citrate therapy before moving to advanced care.

Timely Treatment Supports Positive Patient-Doctor Relationship

Another factor to consider is the psychological toll that multiple unsuccessful treatments can have on women and how it affects the relationship with their treating physician. Patient optimism and satisfaction can be affected by the timing of treatment advancement.

A study published in the Journal of Women's Health supports this observation. Patients who have had a diagnosis of infertility for more than one year before being referred to a specialist were more reluctant to return to their referring obstetrician. When patients were referred to a specialist within 6 months of unsuccessful treatment, the majority (76%) returned to their OB/GYN for delivery but if the referral was made 1-2 years after initiating treatment only 35% returned after they conceived with their Reproductive Endocrinologist.

Moving Forward

In addition to evaluating the medical recommendations, we understand the emotional and financial aspects of infertility can also weigh heavily in the decision to begin treatment or move to a new level of care. Shady Grove Fertility offers a variety of clinical, financial and emotional resources to help you find the answers you need to help you take the next step toward your dream of parenthood.

For more information or to schedule an appointment with one of our physicians, please speak with one of our friendly New Patient Liaisons by calling 888-761-1967.