Medical contribution by J. Ryan Martin, M.D.
Ryan Martin, M.D., is board certified in obstetrics and gynecology and reproductive endocrinology and infertility. His interests include infertility, in vitro fertilization, pre genetic screening (PGS) and fertility preservation for oncologic or social reasons. Dr. Martins see SGF patients in the Warrington, Pennsylvania office.
For over 50 years, clomiphene citrate (also known as clomiphene, Clomid, or Serophene) has been used to help treat infertility. Clomid is an oral medication prescribed for infertility, but unlike more advanced fertility technologies, pregnancy rates with Clomid have not changed over time.
Many people are aware of Clomid as a low-tech, lower-cost option than in vitro fertilization (IVF) and are happy to learn they can try this type of treatment with their existing OB/GYN or primary care physician. While many women are able to conceive with Clomid, for those who don’t, the decision about when is the appropriate time to move on to a different treatment can be unclear.
When is Clomid used for infertility?
Clomid is most successful as the first line of treatment for women who experience irregular or absent menstrual cycles. Clomid can also be used for women who ovulate normally, but who have otherwise unexplained infertility. Clomid treatment generally results in a 10-12 percent pregnancy rate per cycle, even when combined with intrauterine insemination (IUI).
Women who do not ovulate due to low body weight or hypothalamic amenorrhea (when menstruation stops for several months) rarely respond to Clomid.
Clomid pregnancy rates
The goal of treatment with Clomid is to normalize or induce ovulation by taking a 50 mg dose per day on days 3 through 7 of the menstrual cycle. Eighty percent of women taking Clomid will successfully ovulate and 10 to 12 percent will conceive per cycle.
Though Clomid is generally well tolerated by most people, in some cases it can lead to changes in a woman’s cervical mucus and have endometrial effects that can negatively impact success rates. There is no evidence that shows increasing the dosage of Clomid will result in an increase in pregnancy rates. Increased dosages of Clomid may actually worsen the side effects.
Another factor that limits the success of Clomid is that many people have other unknown infertility factors. A previous study showed that 87 percent of women who ovulated but failed to conceive with Clomid had an additional cause of infertility such as Adhesions, tubal disease, endometriosis, male factor infertility, or a combination of these factors. Diagnostic testing such as a hysterosalpingogram (HSG), semen analysis, and ultrasound should be performed prior to Clomid treatment to rule out other fertility factors.
It’s important to note that a woman’s age plays a major role in pregnancy rate outcomes regardless of the diagnosis.
Your physician may recommend you combine Clomid with intrauterine insemination (IUI) if Clomid alone does not result in a pregnancy.
How many cycles of Clomid should you try before moving on?
There are several factors that may influence how many cycles of Clomid you should attempt before moving on to a more advanced line of treatment under the care of a reproductive endocrinologist.
Patients with polycystic ovary syndrome (PCOS), anovulation, or irregular periods taking Clomid without ultrasound monitoring:
- Women under 38 should attempt no more than six cycles.
- Women 38 and over should attempt no more than three cycles
Patients taking Clomid with ultrasound monitoring:
- Women under 37 should attempt no more than three to four cycles.
- Women 37 or older should move on to more advanced treatment immediately.
Every patient’s treatment plan is unique and the type of treatment is based on the age, diagnosis, and medical history of the patient. We take a stepped-approach to treatment, starting with the simplest, most affordable treatment options first and move up to more advanced treatments only if needed. More than half of all treatment cycles we do are considered low tech.
The emotional aspect of treatment
It’s important to consider the psychological toll that multiple unsuccessful treatments can have on couples.
When thinking about moving on to another form of treatment, it is important to consider how many cycles you have attempted, your age, and the guidance from your physician based on data-driven decisions. While we consider the facts and statistics based on each patient’s situation, we encourage our patients to do what feels right for them.
In addition to evaluating the medical recommendations, we understand the emotional and financial aspects of infertility can weigh heavily on the decision to begin treatment or move to a new level of care. At Shady Grove Fertility, we offer a variety of clinical, financial, and emotional resources to help you find the answers and support you need to take the next step towards building a family.
Editor’s Note: This post was originally published in July 2016 and has been updated for accuracy and comprehensiveness as of February 2021.
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