For women who are not ovulating regularly, the goal of treatment is to mature and ovulate a single egg—this is known as ovulation induction.
Ovulation Induction with Clomiphene Citrate
Clomiphene citrate (Clomid, Serophene) is a commonly used ovulation induction medication. It is used primarily to treat women who have ovulation disorders as reflected by infrequent or irregular menstrual cycles. Clomiphene citrate works at the level of the brain and pituitary gland and facilitates the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH and LH, in turn, stimulate the ovaries to produce eggs and the ovarian hormones estradiol (E2) and progesterone (P4).
What to Expect
How to Take Clomiphene Citrate
Clomiphene citrate is a tablet that a woman takes by mouth for 5 days, typically beginning on day 3 of her menstrual cycle. Before you start taking Clomid, your physician must confirm that you are not pregnant by performing a baseline ultrasound, pregnancy test, and hormone tests. The initial prescribed dosage of clomiphene is 50 to 100 mg (one or two tablets) daily at bedtime, or as prescribed by your physician.
Monitoring of egg development is usually done with E2 and LH blood hormone tests and ultrasound scans of the ovaries to determine when the egg is mature.
An injection of Ovidrel is then typically recommended to trigger the release of your egg. One of the biggest benefits of a trigger shot is the increased ability to correctly time intercourse at home or insemination in the office. If you are having timed intercourse, your physician will instruct you to have intercourse on the day of the trigger shot and then again 2 days later to increase potential chances for conception.
Where can I fill my prescription for clomiphene citrate?
You can easily obtain clomiphene citrate that your physician prescribed at most local pharmacies, whether they specialize in fertility medications or not.
What are the common side effects?
Though it is generally well tolerated, clomiphene citrate can cause hot flashes and mood changes as well as lead to cervical mucus changes and thinning of the uterine lining that can negatively impact success rates. Approximately 80 percent of women taking clomiphene citrate will successfully ovulate, but fewer than 50 percent of patients will conceive. Another risk to consider is the increased chance of multiples—which is around 10 percent—compared to the natural rate of twinning, which is between 1 to 2 percent.
Why are monitoring appointments necessary?
Monitoring appointments consist of an ultrasound and bloodwork. The ultrasound allows the physician to visualize the thickness of the uterine lining and the ovaries, more specifically the number of follicles within them. The bloodwork shows the trend of pre- to post-stimulation hormone levels—increased levels of estrogen indicate follicular development. These two measures of cycle progress tell your physician about three important events during stimulation:
Did the ovarian stimulation actually work?
The first thing a physician learns from monitoring the progress of the cycle is if a follicle was recruited and developed. Finding the correct dosage that results in developing a single follicle in the beginning is a bit of guess and check. Some women will respond to a 25 mg dose, while others can require up to 150 mg before follicular development starts to occur. Starting with a conservative dose until the physician knows how you will respond is the best approach, as over-stimulation can result in the development of more than one follicle and, as a result, an increased risk of multiples.
So what if it doesn’t work? Lack of response indicates to the physician that you need a higher dosage of medication. This higher dose can start the same day since you are still in the follicular phase of your cycle. The ability to know that the dosage was ineffective early in the treatment cycle saves you nearly an entire month.
Is the lining thick enough for implantation?
The second factor that monitoring can tell a physician is how the uterine lining responded to the clomiphene citrate. Some women using clomiphene citrate will suffer from a thinning of the uterine lining, making for a less than optimal environment for embryo implantation. Should this occur, physicians can help to supplement the thickening of the lining with an estrogen suppository. In some cases a follicle will develop, but pregnancy may not have occurred because the lining was too thin—a factor that the physician wouldn’t be aware of without an ultrasound-monitored cycle.
Was there an over-response to medication?
Unmonitored cycles can result in an increased chance of multiples, which is risky for both mother and babies. Multiples can occur when several follicles are developed and ovulated in a single cycle. Monitoring can tell the physician when an unsafe number of follicles have been developed, allowing him or her to advise you to abstain from intercourse to avoid the increased risk of a higher- order pregnancy.