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Clomid® or Serophene® (generic name clomiphene citrate) is an orally administered drug used to regulate, or stimulate, ovulation. It is usually started on cycle day 3, 4, or 5 and continued for five days. The dose varies based upon the cause(s) of the patient’s infertility, previous treatment results, and other factors. The usual starting dose is 50 mg and if ovulation does not occur it can be increased up to 150 mg per day.
Clomid® was originally studied as a birth control pill when researchers discovered its ovulation inducing characteristics. Contrary to follicle stimulating hormone (FSH), which stimulates the ovaries directly, Clomid’s® effects are exerted at the hypothalamic gland (See the discussion on the fertility drug overview page).
Clomid® works by competing, or binding, with estrogen receptors at the hypothalamus. When these receptors are occupied, the hypothalamus “measures” lower estrogen levels and thus releases GnRH, which causes the pituitary to increase FSH production. Increased FSH production leads to enhanced follicular recruitment and development.
The most significant problem with Clomid® is overuse. It is widely used by obstetrician/gynecologists, often for longer times than recommended. Numerous studies demonstrate that Clomid® is most likely to be effective in the first 3-6 ovulatory cycles and pregnancies decline dramatically after 3 cycles. If Clomid® has not worked within this time frame, fertility specialists will usually move to other therapies, such as stimulated (addition of FSH) IUI or IVF.
Yet, we see patients who have been on Clomid® for as long as a year. Continued use increases the chances of side effects and is expensive. We also see women taking Clomid® whose husbands have not had a semen analysis. Clomid®, or any other fertility drug, will not work unless there are “adequate”, “quality” sperm available. A semen analysis is always strongly recommended before using ovulation enhancing agents such as Clomid®. A woman should also obtain a hysterosalpingogram (HSG) prior to Clomid® use if she has a history of pelvic infection or pelvic surgery. If there is no history of pelvic problems, an HSG should be completed if conception has not occurred after 2-3 ovulatory cycles on Clomid®.
There are epidemiological studies that suggest if Clomid® is used longer then 12 months there may be an increase in the incidence of ovarian tumors. This is a “weak” association but should be considered when prescribing Clomid®.
Many fertility specialists monitor Clomid® cycles with ultrasound, which allows visualization of follicular development and documentation of ovulation. Other methods of monitoring the time of ovulation include urinary ovulation predictor kits, blood tests for estradiol, progesterone and luteinizing hormone (LH). Basal body temperature charts and serum progesterone levels can be used to to confirm ovulation. Sometimes an injection of hCG will be given to stimulate ovulation if follicles seen on ultrasound are of the appropriate size during monitoring.
Please see the Clomid® manufacturers Web site for a complete listing of potential side effects.
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