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Success rates never mattered more
Clomid Fertility Drug Treatment for Women
Clomid, Serophene, or clomiphene citrate (generic name) is a medication that is commonly used for the treatment of infertility. It is often used to attempt to induce ovulation in women that do not develop and release an egg (ovulate) on their own.
- Women who do not ovulate without medications are said to be anovulatory and have a condition called anovulation
- Many of these women have polycystic ovarian syndrome, or PCOS
- Clomid is also frequently used to stimulate extra follicles to develop in the ovaries of women that already ovulate without medications
- In these cases the hope is that increasing the number of eggs releasing will increase the chances for getting pregnant
How does Clomid work?
Clomid works as an “anti-estrogen” that tricks the brain into thinking that estrogen levels in the body are very low. It does this by binding to estrogen receptors in the brain and blocking the ability of estrogen to bind to those receptors.
The brain then thinks that estrogen levels are very low so it releases GnRH hormone which goes to the pituitary gland and stimulates release of follicle stimulating hormone (FSH). The job of FSH is to stimulate development of a mature follicle (egg containing structure) in the ovary.
Women that do not ovulate regularly, such as those with PCOS, will often ovulate after taking Clomid. However, this is quite variable and many anovulatory women will not respond to Clomid and ovulate at all.
- In general, about three fourths of women that are not ovulating “on their own” will ovulate on Clomid at some dosing level
- Unfortunately, only about half of the women that ovulate with Clomid will get pregnant with it
How long does it take to ovulate using Clomid?
On the average ovulation occurs about 7-10 days after completing a course of Clomid pills. This varies quite a bit, depending on whether the woman ovulates regularly on her own or not.
Some women will ovulate before seven days after the last Clomid tablet and some that have very irregular cycles will ovulate much later – as late as two or three weeks after the last clomiphene tablet.
What is the process or protocol for taking Clomid?
The protocol for taking Clomid is somewhat different according to whether the woman ovulates on her own or not. Please see the Clomid protocols on the appropriate page:
Timing intercourse after Clomid treatment
There is no perfect “ovulation calculator” to use with Clomid. It is best to have intercourse on the day of ovulation possible. The trick is to figure out what day that is.
- Some women use ovulation predictor kits with Clomid cycles to time their sex
- These kits are available at drugstores and supermarkets and are are urine tests that the woman does at home
- These ovulation predictor kits. also referred to as OPK s, are designed to detect the presence of the woman’s LH surge
- The LH surge in the bloodstream begins approximately 36 hours prior to ovulation
- The ovulation prediction kit test is usually done once daily and when it turns positive then sex either the same day or the next morning are the best for fertility.
Couples often ask “when should we have intercourse, and how often” in order to get pregnant.?
- Sex once on the day of ovulation should be good enough
- However if the ovulation day is not certain, then intercourse every other day (or every day) around the time of ovulation is a good option
- If sperm is normal it should live in the reproductive tract of the female for 3 to 5 days
- However, the egg has a life span of only 12 to 24 hours. Therefore, intercourse a day or two before ovulation should be fine, but if the first recent sex is more than 24 hours after ovulation then the egg has already degenerated.
Ovulation generally occurs about 14 days prior to the onset of the next menstrual period. Therefore, when the menstrual cycle length is known for the woman�™s typical Clomid cycle, then intercourse can be timed to fall about 12 to 16 days prior to the “expected” date for the next period.
For example, if the woman has a 32 day cycle length on Clomid, then she is probably ovulating on about day 18. A good plan for having intercourse would be to have sex on about days 16, 18 and 20.
Monitored Clomid cycles using follicle ultrasound scans and blood hormone levels
- Infertility specialists and some gynecologists will monitor the development of follicles with “follicle checks” by ultrasound scans
- This is done with or without monitoring blood hormones during clomiphene treatment cycles
- This approach allows clarification of the level of response and is a good way to determine proper timing for sex or intrauterine insemination, IUI
- Usually when Clomid cycles are monitored an HCG trigger injection will be given to the woman when the growing follicle(s) is at a mature size
- The HCG trigger injection acts in the body just like an LH surge would – and ovulation should occur about 36 to 40 hours after the shot is given
When follicle scans are used with Clomid along with an HCG injection, the ideal follicle size for getting mature eggs is about 18 to 30 mm diameter at the time of the hCG injection.
Ultrasound and blood testing during Clomid cycles will also show us when no mature follicles are developing in response to the medication. In those cases we know that we will need to try a higher dose of Clomid, or move on to another form of therapy.
Clomid and injectable gonadotropins
- Sometimes clomiphene is used in conjunction with injectable gonadotropins (“injectables”), particularly when the woman is not responding and ovulating well to Clomid alone.
- Injectable gonadotropins contain FSH hormone – we boost the FSH level in the blood by injecting FSH
- There are several protocols for adding the injectables in a Clomid cycle
- It is important to monitor follicle development carefully with ultrasound scans and blood hormone levels when injectable FSH products are used
- This is because using Follistim, Gonal-F, Menopur, or Bravelle (injectable FSH brand names) with Clomid can greatly increase the number of developing follicles
One example of a monitored Clomid + injectable protocol is shown here:
- Clomiphene pills taken days 3 to 7
- Start injectable FSH product (Follistim, Gonal-F, Bravelle, Menopur) on day 10 at a dose of 75 units per day
- Monitor response with estradiol and LH blood levels and ultrasound follicle scans starting on day 13
- Repeat monitoring visits as indicated by the egg production response in the ovaries
- Trigger ovulation with 10,000 units of HCG when 1 – 2 follicles measure 17 to 19mm diameter
- It is very important to avoid stimulation of too many mature (or close to mature) follicles because of the risks of multiple pregnancies – including twins, triplets and higher.
Clomid and artificial insemination, IUI
Infertility specialist clinics will often add intrauterine insemination to clomiphene cycles in order to increase the chance for pregnancy. Insemination is particularly beneficial for women that already ovulate on their own and have unexplained infertility or a male factor situation.
Clomid and twins and higher order multiple pregnancies
What is the percentage of conceiving multiples on Clomid? One large study of Clomid use showed that pregnancies were:
Costs of Clomid medication and Clomid treatment cycles
Clomid is not expensive and will cost between about $10 and $100 per cycle depending on the dose and whether a brand name or generic clomiphene citrate is used.
- The average cost for Clomid for a cycle is about $40
- The average cost for generic clomiphene citrate is about $15
- Approximate average costs in the US (and costs at our clinic) for fertility treatment costs
More Clomid and PCOS related pages on our site:
Fertility drug: Clomiphene
Clomiphene citrate can help you get pregnant if:
Depending on your fertility issues or overall health, a doctor might prescribe drugs other than clomiphene. Find out more about fertility drugs for women .
Does clomiphene work for men?
Clomiphene can help men who have a hormonal imbalance linked to low sperm count, or poor sperm quality or motility.
What’s clomiphene treatment like?
Clomiphene treatment can be an emotionally intense process for some women because they’re anxious about their body’s response to the medication. Women taking clomiphene also have to go to the doctor’s office frequently for monitoring.
Here’s how it works:
- Taking the drug. You take a clomiphene pill for five days at the start of your period. This helps your body produce more follicle-stimulating hormone (FSH), which makes the follicles grow. Follicles are the fluid-filled sacs where eggs mature.
- Looking for the surge. After five days of taking clomiphene, your brain releases a “surge” of luteinizing hormone (LH), which signals the ovaries to release one or more mature eggs from the follicles when you ovulate. The LH surge happens five to 12 days after you take the last clomiphene pill.
- Waiting for the release. The doctor monitors you closely to see whether your ovaries are ready to release an egg. A blood test or ultrasounds are done to monitor how the follicles are developing. You may also be asked to use an ovulation predictor kit or a basal body temperature chart to detect when you ovulate.
- Timing the conception. Monitoring when eggs are released helps your doctor figure out the ideal time for you and your partner to have sex, or the best time to schedule a procedure such as IUI. And when an egg meets a healthy sperm in the fallopian tube, there’s a chance you’ll conceive.
How long does clomiphene treatment take?
It depends on how regular a woman’s menstrual cycle is and how many times she has to try before she gets pregnant.
It can take a month or two of drug therapy – with a dosage increase, if necessary – before ovulation begins. Once ovulation occurs, it can take three to six cycles of treatment. Most doctors don’t recommend using clomiphene for more than six treatment cycles.
- For a regular period: Clomiphene is taken for five days, two to five days into a period. To figure out when your next period begins, use our ovulation calculator .
- For an irregular period or no period: A medication called medroxyprogesterone acetate is taken for 10 days to get a period started. Clomiphene is taken after the period begins.
If you don’t succeed after three cycles, the doctor might add another medication or suggest a different treatment.
What are the side effects of clomiphene?
Most women tolerate clomiphene well, but for some it causes minor side effects, including:
- Mood swings
- Hot flashes
- Thick and dry cervical mucus
- Pelvic pain
- Breast tenderness
- Ovarian cysts
- Mild depression
- Blurred or double vision (though this is less common)
What are the risks of clomiphene?
There’s a 5 to 12 percent chance of conceiving twins with clomiphene. (Less than 1 percent of women conceive triplets or more.) Though many couples consider it a blessing, carrying multiples increases your risk of miscarriage. preterm labor, and other complications.
In very rare cases, clomiphene causes a mild form of ovarian hyperstimulation syndrome (OHSS), which can lead to weight gain and a full, bloated feeling. OHSS happens when the ovaries respond too well to fertility drugs and produce too many eggs. The ovaries quickly swell to several times their normal size and produce fluid that leaks into the abdomen.
Mild OHSS usually goes away on its own with bedrest and careful monitoring by a doctor. But in very rare cases it’s life threatening – and hospitalization or more intensive monitoring may be necessary.
On the bright side: Contrary to what some researchers thought years ago, recent studies have found that taking fertility drugs such as clomiphene does not increase your risk of developing ovarian cancer. In the past, this was a major source of controversy and concern.
What’s the success rate of clomiphene?
About 80 percent of women ovulate in the first three months of treatment. Of those, 30 to 40 percent get pregnant by the third treatment cycle.
The chance of giving birth to a baby depends on several factors, including age and the quantity and quality of the sperm.
How much does clomiphene cost?
In the United States, expect to spend $10 to $100 on one cycle of clomiphene, depending on your insurance coverage, the dosage, and whether you choose a brand name or generic drug. But this doesn’t include the cost of doctors’ visits, ultrasounds, or follow-up procedures such as IUI. If an insurance policy doesn’t cover the treatment, you’ll probably have to pay the entire cost up front.
See therapists’ top 10 tips for coping with a fertility problem. Visit the BabyCenter Community to discuss clomiphene and similar fertility drugs with others.
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