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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Fertility drug: clomifene citrate (clomifene, Clomid)
In this article
What is clomifene citrate?
Clomifene citrate is a drug treatment that stimulates your ovaries to release eggs.
Ovulation stimulation using clomifene citrate is a well-established, effective treatment (Brown et al 2009). Clomifene citrate is the most widely used of all fertility drugs.
Other drugs that may be used to treat ovulation disorders include metformin and bromocriptine.
What's the success rate of clomifene citrate?
About 70 per cent of women will ovulate in response to a fairly low dose of clomifene citrate (Homburg 2005). Of those who ovulate, about 40 per cent will become pregnant (Homburg 2005).
Other factors that can affect the pregnancy rate include:
- the time in your cycle that you have sex
- your age and weight
- the count, shape, speed and motility (ability to move) of your partner's sperm
A low dose of clomifene may not be enough. Your doctor may increase the dose to help you conceive. Studies suggest that about 29 per cent of women who start taking the drug go on to have a live birth (NCCWCH 2013:147-8).
Is clomifene citrate right for me?
Clomifene citrate is a recommended treatment for ovulation disorders caused by problems such as polycystic ovaries or polycystic ovary syndrome (NCCWCH 2013:18). It may be used on its own or in combination with another drug called metformin. which you take daily in several doses (NCCWCH 2013:147-8).
It used to be used in some cases of unexplained infertility. However, it's no longer recommended for this, as there's a lack of evidence that it makes any difference compared to trying to get pregnant naturally (Hughes et al 2010, NCCWCH 2013:18).
You might be prescribed clomifene citrate before you undergo a fertility treatment such as intrauterine insemination (IUI), to boost your egg production (HFEA 2009a).
How does clomifene citrate work?
Clomifene citrate blocks the effect of the hormone oestrogen in your body. This blocking effect tricks your body into bumping up levels of two other hormones that are essential for ovulation. These two other hormones are:
- follicle-stimulating hormone (FSH)
- luteinising hormone (LH)
FSH causes the eggs in your ovaries to ripen, ready for release. LH triggers the release of one or more mature eggs from the ovary follicles. The egg or eggs then move down into one of your fallopian tubes.
How long will I have to take clomifene citrate for?
You usually take clomifene in pill form for five days early in your cycle, for up to six months at a time (NCCWCH 2013:142,179). A low dose of 50 mg is often used to start with.
If you have regular cycles. you'll start taking the pills within five days of your period starting, preferably on about day two.
If you're not menstruating at all or if your cycle is very irregular, your doctor will check that you're not pregnant. She'll then give you a synthetic version of the hormone progesterone, a progestogen called Provera.
Progesterone works with oestrogen to keep your reproductive cycle regular. Provera will re-establish your periods. Once you're having periods, you can then start taking clomifene citrate (BNF 2011).
Ovulation generally occurs between five days and nine days after you've taken your last pill. Your fertility specialist may monitor your ovaries using ultrasound, at least during the first cycle (NCCWCH 2013: 180). She'll look to see how your ovaries are responding and whether one egg follicle or more is preparing to release a mature egg into one of your fallopian tubes.
You might ovulate and conceive in the first month of taking clomifene citrate. Or it can take a month or two of drug therapy for you to start ovulating regularly.
Treatment may be continued for up to six cycles, as this is thought to be long enough to see whether your body is responding to the drug (NCCWCH 2013:179-80).
Unfortunately, some women don't respond to clomifene citrate at all. If you don't ovulate on low dose clomifene, your doctor may suggest increasing the dose over the next two months (NCCWCH 2013:142, 178). If you're still not ovulating at doses of 100 to 150 mg a day, then you'll be termed "clomifene resistant" (NCCWCH 2013:142). This can usually be identified within three monitored cycles, so ask your doctor what other drug or surgical options may be open to you.
Does clomifene citrate have any side-effects?
Clomifene citrate can cause a wide range of minor side-effects, including:
- blurred vision (tell your doctor as soon as possible if you experience this)
- hot flushes
- mood swings
- abdominal pain
- breast tenderness
- heavy periods
- weight gain
- nausea (BNF 2011)
Clomifene citrate can also cause your cervical mucus to become drier, so you may want to use a sperm-friendly vaginal lubricant.
Ovarian hyperstimulation syndrome (OHSS) is another potential side-effect of clomifene citrate (BNF 2011). OHSS occurs when you respond too well to fertility drugs and your ovaries become very swollen. Watch out for your tummy swelling up, giving you a full, bloated feeling.
OHSS can develop into a serious condition. However, most cases of OHSS in response to clomifene citrate are mild and are resolved after a few days (Homburg 2005).
Human chorionic gonadotrophin (hCG) is the main fertility drug thought to be responsible for severe cases of OHSS. This means that your chances of getting severe OHSS are increased if you're taking clomifene citrate with hCG. If you do develop severe OHSS, your doctor will monitor you closely (Balen 2008).
I have polycystic ovary syndrome. Will clomifene citrate work for me?
If you have polycystic ovary syndrome (PCOS), there is a chance that clomifene citrate won't work for you. About 30 per cent of women with PCOS are resistant to clomifene citrate (Homburg 2005). This is more common if you have a body mass index (BMI) greater than 25.
If that's the case, your doctor may recommend that you try to lose some weight before you even start taking clomifene (NCCWCH 2013:180). Getting nearer to your ideal weight may be just enough for you to start ovulating regularly.
Your doctor may prescribe medication to help your body to respond to clomifene citrate. The medication is an insulin-sensitising drug called metformin. Metformin can help you respond to clomifene citrate and has been shown to increase your chances of ovulation and pregnancy (NCCWCH 2013:180, Tang et al 2012).
Is there anything else I should know about clomifene citrate?
There is a theory that clomifene citrate's anti-oestrogen effect may increase the risk of miscarriage. It's estimated that about one in five pregnancies conceived after treatment with clomifene citrate miscarry (Homburg 2005, NCCWCH 2013:149-58). However, this is a similar rate to that found in couples who haven't had any fertility treatment.
There's been some ongoing concern that using clomifene citrate may be linked with ovarian cancer. However, reviews of the evidence haven't supported this (NCCWCH 2013:424-5). Findings suggest that it's the fertility problem itself that may increase the risk, rather than the drugs used to treat it.
Drugs that stimulate ovulation can result in more than one egg being released. This increases your chance of multiple pregnancy, which is why ultrasound monitoring is recommended to check how strongly your ovaries respond to the drug (NCCWCH 2013:142). If you take clomifene citrate, you have about a one in 10 chance of a multiple pregnancy, most likely twins (Homburg 2005, NCCWCH 2013:142).
Learn about other fertility drugs for women. find out if herbal remedies can help to boost fertility, or share tips and advice with others trying for a baby in our friendly community.
Last reviewed: May 2013
Balen A. 2008. Ovarian hyperstimulation syndrome (OHSS): a short report for the HFEA. www.hfea.gov.uk [pdf file, accessed May 2013]
BNF. 2011. Clomifene citrate. British National Formulary. www.bnf.org [Accessed May 2013]
Brown J, Farquhar C, Beck J, et al. 2009. Clomiphene and anti-oestrogens for ovulation induction in PCOS. Cochrane Database of Systematic Reviews. (4): CD002249. onlinelibrary.wiley.com [pdf file, accessed May 2013]
Homburg R. 2005. Clomiphene citrate – end of an era? A mini review. Hum Reprod. 20(8): 2043-51. humrep.oxfordjournals.org [pdf file, accessed May 2013]
Hughes E, Brown J, Collins JJ, et al. 2010. Clomiphene citrate for unexplained subfertility in women. Cochrane Database of Systematic Reviews (1): CD000057. onlinelibrary.wiley.com [pdf file, accessed May 2013]
NCCWCH. 2013. Fertility: assessment and treatment for people with fertility problems. National Collaborating Centre for Women's and Children's Health, NICE Clinical Guideline. London: RCOG Press. guidance.nice.org.uk [pdf file, accessed April 2013]
NHS Choices. 2011. IVF. NHS Choices Health A-Z. www.nhs.uk [Accessed April 2013]
Tang T, Lord JM, Norman RJ, et al. 2012. Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database of Systematic Reviews (5): CD003053 onlinelibrary.wiley.com [pdf file, accessed April 2013]
High Clomid Success Rates: An Option Worth Considering
Clomiphene citrate (Clomid) is a commonly prescribed fertility drug. Clomid is often a desirable first step for fertility treatment due to its relatively low cost.
Clomid success rates are typically high. In this article, we list a number of common factors that affect fertility. We also explain ways that Clomid may help (or may not help) you overcome these specific fertility issues. For more information about how Clomid may help you personally, see a fertility specialist in your area.
Clomid success rates and ovulation
If you are having problems with ovulation. Clomid offers you an 80 percent chance of ovulating, usually within the first three months.
Due to this ovulation boost, most women have a 50 percent chance of getting pregnant within the first six months after starting Clomid.
Clomid may be helpful if you are over 35. but only if you still have an ample egg supply.
If you are over 35 and your egg supply is low or dwindling, Clomid may not help you get pregnant.
If you are overweight or underweight. Clomid may be less likely to help you get pregnant.
Before you try to get pregnant with Clomid, make efforts to get to a healthy weight. Ask your doctor about a safe weight-loss plan that includes a healthy diet and regular exercise.
Clomid success rates are affected by dosage. Most women start with a 50 mg dose of Clomid. If this initial dose does not help you ovulate, your doctor may increase your dosage by 50 mg increments in subsequent cycles.
Your doctor may also incorporate other fertility drugs into your treatment to help you ovulate and to boost your chances of pregnancy.
If taking Clomid fails to help you ovulate after four to six cycles, your doctor will probably take you off this fertility drug and move on to another option. The latest studies show Clomid success rates do not improve after six cycles.
How do you know if Clomid is working?
If you take Clomid, you may be curious to know if you are ovulating on this medication. There are a number of ways that you can tell if ovulation is occurring.
Many women are able to observe whether ovulation occurs by using one of the following methods. Discuss these options with your doctor.
You can also chart your your basal body temperature (BBT) by taking your temperature every morning when you wake up. Visit the Attain Fertility Planner website to learn more about charting.
Seek help before it’s too late
Clomid is often very helpful for women that are having ovulation problems. There are some infertility problems that Clomid will not help with, including the following:
If pregnancy does not occur within 6 to 12 months of trying, it is important to seek thorough evaluation and treatment before relying on Clomid infertility treatment. Attain Fertility specialists can be found all over the country if you need help.
Clomid success rates are extremely encouraging, but it’s important to keep in mind that no drug or other treatment can guarantee that you’ll be able to have a baby.
- RESOLVE: Fertility Medications
- American Pregnancy Association: Infertility Medications
- American Society for Reproductive Medicine: Medications for Inducing Ovulation: A Guide for Patients
- UpToDate for Patients: Patient Information: Infertility Treatment with clomiphene
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