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In This Article: Clomid Overview Taking Clomid Patient Monitoring Clomid Effects CCCT

Clomid® (clomiphene citrate) is one of the first treatments usually recommended for women suffering from infertility. Clomid is a well tested treatment that doctors have many years of experience with. It is also a relatively safe and low risk medicine. Clomid is used to treat ovary disorders and malfunctions and to prepare women for a clomiphene citrate challenge test (CCCT). It helps the ovaries to perform two functions. It helps to produce eggs. Clomid also helps to produce the hormones needed in the pregnancy process.

Clomifene molecule

Clomid reduces estrogen production. Low estrogen levels cause the pituitary gland produce more hormones to raise estrogen levels. The pituitary gland produces more FSH and LH hormones which stimulate follicle and egg production in the ovaries. By strengthening the weak egg producing processes, the ovaries produce more eggs. Clomid can often help women who have eggs only two or three months per year to produce every month. This greatly increases the changes of becoming pregnant.

Clomid also corrects luteal phase deficiency (LPD). In LPD, the ovaries don't produce enough luteal hormone (LH). Luteal hormone maintains the uterus's blood vessels which nourishes the embryo. Lack of LH causes the uterine lining to fall out, similar to what happens in a monthly period. Even when a women becomes pregnant, if her uterine lining is not strong enough, she miscarries.

Clomid Treatment

Clomid treatment is usually preceded by tests to determine what is causing infertility. If appropriate, the male partner should also be tested for infertility. If the problem is in the ovaries, clomid is the first treatment usually given. Clomid is taken orally starting on the cycle day 3, 4 or 5 and continued for five days. Clomid is usually effective within three to six months and pregnancy does not occur doctors usually switch to another method.

Clomid is one of the safest fertility drugs available. However, a small percentage of women do experience side effects, including: hot flashes; headaches; mood changes; vaginal dryness; and visual disturbances. These should be reported to a doctor immediately. Repeated, monthly Clomid usage should also be preceded by an ultrasound or a simple pelvic examination at the beginning of each menstrual cycle. Unfortunately, many doctors do not perform this simple but important test.

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Clomiphene Citrate with Estrogen Supplementation

Clomiphene citrate is an oral fertility medication.  It can be used to induce ovulation in women who don’t ovulate, or to produce multiple eggs in women who already ovulate on their own.  It is one of the safest, least expensive and most widely used fertility drugs in the United States.  Recent evidence suggests that adding an estrogen supplement increases the pregnancy rate.  Estradiol is a natural estrogen and has few side effects when used in short episodes; it should not be used if you are a heavy smoker or have a history of blood clots, heart attack or stroke. 

You will take two tablets of clomiphene citrate daily, starting on Cycle Day 3 and ending on Cycle Day 7. You will then use one estrogen pill inserted vaginally on Cycle Days 8 through 12.

An ultrasound is required during your first treatment cycle to check the effectiveness of the medications.  It is also used to time an insemination (IUI). You will need to call the office to schedule the sonogram for cycle day 12.  Once the follicles have reached the size of 18mm or greater, you will be given an injection of hCG to trigger ovulation and the IUI will be scheduled the following day.  Keep in mind 2-3 days of abstinence is recommended (but not longer than 1 week).

If you are timing the IUI by ovulation predictor kit, you should start checking your urine early in the morning with the kit on Cycle Day 11.  Most women will have a positive test around Cycle Day 13 or 14.  Once the test is positive, call the clinic to schedule the IUI.  Semen collection is scheduled in the clinic the following day and the IUI is usually performed approximately 1 - 2 hours later. If you have a positive surge on a weekend you will need to leave a message early in the morning no later than 9:00 am so that we may call you back to schedule your IUI for the following day.  You may collect the specimen at home if you live less than 60 minutes from the office and have a sterile container that we have provided for you.  If your test has not turned positive by Cycle Day 15, call the clinic for assistance. 

There is a 5-10% risk of twins with the use of clomiphene citrate; the risk of triplets or higher order pregnancies is <1%.  Side effects include hot flashes, bloating, breast tenderness, stomach upset, visual changes and headaches.  Visual changes or headaches that do not respond to Tylenol or aspirin should be reported immediately.  Ovarian cysts can appear with the use of clomiphene citrate, which may cause pelvic pressure or pain with intercourse or exertion.  They are usually self-limited and resolve without any further treatment except withholding the next cycle of clomiphene.


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