What is Clomid?
Clomiphene citrate is a synthetic medication that changes how a woman ovulates.
What makes it work?
Chemically, Clomiphene resembles estrogen. Like all hormones, estrogen works by engaging a receptor in different parts of the body. This engaged receptor then sends a signal telling that organ to do something. For instance, in the brain, estrogen directs the release of FSH, which controls the ovary’s development of a mature egg. In the uterus, estrogen directs the thickening of the lining. Clomiphene blocks estrogen’s attachment to its receptor.
How is this beneficial?
Clomiphene affects fertility in a positive way by deceiving the body into believing that less estrogen is present than there actually is. The body reacts by releasing higher amounts of FSH. In women who do not usually ovulate, this extra stimulation can cause ovulation to occur and make pregnancy possible. In women who typically do ovulate, the Clomiphene can produce extra mature eggs, or theoretically improve the maturation of the eggs that are released.
Does Clomiphene have any adverse effects on fertility?
It can. By blocking estrogen’s activity in the uterus, the lining may be inadequately prepared for implantation of the embryo. Many women also find that their cervical mucus suddenly becomes hostile to sperm penetration.
How well does Clomiphene work?
In women who need Clomiphene to ovulate, the pregnancy rates are very high, as much as 33% per cycle for the first three cycles. In women who regularly ovulate, the prices are lower and depend on many other factors, chiefly age, condition of the female reproductive tract, and the malefactor.
How long should I use Clomiphene?
The pregnancy rates with clomiphene use justify up to three months of treatment for women who usually ovulate on their own, or six months for women who do not regularly ovulate without it. There may be limitations on a case-by-case basis, however.
How is the medication given?
Clomiphene citrate comes in 50 mg tablets that are taken on the fifth through the ninth day of the ovulatory cycle. The standard doses are one, two, or three pills daily. There are legitimate variations on this dosing regimen, however.
The medication can be given days 3-7, 4-8, or extended 3-9 or even longer. It is sometimes combined with injectable drugs, such as HCG, human menopausal gonadotropins (Pergonal or Metrodin), or an oral steroid such as Dexamethasone. Occasionally we use higher doses than three pills daily.
What are the short-term side effects of Clomiphene?
Some women experience hot flashes, presumably because the action of estrogen is blocked at the level of the skin. Headaches are not uncommon (approximately 10% of women), and moodiness or depression are reported in approximately 5%. It is believed that the incidence of side effects does not change with higher or lower doses.
What about long-term side effects?
Is Clomiphene associated with ovarian cancer? The relationship between Clomiphene and ovarian cancer has long been a concern, and the right answer is that we still do not know for sure. No meaningful increase in ovarian cancer rates has been seen since the use of Clomiphene became widespread, although one study published in 1993 implicated clomiphene use for greater than twelve months with a possible increase in cancer risk. For these reasons, Clomiphene should be used for a relatively short time only.
How about multiple pregnancy rates with Clomiphene?
The risk of having a twin pregnancy is approximately doubled with clomiphene use, presumably due to an increase in the number of mature eggs available. Triplets are no more likely than using no medications at all. Is there an increment in congenital disabilities or pregnancy complications? None other than those associated with the higher twin rate.