| Clomiphene citrate for infertility Examples clomiphene citrate (Clomid, Serophene, Milophene) How It Works Clomiphene stimulates the release of hormones needed to cause ovulation. Clomiphene therapy is typically used for 5 consecutive days early in the menstrual cycle, for three to six monthly cycles. It may take several cycles to find the right dose to stimulate ovulation. Once that dose is determined, a woman will take the drug for at least three more cycles. If she does not become pregnant after six cycles, it is unlikely that further clomiphene treatment will be successful. Why It Is Used For women. Clomiphene may be prescribed to: Stimulate ovulation in a woman who does not ovulate or who ovulates irregularly. Her estrogen levels and pituitary gland function must be normal, and her male partner must be diagnosed as fertile. Perform a clomiphene challenge test, which is sometimes used to evaluate a woman's ovulation and egg quality (ovarian reserve). When given for 5 days early in a woman's menstrual cycle, clomiphene elevates a woman's follicle-stimulating hormone (FSH) level. On the next day, an FSH blood level that has dropped back to normal is a sign of a normal ovarian reserve and ovulation; an elevated FSH is a sign of low ovarian reserve. Women with a diminished ovarian reserve can use donor eggs, which greatly improves their chances of giving birth to a healthy child. Stimulate the development of multiple eggs for use with assisted reproductive technology, such as in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT). Regulate ovulation in a woman who ovulates irregularly and/or is going to have intrauterine insemination or artificial insemination. Clomiphene is sometimes used together with other medications and infertility treatments. Before trying clomiphene, women with polycystic ovary syndrome (PCOS) who are overweight are advised to lower their body mass index (BMI) with diet and exercise; achieving a healthy weight can trigger ovulation.1 If that isn't successful, using metformin to correct insulin metabolism often starts ovulation; if not, continuing metformin increases the likelihood that clomiphene will stimulate ovulation.2 For men. Clomiphene may be used to treat low sperm counts (oligospermia). How Well It Works Unexplained infertility. Clomiphene alone is not an effective treatment for couples with unexplained infertility. However, when clomiphene is used to generate multiple eggs before an insemination procedure, it improves a couple's chances of conception.3 Infrequent or no ovulation. Of women whose infertility is caused only by absent or infrequent ovulation, with clomiphene treatment approximately 80% will ovulate, and 40% will become pregnant, with a 20% to 25% chance of becoming pregnant per cycle.4 (These rates do not reflect miscarriage rates, however, which are about 20% among women who become pregnant using clomiphene, slightly higher than the average rate for all pregnancies.)5 Polycystic ovary syndrome. Clomiphene alone is not an effective treatment for most women with polycystic ovary syndrome (PCOS) and severe insulin resistance, which is closely linked to obesity.4 Women with PCOS: And obesity often begin ovulating when they reduce their body mass index (BMI) with diet and exercise.1 With severe insulin resistance can increase their chances of ovulating with clomiphene and metformin combined.1, 2 Couples who have additional causes of infertility have a decreased chance of conceiving with clomiphene therapy alone. Side Effects Side effects of clomiphene include: Ovarian hyperstimulation, ranging from mild, with enlarged ovaries and abdominal discomfort; to moderate, additionally causing nausea, vomiting, or shortness of breath; to severe and life-threatening. Hot flashes. Irritability. Nausea, abdominal pain. Headaches. Thick cervical mucus, which sperm cannot travel through. This can be reversed with medication or bypassed with intrauterine insemination. Breast tenderness. Blurred vision. Hair loss (very rare). Women who become pregnant after clomiphene therapy have an approximately 10% chance of multiple pregnancy, compared to the 1% to 2% chance in the general population. Multiples resulting from clomiphene treatment are almost exclusively twins; triplets are rare.4, 3 Miscarriage risk? Clomiphene may be associated with a higher risk of miscarriage (possibly related to an early hormonal effect on the egg).5 However, the slightly higher rate of miscarriage that occurs among women who use clomiphene treatment may be related to preexisting conditions such as age or polycystic ovary syndrome. Clomiphene has not been observed to harm the fetus.4 Ovarian cancer risk? A 1994 study has suggested that 12 or more cycles of clomiphene increase the risk of ovarian tumors. Four studies since then have found no link between clomiphene and ovarian cancer.3 The issue is still being studied. Few specialists recommend long-term use of clomiphene. See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.) What To Think About Many women try clomiphene therapy before beginning a series of infertility tests. If your pituitary, thyroid, and adrenal function have been checked, you have no signs of endometriosis, and your partner's fertility has been confirmed, three cycles of clomiphene are considered a safe and simple option.4 Make sure your doctor knows of any abnormal vaginal bleeding or history of problem ovarian cysts before prescribing clomiphene for you. See a list of questions to ask your doctor about medications. References Citations American College of Obstetricians and Gynecologists (2002). Management of infertility caused by ovulatory dysfunction. ACOG Practice Bulletin, No. 34. Washington, DC: American College of Obstetricians and Gynecologists. Barbieri RL (2003). Metformin for the treatment of polycystic ovary syndrome. Obstetrics and Gynecology, 101: 785�793. Duckitt K (2003). Infertility and subfertility. Clinical Evidence (9): 2044�2073. Speroff L, et al. (1999). Induction of ovulation. In Clinical Gynecologic Endocrinology and Infertility, 6th ed., pp. 1097�1132. Philadelphia: Lippincott Williams and Wilkins. Schieve LA, et al. (2003). Spontaneous abortion among pregnancies conceived using assisted reproductive technology in the United States. Obstetrics and Gynecology, 101: 959�967. Credits Author Kathe Gallagher, MSW Editor Geri Metzger Associate Editor Lila Havens Primary Medical Reviewer Joy Melnikow, MD, MPH - Family Practice Specialist Medical Reviewer Kirtly Jones, MD - Obstetrics and Gynecology Last Updated May 24, 2004 |
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| Clomid, Serophene, Milophene |
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