What is Clomid?
Clomid is the brand name for the fertility drug clomiphene citrate. Clomiphene citrate may also be sold under the brand name Serophene. Whether you’re taking the brand name Clomid, Serophene, or a generic version of clomiphene citrate, it’s all the same drug. (Think of Clomid in the same way that we use Kleenex® to refer to facial tissues.)
Clomid is the most well-known fertility drug, probably because it is the most commonly used. And with good reason. About 25% of female factor infertility involves a problem with ovulation, and clomiphene citrate, as a fertility drug, is easy to use (taken as a pill, not an injection), with not too many side effects, is pretty inexpensive compared to other fertility drugs, and is effective in stimulating ovulation 80% of the time.
When is Clomid Used?
Clomid is used when there are problems with ovulation, but no problems with blocked fallopian tubes. (In that case, stimulating ovulation would be pointless — the egg and sperm can’t meet if the tubes are blocked.) If a woman has irregular cycles, or anovulatory cycles (menstruation without ovulation), Clomid may be tried first.
Clomid is often used in the treatment of polycystic ovarian syndrome (PCOS) related infertility. It may also be used in cases of unexplained infertility, or when a couple prefers not to use the more expensive and invasive fertility treatments, like IVF.
Clomid may also be used during an IUI (intrauterine insemination) procedure, but it is rarely used during IVF treatment. With IVF, injectable ovulation meds are more frequently chosen.
How is Clomid Taken?
You should follow the directions your doctor gives you, as every doctor has a slightly different protocol.
However, the most common dosage of Clomid is 50 mg, taken for five days, on days 3 through 7 of your cycle, or days 5 through 9 of your cycle. (With day one of your cycle being the first day of real menstrual bleeding, and not just spotting.) Ovulation and pregnancy rates have been shown to be similar whether the drug is started on day two, three, four, or five, so don’t feel concerned if your doctor tells you a different protocol to follow than your friend.
If 50 mg doesn’t work, your doctor may increase the medication, according to their judgment, for a successive cycle. Or, they may give it another try at 50 mg. You might think that more is always better, but higher doses, especially at or above 150 mg, can actually make conception more difficult. (See below, under side effects.)
What are Clomid’s Common Side Effects?
Clomid’s side effects aren’t so bad, as far as fertility drugs are concerned. The most common side effects are hot flashes, breast tenderness, mood swings, and nausea. But once the medication is stopped, the side effects will leave, too.
The side effect you’re probably most familiar with is the risk of multiples. You have a 10% chance of having twins when taking Clomid, but triplets or multiples of more are rare, happening less than 1% of the time.
One of the more annoying side effects to comprehend is that Clomid can decrease the quality of your cervical mucus (which sperm need to make their way to the egg), making conception more difficult. Clomid can also make the lining of your uterus thinner and less ideal for implantation. This is why “more” is not necessarily better when it comes to Clomid dosage and use.
How Successful Is Clomid?
Clomid will jumpstart ovulation in 80% of patients, and about 40% to 45% of women using Clomid will get pregnant within six cycles of use.
Using Clomid for more than six cycles is not generally recommended. If six cycles go by, and pregnancy is not achieved, other alternatives may be considered.
When Clomid Does Not Achieve Ovulation
While 75% of women taking Clomid for anovulation will ovulate, 25% will not. Without ovulation, pregnancy achievement is impossible. If you don’t achieve ovulation on Clomid, will you need to move on to stronger drugs or more complex treatments? Not necessarily.
Clomid Resistance
Sometimes, the reason you may not ovulate on Clomid is because the dosage is too low. It’s common to start Clomid treatment at 50 mg, and then increase to 100 mg if you don’t respond to 50 mg. In some cases, doctors will try doses up to 250 mg. However, if you’re still not ovulating, your doctor may say you are Clomid resistant.
Clomid resistance is just a fancy way of saying that your body does not respond the way we’d like to Clomid.
What Causes Clomid Resistance?
Your doctor’s approach to treating Clomid resistance depends partially on why he thinks you are not responding. Here are a few known, possible reasons for Clomid resistance:
PCOS: Women with PCOS commonly have trouble with Clomid resistance, especially those who are diagnosed as insulin resistant or with hyperandrogenic levels (high levels of DHEAs and male hormone levels).
BMI over 25: A body mass index (BMI) over 25 can decrease the chances of Clomid working successfully.
Hyperprolactinemia: Women with hyperprolactinemia may not respond well to Clomid, without also treating the hyperprolactinemia.
Of course, there are times when it’s not clear why Clomid is not helping induce ovulation.
Options in Treating Clomid Resistance
For women with PCOS, treatment with the insulin resistance drug Metformin, also known as Glucophage, may help. Ideally, Metformin would usually be prescribed for a period of three to six months before trying Clomid again. Some studies have shown that besides improving ovulation rates, taking metformin and Clomid together may also increase the pregnancy rate and decrease the risk of miscarriage.
Ovarian drilling is an older method of treating Clomid resistance in women with PCOS, but is not commonly used today because of the risks. If your doctor suggests ovarian drilling, you may want to question the reason for that choice, when there are other options that can and should be tried first.
If your BMI is over 25, your doctor may suggest that you lose some weight before retrying Clomid. Losing just 10% of your current body weight may improve Clomid’s effect.
– Could Your Weight Keep You From Getting Pregnant?
For those with hyperprolectinemia, treatment with the drug Bromocriptine, either alone or in combination with Clomid, may improve ovulation rates.
Birth Control Pills for Infertility?
One interesting way of dealing with Clomid resistance is taking birth control pills for one to two months before trying another cycle of Clomid. This is recommended for women with high levels of the hormone DHEAs.
It seems a bit counterintuitive — birth control pills will help you get pregnant? But research studies have shown good results. In one study on the use of birth control pills, just over 65% of Clomid resistant women ovulated, after taking oral birth control pills for two months preceding a cycle of Clomid treatment.
