Clomiphene (Clomid)

Clomid is a medication that blocks estrogen receptors in the hypothalamus & pituitary glands which causes the pituitary gland to release to more Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH).  FSH and LH are the two main hormones that allows eggs (oocytes) within the ovary to mature and allows the ovary to produce hormones.  Clomiphene is a prescription medication that is started on day 3 or day 5 after your menstrual cycle begins and taken for a total of 5 days (cycle day 3 to 7 or cycle day 5 to 9).  The usual starting dose is 50 mg (1 pill) or 100 mg (2 pills) daily and women usually ovulate 5-12 days after the last dose.  After your doctor has prescribed Clomiphene, you should contact your doctor’s office on day 1 or 2 of your cycle so that an ultrasound can be performed prior to starting your medication.  The ultrasound is used to confirm there are no ovarian cysts (follicles which did not release an egg during a previous cycle) that may interfere with your treatment.  After your treatment cycle has begun, your doctor will follow the maturation of the eggs (oocytes) with an ultrasound.  The ultrasound is used to measure the growth and number of follicles (fluid-filled compartments containing the eggs) within the ovary.  When the follicles are large enough, it indicates to your doctor that the eggs (oocytes) inside are mature and it is time to consider intercourse or insemination.  An injectable medication such as Ovidrel or Novarel will often be prescribed to the patient to cause ovulation prior to intercourse or insemination.

 

Common side effects of clomiphene include hot flushes, abdominal or pelvic tenderness, nausea, headache, blurry vision and thinning of the endometrial lining. Approximately 10% of pregnancy resulting from Clomiphene will be twin pregnancies and 1 in 200 will be triplet pregnancies.  About 2% of patients will experience reversible blue discoloration of their vision which goes away when the medication is stopped.  If you experience any vision changes you should notify your physician as soon as possible.  Women who take Clomid may also experience Ovarian Hyperstimulation Syndrome (OHSS) although less frequently than women taking injectable fertility medications that contain follicle stimulating hormone (FSH).

 

Ovarian Hyperstimulation Syndrome (OHSS) is a syndrome that rarely occurs after the use of Clomiphene.  Women with a history of Polycystic Ovarian Syndrome or a prior history of OHSS may be more likely to experience OHSS.  Some initial symptoms include headache, breast tenderness, nausea, vomiting and weight gain.  In more involved cases of OHSS, women may experience weight gain from fluid retention, abdominal swelling, difficulty breathing or decreased urination. If you experience these symptoms after taking Clomiphene please contact your physician as you may require an ultrasound and laboratory evaluation.