When facing the challenges of infertility, understanding your treatment options will go a long way in helping you be informed and prepared. One widely used medication in this field is Clomid, which is a fertility drug treatment for women, also known generically as clomiphene citrate. Whether you are just starting your fertility journey or have been trying to get pregnant for some time, Clomid offers hope by addressing certain types of female infertility.
The purpose of this blog is to help you understand how Clomid works and how its role in treating infertility can provide you with the insight and reassurance you need as you plan to start or expand your family.
Table of Contents
What Is Clomid?
Also known as clomiphene citrate, clomid is an oral medication often prescribed to treat female infertility. It works by stimulating the secretion of follicle-stimulating hormone (FSH), which prompts the ovary to produce one or more egg follicles. It also helps boost the production of estrogen, which can lead to a surge in luteinizing hormone (LH) levels. This ultimately triggers ovulation or the release of an egg. It has about an 80% success rate in inducing ovulation.
Typically prescribed by primary care physicians or OB-GYNs, Clomid is often a first-line treatment before referring a couple to a fertility specialist or doctor for more advanced care. Even some reproductive specialists continue to use Clomid in their practices. This is because Clomid enhances your chances of conception as it helps in increasing the number of eggs released during ovulation, which in time offers a potential solution for those dealing with infertility.
How Does Clomid Work?
Clomid is a medication often prescribed to address female infertility. It works by giving your body a nudge in the right direction when it comes to ovulation, the process of releasing an egg from your ovary. Let’s break down the science behind Clomid and how it might help your fertility.
Here’s the key: Clomid acts like an “estrogen messenger interceptor” in your brain. Normally, estrogen sends signals to your brain about its levels. Clomid steps in and blocks these signals, essentially tricking your brain into thinking your estrogen levels are lower than they actually are.
This little deception has a big impact. When your brain perceives low estrogen, it responds by releasing a hormone called GnRH. GnRH then travels to your pituitary gland, which in turn produces follicle-stimulating hormone (FSH). FSH is like a cheerleader for your eggs, stimulating their growth and development within follicles in your ovaries.
The goal? For one or more of these follicles to mature and release a healthy egg, ready for fertilization. This process of ovulation is what Clomid aims to stimulate, especially for you if you don’t ovulate regularly, such as those with PCOS.
If you do not ovulate regularly, such as those with PCOS, Clomid can often induce ovulation. However, the response to Clomid can vary, and you might not ovulate even with this medication.
Generally, about three-fourths of women who do not ovulate naturally will begin to ovulate with Clomid at some dosage level. Unfortunately, only about half of these women who ovulate with Clomid will go on to achieve pregnancy with it.
Read more: Does Female Masturbation Cause Female Infertility?
When Is Clomid Prescribed?
Here’s a breakdown of when Clomid might be prescribed to you by your doctor:
- Been trying for a year (or 6 months if you’re over 35): Generally, doctors consider Clomid after a year of actively trying to get pregnant (or 6 months if you’re over 35).
- Unexplained infertility: If you’ve undergone tests and received a diagnosis of “unexplained infertility,” Clomid can be a good first step. It’s a non-invasive and relatively affordable option compared to some other fertility treatments.
- Irregular periods or PCOS: Clomid can also be helpful if you have Polycystic Ovary Syndrome (PCOS) or irregular menstrual cycles that prevent ovulation from happening naturally. Letrozole is another medication that can be used in similar situations.
Clomid, however, isn’t recommended if you’ve already gone through menopause and your ovaries are no longer producing viable eggs.
Benefits of Clomid
If your doctor prescribes Clomid to help you conceive and you are religiously taking it, here are some benefits you can look forward to:
- Cost-effective: Compared to some fertility treatments like IVF treatments, Clomid can be a much more budget-friendly option.
- Convenient: Clomid comes in easy-to-take pills, so there are no needles or surgery involved.
- Accessible: You might not need a referral to a fertility specialist. Often, your OB-GYN or primary care provider can prescribe Clomid.
- Well-tolerated: Side effects tend to be mild and uncommon for most people who take Clomid.
How Do I Take Clomid?
Typically, your doctor will recommend starting Clomid at the beginning of your menstrual cycle, usually between days 3 and 5. You’ll then take one pill daily for five consecutive days. After that, you’ll continue your normal routine until your next cycle is about to start. If you don’t conceive during the first cycle, your doctor might recommend another course of Clomid. There’s usually a limit of around six cycles. If pregnancy hasn’t occurred after this point, it suggests there might be another underlying fertility issue. Your doctor will likely recommend further investigation at that point.
What Are the Side Effects of Clomid?
While Clomid can be a helpful tool for ovulation induction, it’s important to be aware of some potential side effects:
- Mood Swings: Clomid can sometimes lead to emotional ups and downs. Around one-fourth of women experience mood swings or feel more irritable while taking the medication. These effects are often described as similar to intense PMS symptoms. The good news is that not everyone experiences them, and they usually don’t last.
- Hot Flashes: Just like some women experience during menopause, hot flashes can occur while taking Clomid. They’re usually bothersome but not severe enough to discontinue treatment.
- Visual Disturbances: Some women experience temporary vision changes, such as seeing flashes of light, blurred vision, or spots.
- Uterine Lining Thinning: Clomid has a mild anti-estrogen effect, which can sometimes prevent the lining of your uterus (endometrium) from thickening as much as it would naturally during your cycle. A healthy lining is ideal for implantation, so your doctor will monitor this during treatment.
- Reduced Cervical Mucus: Cervical mucus plays a role in sperm health and transport. Because Clomid has some anti-estrogenic properties, it might reduce the production of cervical mucus in some women. This can make it harder for sperm to reach the egg. However, if you’re undergoing intrauterine insemination (IUI), this side effect becomes less relevant as the sperm is placed directly into the uterus.
- Cancer: In a research study published in the New England Journal of Medicine, scientists investigated the link between clomiphene citrate, a medication used to induce ovulation, and ovarian tumours in infertile women. The study found an increased risk of ovarian tumours in women who used clomiphene citrate, particularly for those who used it for 12 or more cycles. However, the researchers cautioned that this increased risk could be due to underlying ovulation problems rather than the medication itself. Further studies still need to be done to confirm the association between clomiphene citrate and ovarian tumours.
- Multiple Pregnancies: Clomid (clomiphene citrate) can increase your chances of having twins. It does this by boosting the levels of two key hormones, LH and FSH. These hormones normally trigger ovulation, but with Clomid, they might stimulate the release of multiple eggs at once. This raises the possibility of a multiple pregnancy, with twins being the most common outcome. According to research published in 2022, the multiple pregnancy rate in patients undergoing treatment with clomiphene citrate for WHO group II ovulatory disorders was 3.8% (3.6% twins/0.2% triplets). (https://pubmed.ncbi.nlm.nih.gov/33451262/)
How Long Does It Take To Ovulate Using Clomid?
The timing of ovulation with Clomid can vary slightly. On average, it occurs 7-10 days after you finish your course of Clomid pills. This timeframe can be influenced by your natural ovulation pattern. If you typically ovulate regularly on your own, you may fall closer to the 7-day mark. However, for women with irregular cycles, ovulation after Clomid might occur anywhere from two to three weeks after the last pill.
Read more: Did I Ovulate or not?
What Is The Process Or Protocol For Taking Clomid?
The specific protocol for taking Clomid depends on whether you ovulate on your own (have regular menstrual cycles) or not.
If you ovulate on your own:
- Clomid is typically started on day 2 or 3 of your menstrual cycle (the first day of your period is considered day 1).
- You will take it once a day for 5 days.
- The most common dosage is 50 milligrams (mg), but your doctor may adjust this based on your individual situation.
If you do not ovulate on your own:
- The doctor may prescribe a slightly higher dose of Clomid.
- They may also recommend taking it for a longer duration.
Timing Intercourse After Clomid Treatment
Pinpointing ovulation after Clomid isn’t an exact science, but there are ways to increase your chances of conceiving:
- Ovulation Predictor Kits (OPKs): These drugstore tests detect a surge in a hormone (LH) that happens about 36 hours before ovulation. A positive test means intercourse that day or the next morning is ideal for conception.
- Frequency: If you’re unsure of your exact ovulation day, aim for intercourse every other day (or daily) around your predicted fertile window. This strategy maximizes sperm presence while the egg is viable (around 12-24 hours).
- Cycle Tracking: Knowing your typical cycle length helps estimate ovulation. With a 32-day cycle on Clomid, ovulation might occur around day 18. In this case, consider having intercourse on days 16, 18, and 20 to cover your bases.
Monitored Clomid Cycles Using Follicle Ultrasound Scans And Blood Hormone Levels
When using Clomid for fertility treatment, some gynecologists and infertility specialists will monitor your progress through “follicle checks” with ultrasound scans, sometimes in conjunction with blood hormone level tests. This monitoring method helps assess your response to the medication and determines the optimal timing for intercourse or intrauterine insemination (IUI).
Here’s how the monitoring process typically works:
- Follicle Scans: These quick ultrasounds check the growth of follicles, the fluid-filled sacs in your ovaries that contain eggs. With or without blood hormone tests, this helps determine your response to Clomid.
- Benefits of Monitoring: Knowing your response allows doctors to pinpoint the best time for intercourse or intrauterine insemination (IUI) to maximize fertilization.
- Trigger Shot: If your cycle is monitored, you might receive an HCG injection when a follicle reaches a mature size (18-30 mm). This mimics your body’s natural LH surge and triggers ovulation 36-40 hours later.
- In Case of No Response: Monitoring can also reveal if no mature follicles develop. In that case, your doctor can adjust your Clomid dosage or explore alternative treatments.
Clomid And Injectable Gonadotropins
Sometimes, Clomid alone might not be enough to induce ovulation effectively. In such cases, your doctor may combine Clomid with injectable gonadotropins, often referred to as “injectables.” These medications contain follicle-stimulating hormone (FSH) and help boost FSH levels in your blood through injections.
Here’s how this combination treatment works:
- When Clomid Isn’t Enough: If you’re not responding well to Clomid alone, adding injectables like Follistim, Gonal-F, Menopur, or Bravelle can help stimulate your ovaries more effectively.
- Injectable Gonadotropins: These medications contain FSH, which plays a crucial role in developing follicles in your ovaries. Injecting FSH can enhance follicle development and improve your chances of ovulating.
- Monitoring: Careful monitoring is essential when using injectable FSH products. This involves regular ultrasound scans and blood tests to track follicle development and hormone levels. Monitoring ensures that the follicles are developing correctly and helps to avoid overstimulation.
Here’s a possible example of a monitored Clomid + injectable protocol:
- Days 3-7: You’ll take Clomid pills.
- Day 10: You’ll start daily injections of a specific FSH product (brand names like Follistim, Gonal-F, Bravelle, or Menopur) at a set dose (e.g., 75 units).
- Day 13 onwards: Monitoring kicks in. Your doctor will track your response through:
- Blood tests for estradiol and LH levels (hormones involved in ovulation)
- Ultrasound scans to check follicle development
- These monitoring visits will happen regularly based on how your ovaries are responding.
- Trigger shot: Once 1-2 follicles reach a specific size (around 17-19mm), you’ll receive an HCG trigger shot (10,000 units) to induce ovulation.
Note: The goal here is to stimulate a healthy number of eggs, not too many. This is to minimize the risk of multiple pregnancies.
Clomid and artificial insemination, IUI
If you’re undergoing Clomid treatment and have unexplained infertility or male factor issues, your doctor might recommend combining it with intrauterine insemination (IUI).
Here’s the general idea:
- Clomid: Stimulates ovulation, potentially increasing the number of eggs released.
- IUI: Places sperm directly into your uterus, bypassing potential challenges with sperm travelling through the cervix.
This combined approach can increase your chances of pregnancy.
Read more: IUI vs IVF
Clomid Medication And Clomid Treatment Cycles Cost
The cost of Clomid may vary depending on the brand, dosage, and pharmacy. In India, it generally costs less than Rs 100 per strip.
In some cases, health insurance may cover the cost of Clomid treatment in India.
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FAQs on Clomid, It’s Benefits and Side-effects
What Should I Avoid While Taking Clomid?
Here are some things to avoid while taking Clomid:
– Alcohol and marijuana: Because Clomid can cause dizziness or vision changes, alcohol and marijuana can worsen these symptoms.
– Driving or operating machinery: It’s best to avoid driving or operating heavy machinery until you know how Clomid affects you. This is because Clomid can cause dizziness or blurred vision.
You must discuss any concerns you have about side effects with your doctor as soon as possible.
How Do I Know if Clomid Is Working?
While there isn’t a single definitive way to tell if Clomid is working, there are a couple of approaches to get a sense of its effectiveness. One is simply having a regular menstrual cycle – a period arriving within 27-30 days after taking Clomid is a positive sign.
However, for a clearer picture, your doctor might recommend ovulation-tracking methods. This could involve blood tests to measure hormone levels that confirm ovulation has occurred. Another option is basal body temperature charting, where you take your temperature every morning. You and your doctor can potentially identify when ovulation happens by tracking these slight temperature shifts.
When Do I Ovulate on Clomid?
The timing of ovulation on Clomid can vary from person to person. On average, you’ll likely ovulate between 5 to 10 days after taking your last Clomid pill. However, it’s important to note that some women may ovulate later, even as late as 14 – 21 days after the last Clomid tablet.
How Do I Get Pregnant on Clomid?
To increase your chances of getting pregnant on Clomid, here are some tips:
– Timely Intercourse: Track your fertility by taking your temperature daily or using an ovulation prediction test kit. If you’re using a test kit, have unprotected sex within 24 hours of detecting a spike in luteinizing hormone, which indicates ovulation is imminent.
– Healthy Lifestyle: Maintain a balanced diet, exercise regularly, stay hydrated, and avoid excessive alcohol and recreational drugs. Additionally, practice mindfulness to keep your stress levels low, as high stress can negatively impact fertility.
What is the percentage of conceiving multiples on Clomid?
As per an article published by the Advanced Fertility Center of Chicago, a study on Clomid use revealed that pregnancies resulted in 92% singletons, 7% twins, and 0.5% triplets, with higher-order multiples being quite rare.
Sources:
Cleveland Clinic. “Anovulation: Signs, Symptoms, Causes & Treatment.” Cleveland Clinic, 25 Aug. 2021, my.clevelandclinic.org/health/diseases/21698-anovulation.
“Do Fertility Drugs Cause Ovarian Cancer? What the Research Shows.” Healthline, 21 Mar. 2022, www.healthline.com/health/womens-health/do-fertility-drugs-cause-ovarian-cancer#infertility-drugs-ovarian-cancer. Accessed 7 June 2024.
Garthwaite, Heather, et al. “Multiple Pregnancy Rate in Patients Undergoing Treatment with Clomifene Citrate for WHO Group II Ovulatory Disorders: A Systematic Review.” Human Fertility, 15 Jan. 2021, pp. 1–10, https://doi.org/10.1080/14647273.2021.1872803.
