Clomiphene
What is the first choice for ovulation induction in most
women?
Clomiphene citrate ( Clomid,
Serophene) is the first line agent used in most women for ovulation induction.
It became available in 1968 and is a good medication, given its safety
profile, effectiveness and cost. Treatment with clomiphene is indicated to
improve the timing and frequency of ovulation and to enhance the
possibilities of conception for the patient who ovulates only occasionally. It
works by increasing the levels of FSH (follicle stimulation hormone) and LH
(luteinizing hormone) secreted by the ovary to stimulate the maturation of
follicles (which contain the eggs) in the ovary leading to ovulation and more
predictable cycle length.
How is clomiphene given?
When you
are planning a clomiphene cycle, we ask that you call our office on the first
or second day of your menstrual cycle. If you start on a weekend, call on
Monday morning.
The nurse will talk with you about the cycle, schedule an
ultrasound if needed and call your prescription to the pharmacy. The usual
clomiphene dose is 100mg/day for 5 days beginning on cycle day 3, 4, or 5.
Ovulation usually occurs approximately 7 days after the last pill is taken.
How is treatment begun if I have no menstrual cycle?
Progesterone is used to induce a menses. After 5 days of progestin therapy, a
period occurs, then clomiphene is started on the fifth day of bleeding. We
usually start at a dose of 100 mg a day taken cycle day 5 thru 9.
How do I know when I am ovulating?
Ovulation can be predicted with
the use of an ovulation predictor kit, which detects the surge of LH that
occurs 1-2 days prior to ovulation . Alternatively, we use ultrasound to
evaluate the growth of ovarian follicles, as well as to look at the endometrial
thickness.When follicles measure 18-20 mm, and the endometrial thickness is
adequate, we give an injection of hCG which triggers the ovary to release the
eggs from the follicles. Intercourse and/or intrauterine insemination (IUI) can
then be timed to coincide with ovulation. We obtain a progesterone level in the
second half of the cycle to evaluate ovulation.
What specific
findings are we looking for with ultrasound monitoring?
We are looking
at the number and size of the follicles as well as the pattern and thickness of
the endometrium.
When can I tell if I am pregnant?
If you
have not had a period 14-16 days after ovulation, you may do a home pregnancy
test. (Doing the test before 14 days may result in a false positive.) Call the
nurse with the results. If it is positive, we will have you come in for a blood
pregnancy test. If it is negative, we will ask you to wait a few more days,
then repeat the test. If it is still negative, Dr. Goldstein will prescribe
provera to induce a period.
How long do I stay on clomiphene?
Of the women who conceive on clomiphene, approximately 90% do so within the
first 3-4 cycles of taking the medication. If you are not pregnant after this
time, we would schedule a consultation with Dr. Goldstein to discuss further
treatment options.
What side effects can I expect from
clomiphene?
For most women side effects are minimal and transient, but
this is variable.
The most common side effect is hot flashes during the
time you are taking the medication. Other side effects can include nausea,
breast tenderness, mood changes, depression and vaginal dryness. Some
complaints such as visual disturbances may require that clomiphene be stopped.
Does clomiphene decrease cervical mucous and utering lining?
Estrogen is the hormone that causes the cervical mucous to increase and
facilitate the passage of sperm through the cervix. It also causes the uterine
lining (endometrium) to thicken in preparation for the implantation of a
fertilized egg. For some women,
clomiphene can have an anti-estrogenic
effect on the cervical mucous and endometrium. The use of intrauterine
insemination provides a way to by-pass the cervical issue by placing the sperm
directly into the uterine cavity with a small catheter.
The addition of
estrogen either orally or with an estrogen patch has been shown to increase the
endometrium, but whether this results in improved pregnancy rates is unknown.
If the endometrium is less than 8 mm at the time of ovulation, then treatments
other than clomiphene should be considered.
What alternatives to
clomiphene are available?
Letrozole (Femara) works in much the same
way as clomiphene, but may have less of an adverse effect on the cervical
mucous and endometrium. If these medications are not successful, the next form
of treatment is the use of injectable medications called gonadotropins. For
more information on this form of therapy, please see the next page on our
website.
What is the incidence of twins with clomiphene?
Approximately 8% of pregnancies conceived with clomiphene result in twins.
Triplets, though rare, can occur. There is no increase in the incidence of
congenital anomalies.
|  | Fertility Specialists of
Dallas
Phone: 214.750.5500
Presbyterian Hospital of
Dallas
8230 Walnut Hill Lane Suite 300
Dallas, TX 75231
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Presbyterian Hospital of Plano
6300 W.
Parker Rd
Bldg II, Suite 424
Plano, TX 75093
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Texarkana Satellite
1002 Texas Blvd Suite 401
Texarkana, TX 75503
903.793.5500
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