Clomid is a widely used ovulation induction drug and is frequently a first line infertility treatment. It is administered by obstetrician gynecologists and reproductive endocrinologists. We include several articles about clomiphene on our Web site and, given it's widespread use, have devoted a separate Web section to Clomid.

Lack of ovulation (anovulation) is one of the most common causes for infertility in otherwise fertile couples. Once successful ovulation is achieved, fertility is often restored. For many years, the first line of pharmacologic ovulation induction has involved the use of clomiphene citrate. Clomiphene results in successful ovulation induction in approximately 80% of women, and ultimately half are able to achieve pregnancy.

Clomid use has also been extended to superovulation, in patients who ovulate normally, but have unexplained infertility. Yet despite advances in ultrasonographic technology, hormone assays, and urinary leutinizing hormone kits, success with clomiphene have not changed dramatically, with pregnancy rates ranging from 10-20% per cycle. Whereas the goal in anovulatory women is mono-ovulation (one follicle to develop), the goal with superovulation is the development of multiple follicles.

Clomiphene is a tablet taken orally and it works by increasing levels of follicle stimulating hormone (FSH) produced at the beginning of a cycle. Because it can cause more than one egg to develop, it increases the odds of a multiple pregnancy to about 8%, usually twins. Although clomiphene causes follicles containing eggs to grow, it does not necessarily cause the eggs to ovulate. While most women respond by producing LH normally, not all do. In this case, an injection of human chorionic gonadotropin (hCG) may be necessary to trigger the egg to be released. hCG is very similar structurally to LH, and "tricks" the egg(s) into ovulating.

Clomiphene patients often receive IUI with an injection of hCG to stimulate ovulation. If clomiphene IUI is not effective, the next step may be ovulation induction with follicle stimulating hormone and hCG. Some centers may use a mixed protocol of Clomid and FSH in select patient groups.

Clomid is usually started at a dose of 50 mg (one tablet) per day starting on the third, fourth, or fifth day of the menstrual cycle. This dose is continued for a total of five days. It is very important to be monitored by ultrasound while taking Clomid to determine if in fact the medication is effective. If it is not effective, the dose may be increased to 100 or 150 mg If ovulation occurs on a dose of clomiphene, there is usually no benefit to increasing the dose in a subsequent cycle. In fact, increasing the dose of clomiphene could increase the incidence of side effects with no increase in efficacy.

Clomiphene's use may be limited by side effects. Namely, it exerts undesirable anti-estrogenic effects in the periphery (endocervix, endometrium, and ovary) that helps explain the discrepancy between ovulation and conception rates. Additionally, vasomotor flushes may occur as frequently as in 10% of cycles. Other side effects include mood swings, visual disturbances, breast tenderness, pelvic discomfort, and nausea. It is imperative to be monitored under the care of a physician when taking clomiphene . The unrestricted use of clomiphene may place a patient at the unnecessary risk of higher order multiple pregnancies and hyperstimulation syndrome.

Widespread use of clomiphene by obstetricians is not always accompanied by a semen analysis. We now know that over 47% of infertile couples will have a male infertility component and no treatment of the female can work in the absence of quality sperm. Reproductive endocrinologists always order the semen analysis as a benchmark study before beginning any therapy on the female. Additionally, specialists are more likely to advance patients to the next treatment step such as FSH stimulated IUI. In general, the OB/GYN should use clomiphene for no more than three cycles and the patient should be examined every month. Patients failing clomiphene should be referred to a reproductive endocrinologist.

Clomid should not be used incessantly or for more than 6 months. If a patient has not been able to achieve pregnancy in this time, the efficacy of clomiphene may have already been maximized. Furthermore, depending on the age of the patient, it may delay more appropriately aggressive treatment that is needed to achieve pregnancy such as IVF.

Lastly, there are studies that suggest that if clomiphene is used in excess of 12 months, that there may be an increase in the development of ovarian tumors. The long-standing safety and efficacy of clomiphene is optimized under the guidance of a physician. Overzealous and miss-use of clomiphene can result in unnecessary complications; however, when carefully monitored, it is an efficacious and powerful tool in treating infertility.

Read an Article on Fertility Drugs- "Demystifying Fertility Drugs"

• Clomiphene for ovulation induction.
• Glucophage (metformin) is used in the management of polycystic ovarian syndrome.
• Parlodel for Hyperprolactinemia
• Lupron or Ganirelix Acetate are used to prevent premature ovulation in assisted reproductive technology cycles.
• hCG or Luveris will be used to stimulate ovulation 36 hours prior to egg retrieval in ART procedures or 36 hours prior to insemination in IUI cycles. Luveris may also be prescribed for women with hypogonadotropic hypogonadism, which is extremely low levels of FSH and LH.
• Birth Control pills may be prescribed to insure there are no "leftover follicles" from previous cycles.
• Antibiotics will be used to treat infections in the male and female.
• Alternatives to FSH for Ovulation Induction