Super Ovulation with Clomid and Femara
Clomid is a fertility drug often used to treat patients with ovulatory dysfunction presenting with prolonged cycles, irregular menses and/or polycystic ovaries, in order to induce ovulation. Clomid is also sometimes utilized for unexplained infertility, helping a woman “superovulate”, or to enhance treatment for male infertility.
Clomid is a nonsteroidal agent with weak estrogenic activity. Clomid works at the level of the hypothalamus, where it competes with estrogen for binding sites. The hypothalamus then “reads” lower estrogen levels and signals the anterior pituitary gland to produce FSH, which stimulates the ovaries.
Clomid induces ovulation, and once ovulation is documented, further increases in dosage are usually not warranted. Success with this fertility drug is most likely to occur during the first three to six ovulatory cycles of therapy, and treatment beyond six cycles is not usually recommended.Ovulation on Clomid can be documented by using urinary test kits, by measuring progesterone levels, and by other methods. If pregnancy has not occurred after six cycles of Clomid, in most cases, an infertility specialist should be consulted. Clomid is given orally for five days during each menstrual cycle. Clomid is usually taken on cycle days 3-7 or 5-9, as determined by the physician. Cycle day 1, by definition, is the first day of full flow during the menstrual cycle. In a typical clomid treatment cycle, a pelvic sonogram is ordered before starting the medication to ensure that the ovaries are normal.
Different women respond to Clomid in different ways. Therefore, the initial dose may vary depending upon patient age, weight and other factors. The treatment plan usually starts with clomiphene 50mg (1 tablet) daily for five days. If there is no evidence of ovulation, the dose of Clomid increases by 50mg daily for each subsequent cycle (as directed by the physician) until ovulation occurs. If adequate ovulation has occurred, the ovulatory dose is usually continued for three to four ovulatory cycles prior to further evaluation. Physicians may combine Clomid with gonadotropin injections in some cases.
Clomid Precautions and Side Effects
Multiple Gestation: Clomid is associated with a slightly increased risk (5-8 percent) of multiple gestation pregnancy (more than one baby during pregnancy, i.e., twins, triplets, or more).
Suspected Pregnancy: Clomiphene is contraindicated during pregnancy. It is not to be used during pregnancy or suspected pregnancy. Please note there is no evidence of an increased risk of birth defects in women taking clomiphene before pregnancy occurs.
Liver Disease: Patients should not use this fertility drug in the presence of active liver disease.
Ovarian Enlargement: About 15 percent of patients will notice ovarian cyst formation, possibly accompanied by abdominal discomfort and/or bloating. These cysts usually regress without need for treatment. There may be mild mid-cycle abdominal pain at the time of ovulation, which is normal.
Hot Flashes: Approximately 10 percent of patients will have vasomotor symptoms known as hot flushes, a temporary feeling of facial flushing or tingling and numbness in extremities. These are self-limiting.
Decreased Cervical Mucus: Approximately 20-25 percent of patients will experience a decrease in the amount of cervical mucus produced or a thin endometrial lining.
Uncommon Clomid Side Effects
- Nausea or Vomiting (2%)
- Breast Tenderness (2%)
- Blurred or spotted vision (1%). If this occurs, discontinue Clomiphene use immediately and contact the office.
- Headaches (1%)
- Mood Changes
Ovarian Cancer Risk: Some studies have suggested that the use of fertility medications may increase the risk of ovarian cancer. This finding has been refuted in other studies.