Clomiphene citrate (brand name Clomid, Serophene) is used to induce ovulation. It revolutionized the field of infertility in the late 1950s.

Description
Clomiphene citrate is an orally administered medication. The initial dosage is 50 mg per day for five days, from day three to seven of the woman's cycle. The dose may be increased in subsequent cycles if the minimum dose does not result in ovulation.

Clomiphene citrate appears to act on the hypothalamus and is useful for women who do not ovulate because of hypothalamic or pituitary problems. Given early in the menstrual cycle (day three to seven), it suppresses the amount of naturally circulating estrogen. This "tricks" the pituitary into producing more follicular stimulating hormone (FSH) and luteinizing hormone (LH). These hormones then stimulate the ovary to ripen a follicle and release an egg. Of patients who are properly screened for use of this drug, about 70 percent will ovulate, and 40 percent of those will become pregnant. If a patient ovulates but does not become pregnant, the physician should check cervical factors. The anti-estrogenic effect of clomiphene citrate can create a "hostile" environment for conception.


Use
We usually start with the lowest dosage to minimize adverse reactions. We then increase the dose in a subsequent cycle if ovulation does not occur. The patient should begin testing urine for an LH surge daily with an ovulation test kit, beginning on day 11 or 12 of the cycle. Call the office when an LH surge occurs.

In most cases, we will examine you with transvaginal ultrasound to see whether the follicles are ready for ovulation and check the size of the ovaries. If they are excessively enlarged, we will stop treatment until the ovaries are back to the pre-treatment size. If the follicles are ready to ovulate, we will proceed with your treatment, which may include scheduling an intrauterine insemination, or advising you when to have natural intercourse.


Risks
Women with liver disease should not use clomiphene citrate. Patients with abnormal or irregular uterine bleeding should be examined for endometrial or cervical abnormalities before treatment. This medicine should not be given to patients with ovarian cysts, since they may grow larger. It should not be taken by a patient who may be pregnant, although there is no proof of fetal damage. If a patient has not had a menstrual period for a significant length of time, there may a benefit from inducing menstruation with progesterone before using clomiphene citrate therapy.

Some patients who use clomiphene citrate get blurred vision or other visual symptoms. In these cases, driving and operating machinery may be dangerous, especially in conditions of variable lighting. If eye symptoms persist, therapy should be stopped, and the patient should have a complete eye examination. Common side effects include ovarian cysts and ovarian enlargement. Some women feel "throbbing" in the ovaries before ovulation, and others report occasional "hot flashes," insomnia, or irritability. About six percent of clomiphene citrate-induced pregnancies are multiple pregnancies, which is more common than for spontaneous ovulation. Most of the multiple pregnancies are twins.