Clomid (Clomiphene)
The drug Clomid is the most commonly used fertility drug; Clomiphene has been in use since the 1960s. Clomid is the first-line treatment for ovulation induction in women with ovulatory failure. Clomid is cheap, effective, easily available and well tolerated. Clomid blocks the estrogen receptors on the hypothalamus causing them to “think” there is estrogen deficiency. Hence the hypothalamus sends messages to the pituitary gland to release follicle stimulating hormone (FSH) and luteinizing hormone (LH) which causes the growth of the follicles.
How to take Clomid?
Clomid (Clomiphene) is usually given as one 50 mg pill a day for five days e.g. from day 2 �6 or days 5-9 of the menstrual cycle. If the patient has no period or her periods come very infrequently it is essential to exclude pregnancy before taking Clomid. If you are not pregnant your doctor may prescribe progestogen tablets to be taken orally to induce a withdrawal bleed so you can take the tablet on day 2 of the withdrawal bleed. The Clomid dose can be doubled or trebled subsequently if ovulation does not occur. It is important to determine whether you have responded to the treatment (i.e. ovulated) by measuring blood progesterone levels around day 21 to 23 of the treament cycle or performing an ultrasound scan during at least the first cycle of treatment. The starting dose of Clomid should only be increased if their is no response after the second cycle of treatment because of those women who will respond to 50 mg dose, only two thirds will do so in the first cycle. If the Clomid drug treatment is successful, ovulation tends to occur about a week after the last pill. You are advised to have intercourse every other day for about a week, starting five days after the last pill. Though clomid induces ovulation in about 70-80% of appropriately selected patients, the pregnancy rate is about 30-50% following up to six cycles of treatment. The risk of twin pregnancy is about 10% and the risk of high order of multiple pregnancy is about 1%.
What are the side effects of taking Clomid?
Like all medicines Clomid can cause unwanted effects although not everybody get them. These unwanted effects are uncommon and include; hot flushes, nausea, mood changes, headaches, flashes of light, blurred vision, ovarian cysts, or abdominal discomfort. It is normally recommended that clomid should not be used for more than 6 months because of the increased risk of ovarian cancer.
Clomid in high doses and in some women may alter the quality of cervical mucus, making it thick, and may also affect the endometrium making it less receptive.It is recommended that if ovulation has not been achieved after four treatment cycles, the patient is considered unresponsive and treatment using Clomid is discontinued.
What is next if the patient failed to respond to climid?
Patient who are known to be resistant to Clomid, one of the following second-line treatments may be considered, depending on clinical circumstances and the patient's preference: laparoscopic ovarian drilling or combined treatment with clomifene citrate and metformin if not already had had this as first-line treatment or use of low dose gonadotrophins.
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