The info below covers the following topics:
What is Clomid?
Is more better? (taken from this website:http://atlanta.babyzone.com/features/expertsqa/default.asp?QAID=15181&ExpertID=7
Clomid (Clomiphene Citrate)
Clomiphene citrate (Clomid, Serophene) is the most commonly used medication for women with impaired
fertility. It is relatively inexpensive, is taken orally, and it works by inducing the pituitary gland to produce increased
amounts of follicle stimulating hormone (FSH). In essence, clomiphene "fools" the pituitary into thinking that the ovaries
are not producing any estradiol by blocking the effect of estradiol on the gland. In other words, although there may still
be plenty of estradiol around, the pituitary does not think so because it can't "see" it. The gland responds to this "apparently
low estradiol level" by increasing the production of FSH, which in turn increases the stimulation to the ovary. In response
to higher levels of FSH, the ovary becomes more likely to produce a mature egg.
Clomiphene is most useful in women
with irregular, or even absent, ovulation. It is typically given for five days beginning on either day four or day five of
the cycle. The lowest dose of clomiphene is 50 mg., or one tablet. This should almost always be the starting dose. The response
to clomiphene can be monitored with temperature charts (BBT), ultrasounds, and/or progesterone levels. At the lower doses
(50 or 100 mg. per day), simple recording of a BBT and a progesterone level in the mid-luteal phase are probably adequate.
At higher doses (some physicians will use doses of up to 250 mg.), ultrasounds should be performed and HCG given if the follicle(s)
has (have) reached mature size. HCG functions as a signal to the follicle, just as LH does, that it is time to release the
egg, or ovulate.
Clomiphene is associated with a fair number of side effects. A small percentage of women will experience
mild headaches, bloating, hot flushes, or visual symptoms (you should notify your physician if you experience visual effects).
A rather large percentage of couples report that the use of clomiphene results in some emotional instability. If you are taking
clomiphene and find that your emotions are a little hard to control, especially in the second half of the cycle, blame it
on the clomiphene.
There are no known risks to the fetus or adverse effects on the infant should conception occur.
Ovarian cysts may occur in some individuals on clomiphene, but if no additional clomiphene is given, the cysts will almost
always resolve on their own. For this reason a pelvic exam or an ultrasound should be performed in-between cycles of clomiphene
to be sure that the ovaries have returned to normal before more clomiphene is taken. There is some increase in the risk of
multiple pregnancies with clomiphene. Women who conceive have about a seven percent chance of having twins. The risk of triplets,
quadruplets, etc. is not really increased.
There are several important points to make about clomiphene:
- Either a dose works, or it doesn't. If taking 50 mg. a day does not result in normalization of ovulation (and therefore
your cycle) one month, there is no point in trying that dose again. The dose needs to be increased the next month.
- More is worse, not better. Once the dose that normalizes the cycle and results in good ovulation and progesterone production
is determined, there is no point in increasing the dose further. In fact, increasing the dose further may actually make it
harder or even impossible to get pregnant. Remember - clomiphene functions by preventing the pituitary from "seeing" the estradiol
that is present. It does the same thing to the cells that produce the cervical mucus and to the cells that line the uterus-
if they don't "see" the estradiol, the cells of the cervix won't produce cervical mucus, and the cells lining the uterus won't
develop to an extent adequate to allow implantation. Everyone has a threshold dose of clomiphene (the dose that normalizes
ovulation)- and going beyond that dose does more harm than good.
- Clomiphene is an anti-estrogen. This means that it does indeed prevent some cells from "seeing" the estradiol and because
of this blocks the action of estradiol on those cells. The possibility of this type of effect needs to be checked once the
threshold dose is achieved. This should include a post-coital test to be sure that there is adequate cervical mucus production,
and a measurement of the thickness of the endometrium by ultrasound to be sure that it is developing to an adequate thickness.
Normal endometrium develops to about ten millimeters in thickness - an endometrial thickness of seven millimeters or less
is associated with very poor pregnancy rates. This is often a problem at some of the higher doses of clomiphene - although
it results in ovulation, there is enough of an anti-estrogen effect on the cervical mucus or endometrium to prevent pregnancy
from occurring even though ovulation is normalized.
- The vast majority of the pregnancies that occur as a result of the use of clomiphene occur within the first four ovulatory
cycles. Once the threshold dose is achieved, there is really little point in pursuing the use of clomiphene beyond four, or
certainly six, cycles at the most. (The chances of conceiving in a cycle of clomiphene beyond the fourth may be as low as
three to four percent, and those chances decrease even further soon thereafter.) There is another reason for limiting the
number of cycles of clomiphene. There is at least one study suggesting that the use of clomiphene for more than a year is
associated with an increase in the risk of ovarian cancer.
- Finally, and perhaps most importantly, there is no role for clomiphene in a woman with regular ovulatory cycles. There
is absolutely no good evidence that clomiphene improves pregnancy rates in women with normal cycles. It is not a "fertility
enhancer" and in fact, because of its anti-estrogen properties, it can actually make it harder to get pregnant rather than
When to take Clomid?
Some women find that by taking Clomid at night, the "hot flash" and other side effects can be "slept through"
When will I ovulate?
You should ovulate within 5-7 days after taking your last Clomid pill.