Clomiphene (Clomid) is a medication used in the treatment of female infertility, specifically in those who do not ovulate. Clomiphene triggers ovulation by stimulating the growth and release of eggs in the ovaries, making fertilization possible.
Before prescribing clomiphene, an OBGYN or other healthcare provider will typically order tests to rule out other possible causes of infertility in order to determine the most appropriate treatment.
Clomiphene, often referred to as the brand name Clomid, is available by prescription only. It comes in 50 mg pills and can be found at most pharmacies and drug stores.
Indications for use
Clomiphene is indicated for the treatment of female infertility caused by anovulation (inability to ovulate). It stimulates the release of hormones from the pituitary gland necessary for egg development and release, allowing for fertilization. Ovulation typically occurs 6 to 12 days after taking the medication.
Clomiphene may also be used to trigger ovulation prior to artificial insemination or other procedures involved in artificial reproductive technology (ART).
How to take
Treatment with clomiphene consists of 3 cycles, which may be done consecutively (one right after another) or with breaks in between as determined by your doctor.
The recommended dose during the first cycle is one 50 mg pill once a day for 5 days. In women or people assigned female at birth (AFAB) who do not menstruate, treatment may be initiated at any time of the menstrual cycle. In people who do menstruate, or have had menstruation induced through the use of progesterone, clomiphene should be started on day 5 of the menstrual cycle.
If ovulation occurs at the 50 mg dose, it is not necessary to increase the dose during the next two cycles. If ovulation does not occur during the first cycle of treatment, the dose should be increased to 100 mg per day for 5 days during the second cycle, which would take place 30 days following the prior treatment.
The maximum dose for clomiphene should not exceed 100 mg per day for 5 days. It is also not recommended to continue treatment after 3 cycles if ovulation does not occur.
Clomiphene should be stopped if pregnancy occurs during treatment.
Side effects
The most common side effects of clomiphene include:
- Hot flashes;
- Facial flushing;
- Vision changes such as sensitivity to light and seeing flashing lights;
- Abdominal discomfort;
- Breast pain;
- Insomnia;
- Headache;
- Dizziness;
- Vertigo;
- Urinary frequency and dysuria (pain with peeing);
- Endometriosis or exacerbation of pre-existing endometriosis;
- Increased risk for ectopic pregnancy (pregnancy outside the uterus).
Clomiphene can also cause a condition called ovarian hyperstimulation syndrome, with symptoms such as abdominal bloating, nausea, vomiting, diarrhea, rapid weight gain (especially in the face and belly), decreased urine production, pain with breathing, shortness of breath (especially when lying down), and accelerated heartbeat. It is important to stop treatment right away and seek urgent medical attention if you experience any of these symptoms.
Contraindications to use
Clomiphene should not be used in people with an allergy to clomiphene or any of its ingredients.
Clomiphene should not taken by people who are pregnant or breastfeeding or who have certain conditions such as liver disease, hormone-dependent tumors, abnormal uterine bleeding without a known cause, thyroid or adrenal dysfunction, or organic brain damage such as a pituitary tumor.
Clomiphene should also be avoided in the case of an ovarian cyst, as treatment could cause the cyst to get bigger. An exception to this is in people with polycystic ovarian syndrome.
Use in men
Clomiphene is not FDA approved for treatment of infertility in men or people assigned male at birth (AMAB).
Some studies suggest that clomiphene may increase testosterone levels in males, which could be potentially beneficial for those with low sperm count or unexplained infertility.
Further studies are needed to confirm the efficacy of clomiphene in this population as well as safe dosing. At this time, clomiphene should only be used in the treatment of male infertility when advised by a doctor following a full workup and discussion of the risks and benefits of treatment.