Clomid has been around for decades, and that can reframe all these fancy new drugs as just quaint, prehistory methods that are already in disuse by any serious fertility clinic.
But doctors still write the prescription for it for a simple and valid reason: for certain women it can help an egg to emerge from the ovary.
The tablets are only taken for five days. The waiting, cycle tracking and second-guessing take considerably longer.
Why is Clomid prescribed?
Clomid is the brand name for clomiphene citrate. It is mainly used when ovulation is irregular or absent, and in fact a common underlying diagnosis for anovulation is polycystic ovary syndrome (PCOS).
The drug temporarily blocks estrogen receptors in the brain, mistaking low levels of circulating estrogen for a systemic deficiency; The hypothalamus therefore secretes more follicle-stimulating hormone and luteinizing hormone, which act on the ovary to stimulate follicular development and ultimately egg release.
It does not “make you fertile”, per se: it only addresses the narrow mechanism of ovulation, and pregnancy success still depends on the quality of the sperm, the openness of the fallopian tubes, the receptivity of the uterus (if and when the egg reaches it), and the woman’s age. This is why a fertility work-up should happen at the same time as clomiphene administration – months spent artificially stimulating the ovulation process will be thwarted if the sperm can’t meet the egg.
What does a cycle on Clomid look like?
There’s a common starting point of 50 mg daily for a total of 5 days near the beginning of the menstrual cycle, but specific days and dosing should be determined by the prescriber, and not by another patient’s account or advice on an online forum.
Ovulation typically occurs a few days after the last dose of the drug, and some women use at-home ovulation predictor kits to try and time sexual intercourse with ovulation (a more reliable method is bloodwork or ultrasound monitoring ordered by a physician, especially if a patient wishes to determine how many follicles have developed in the ovary).
There’s also an unusual tension: the comparatively easily managed medication routine of taking Clomid is balanced out by the anxiety of trying to time sex correctly – couples may even find themselves making intimacy a chore in their attempt to conceive.
This is not abnormal, and not a sign of treatment failure.
If ovulation didn’t occur, the physician may choose to increase the dose (or move to another medication) in a subsequent cycle. But it’s important to remember that higher daily clomiphene doses don’t equal better results, and the aim is often to reach safe ovulation rather than a maximum ovarian reaction.
Clomid is generally not prescribed indefinitely – and after a few cycles of monitoring that fail to produce ovulation, the question moves from “Should I keep trying the same thing?” to “Am I attacking the right problem?” ?
Does it work for PCOS?
Sometimes, but it’s often being replaced as a first option by another drug called letrozole.
The current recommendation seems to be that for women with PCOS-associated anovulation and without accompanying infertility factors, letrozole may be slightly more effective and safer (in terms of likelihood of conceiving multiples) than clomiphene. It doesn’t necessarily mean that Clomid is outdated – women and their doctors still have to take into account medical history, accessibility, tolerability and personal preferences – but letrozole is now the preferred option in most cases, as it is FDA-approved for ovulation induction, unlike clomiphene.
Women considering their fertility options should avoid thinking of this as a competition between drugs. The best choice depends on the mechanism of ovulation failure.
But there are some common side effects.
The most well-known complaint is hot flashes, though mood swings, nausea, breast tenderness, bloating, and headaches are also possible. Some women will barely notice their dose of clomiphene, while others will feel particularly frayed and sensitive.
These effects usually pass after the five-day “burst” of medication, but sudden visual changes should always be reported to the physician who prescribed the pill, as clomiphene has been associated with vision problems (usually transient, but requiring an ophthalmological evaluation if they occur).
Severe pelvic, ovarian or abdominal pain or distension should also be brought up with a healthcare professional immediately – clomiphene can cause enlarged ovaries, and although serious ovarian hyperstimulation (OHSS) is much more common with injectable stimulation drugs, it’s still not something to take lightly.
Finally, it’s worth mentioning that conception of multiples (usually twins) is more likely while taking clomiphene – many such pregnancies are healthy and go smoothly, but a conversation about multiple births should always happen before starting any fertility medication, and not as a surprise at the six-week ultrasound appointment.
What if the Clomid isn’t working?
Make sure that it actually was working – if clomiphene didn’t trigger ovulation each cycle, then the dose and administration method should be re-examined. But if regular cycles of ovulation have occurred without pregnancy, then it may be worth looking elsewhere.
The next course of action could be looking into fallopian tube patency, semen analysis, other hormonal imbalances and considerations related to advancing maternal age.
Switching to another medication (including letrozole mentioned above, or a fertility injection), intrauterine insemination, or in vitro fertilization could also enter the conversation. In some cases, the reason for ovulation failure may be diagnosed and treated.
A prescription for clomiphene should also come with a plan of how it’s intended to work; when the tablets should be taken, how ovulation will be tracked and how many cycles will be attempted before re-evaluation. Buying clomiphene online without such a strategy leaves the whole “fertility journey” open for interpretation.
Clomid can be a wonderful fertility medication, and for some women it may even fulfill that sacred role of “all it took was ___”. Just remember that it’s only one part of the equation, and the most important thing about your treatment should be understanding precisely why you’re taking this medication, and when it’s time to move on.
