Clomid (clomiphene citrate)

Treatment of Ovulation Disorders

Dr. Berger recommends Clomid when ovulation problems prevent pregnancy after tubal reversal.

Gary S. Berger, M.D.
Medical Director

When is clomid useful?

Some women fail to become pregnant after tubal reversal surgery because they do not ovulate regularly. The cause may be that their pituitary glands don’t produce enough follicle stimulating hormone (FSH) and luteinizing hormone (LH) at the right time during the cycle. For these women, the medication most doctors prescribe is clomiphene citrate (Clomid).

How does Clomid work?

FSH and LH surge in the middle of the ovulation cycle. Sometimes tubal reversal patients need Clomid to ensure ovulation.

Clomid causes the pituitary to secrete higher levels of FSH and LH. These hormones stimulate the ovary to produce and release a mature egg. Structurally similar to estrogen, clomiphene binds to estrogen receptor sites in the brain. When these receptor sites are filled with Clomid, they can't bind with estrogen circulating in the blood. In essence, the brain is tricked into thinking that the amount of estrogen in the blood is too low. In response, the pituitary produces more FSH. The increased level of FSH in turn stimulates maturation of an egg within an ovarian follicle.

Who is a good candidate for treatment with Clomid?

If a woman is menstruating, even if irregularly, clomiphene is usually effective. Women with irregular menstrual cycles ovulate infrequently. They are usually excellent candidates for clomiphene treatment since more frequent ovulation presents more opportunities to become pregnant.

Clomiphene is also often effective in treating luteal phase defect (LPD). In this case, a woman may ovulate but then have inadequate production of the hormone progesterone in the post-ovulatory or luteal phase of the cycle. Following ovulation, the ovary produces progesterone - the hormone needed to prepare the uterine lining for implantation of a fertilized egg. A fall in blood progesterone levels during this critical time can prevent implantation or cause a woman to menstruate too early, thus ending a pregnancy within a few days after implantation has occurred. Clomiphene stimulates the ovary to produce higher progesterone levels in the luteal phase of the cycle.

How should Clomid treatment be monitored?

Using an LH-urine detector kit (also called ovulation detector kit or OPK), or keeping a basal body temperature (BBT) chart, can help a woman determine if she is ovulating and whether the luteal phase of her cycle is normal. The luteal phase of the cycle, the length of time from ovulation until she menstruates, has a normal range of 12 to 16 days.

How is Clomid prescribed?

Clomiphene is taken by mouth for 5 days, usually cycle days 3-7. The starting dose is one tablet (50 mg) daily for five days. If ovulation doesn't occur with this dosage, then the dosage may be doubled in the next treatment cycle.

What effects can Clomid have on cervical mucus?

Because clomiphene binds to estrogen receptors - including the estrogen receptors in the cervix - it can interfere with the ability of the cervical mucus glands to produce fertile mucus. The absence of fertile cervical mucus during the days preceding ovulation interferes with sperm penetration into the uterus and fallopian tubes and is sometimes referred to as "hostile" mucus. If this occurs, adding a small amount of estrogen beginning on cycle day ten and continuing until the LH surge usually improves the amount and quality of cervical mucus.

Ovulation induction is sometimes needed to have a baby after tubal reversal surgery.

"We are so thankful that God has blessed you with your talents to help work miracles for families like us." Read More

What side effects may occur with Clomid?

Some women taking clomiphene experience hot flashes and premenstrual-type symptoms such as migraine headaches and breast discomfort. Visual symptoms (spots, flashes, or blurred vision) are infrequent. If these occur treatment with Clomid should be discontinued immediately.

What are the contraindications to Clomid?

Liver disease is an absolute contraindication to taking Clomid, since this drug is metabolized by the liver. Enlarged ovaries, ovarian cysts, or polycystic ovaries are relative contraindications since clomiphene may result in ovarian hyperstimulation.

When should Clomid be stopped?

If pregnancy does not occur within 3 or 4 months while taking clomiphene, this medication should be discontinued and a fertility specialist should be consulted.

More about Clomid