Clomid, Clomiphene, Serophene
Background Information about Clomid
Clomid is an oral medication commonly used in infertility treatment. Clomid is actually a trade name. The generic name is clomiphene citrate. Another trade name from a different pharmaceutical company is Serophene. All three formulations are thought to work the same.
Clomid is composed of two different forms or isomers. Zuclomiphene is inert and makes up about one third of the total medication. Enclomiphene is the active part and makes up the remaining two thirds. It takes a long time for clomiphene to be cleared by the body. In fact, traces of clomid can be found several weeks later. Because of this, clomiphene levels will increase in the blood over time if given over the course of a few months.
Clomid works by blocking estrogen receptors in the hypothalamus and pituitary gland. The result is that the pituitary gland is stimulated to produce more of the hormones that cause eggs to develop in the ovaries. These hormones are called gonadotropins and there are two important ones: FSH or follicle stimulating hormone and LH or luteinizing hormone. During clomid treatment, the levels of LH and FSH both increase. It is the FSH that is initially more important to get eggs to develop.
Clomid for ovulation problems
Studies in women with ovulation problems have shown that on average, about 72% of the women who take Clomid or Serophene or generic clomiphene will develop at least one egg and ovulate. Women who don’t get periods at all (amenorrhea) don’t ovulate as often as women who had periods occasionally (oligomenorrhea). Women with PCOS – polycystic ovary syndrome also do not ovulate as often with clomid.
Increasing the dose of Clomid will increase the chances for ovulation to occur. All three forms, Serophene, Clomid and generic clomiphene come as 50 mg tablets. Most physicians will start patients on a dose of 50 or 100 mg. If ovulation does not occur, the dose can be increased by 50 mg increments. 85% of patients will ovulate by a dose of 150 mg. For those who are still resistant, there are several different options for physicians to try to get ovulation to occur :
- Adding other medications–The most popular are the insulin sensitizing medications such as metformin — Glucophage
- Increasing the dose of Clomid beyond 150 mg
- Extending the duration of Clomid use beyond the usual 5 days
- Performing a multiple ovarian cystotomy
Women who still do not respond to clomiphene can be switched to a different class of medications such as an aromatase inhibitor or a gonadotropin.
Clomid for unexplained infertility
Clomid is commonly used in women who already ovulate to try to increase the chance for a pregnancy. The idea is to get more than one egg to be released from the ovary in a given month. For example, if there are two eggs released, there is a better chance that at least one of them will fertilize and implant.
Increasing the dose of Clomid for unexplained infertility does not increase the chance for pregnancy
Clomid side effects
Clomid’s ability to function is based on its ability to block receptors for estrogen. The body believes that estrogen levels are lower than they really are. Most Clomid side effects are similar to those seen in women who have low estrogen levels.
Side effects that occur in 10% of patients:
- hot flashes
- headaches
Side effects that occur in 6% or less of patients :
- Visual-blurring
- Visual spots or flashes
- Nausea and vomiting
- Abnormal uterine bleeding
- Abdominal or pelvic pain
- Weight gain
- Breast discomfort
Other side effects, including allergic reactions, have been reported but with an incidence of less than 1%
Clomid and pregnancy
The risk of miscarriage or stillbirth does not appear to be related to the use of clomiphene. The incidence of miscarriage in clinical trials was approximately 20% and the risk for stillbirth was 1%. Clomiphene is considered pregnancy Category X. Its use is contraindicated in women who are already pregnant. Studies in rats and mice have shown a dose-related increase in some types of malformations and an increase in mortality. Studies in human beings do not support an association between clomiphene and congenital defects.
Clomid Treatment Protocols
Monitoring with ovulation predictor kits and having intercourse only.
1. Call the office on Day 1 of your period.
2. Day 2 or 3 – Office visit- Blood test and ultrasound.
3. Take the clomiphene Day 5, 6, 7, 8, and 9
4. Start testing urine on the morning of day 10 or 11.
5. Look for the first definite color change. Do not continue to test after the color change.
6. Have intercourse the same day you see the color change and the next day.
7. Call the office when you see the color change. Schedule an appointment approximately one week later for a blood test to verify ovulation.
Monitoring with ovulation predictor kits and having an intrauterine insemination – IUI
1. Call the office on Day 1 of your period.
2. Day 2 or 3 – Office visit- Blood test and ultrasound.
3. Take the clomiphene Day 5, 6, 7, 8, and 9
4. Start testing urine on the morning of day 10 or 11.
5. Look for the first definite color change. Do not continue to test after the color change.
6. Call the office the same morning you see the color change. Have intercourse that night.
7. Schedule the insemination for the next day (The day after the color change)
8. Schedule an appointment approximately one week later for a blood test to verify ovulation
9. Schedule an appointment approximately two weeks later for a pregnancy test
Monitoring in the office with intrauterine insemination or intercourse
1. Call the office on Day 1 of your period.
2. Day 2 or 3 – Office visit- Blood test and ultrasound.
3. Take the clomiphene Day 5, 6, 7, 8, and 9
4. Day 10 or 11 – Office visit – Blood test and ultrasound. You will receive instructions that afternoon when to return for the next visit.
5. Only when instructed – Take hCG trigger injection in the evening. Have intercourse that evening also.
6. Schedule the insemination for 2 (two) days after the hCG trigger. If you are not doing insemination, have intercourse again on this day
7. 1 week after hCG trigger– Office visit – Blood test only (Progesterone level)
8. 2 weeks after hCG trigger– Office visit – Blood test only (Pregnancy test)
Other Clomid Information
