Clomid: Use and Side Effects

Clomid is a brand name for clomiphene citrate, a prescription medication used to treat female infertility. It’s often the first line of defense for women who aren’t ovulating on their own a regular basis – or at all – depending on the cause of infertility. Fertility specialists feel confident with Clomid’s results and use it most often to treat their patients because it has been in use successfully for more than 60-years.

Clomid is an oral fertility medication, taken exactly as directed by your doctor, at specific points in your menstrual cycle. Dosage varies from patient to patient, depending on your infertility diagnosis as well as your response to the treatment, which will be closely monitored by your doctor.

It is not advised that any woman use Clomid for more than six cycles in a row. Other fertility treatments will be recommended by that point.

Who benefits from Clomid?

The best candidates for Clomid are those who:

• Have a history of irregular periods (a sign you’re not ovulating)
• Have polycystic ovarian syndrome (although this is changing rapidly since studies show Letrozole seems to be more effective for patients with PCOS)
• Have unexplained fertility. Studies show couples with unexplained fertility diagnosis have higher pregnancy rates using Clomid than any other fertility med, including injectable gonadotropins
• Pursue IUI in order to release more than a single egg, increasing the odds of fertilization
• Are 35-years and younger (often, fertility specialists recommend that women 36-years or older pursue more aggressive fertility medications to increase their chances of getting pregnant)
• Have regular periods but who have low luteal phase progesterone levels to support embryo implantation
• Are diagnosed with endometriosis that affects fertility

While OB/GYNs do have the ability to diagnose infertility and prescribe Clomid, the best fertility success rates and pregnancy outcomes occur for women who seek treatment from a fertility specialist. If you’re struggling to get pregnant and are considering the use of Clomid, we recommend scheduling a consultation with a reputable fertility specialist in your area to prevent or mitigate negative side effects and/or the chance of a multiples birth, which is never the ideal. This will also assure you start out with the first, best treatment for your diagnosis (what if it were your partner who is actually infertile?).

How does Clomid Work?

There are two ways Clomid works to “trick” the brain into ovulating. First, it triggers the ovaries to make more estrogen (estradiol) as well as progesterone. Both of these hormones are required for a successful pregnancy, and low levels of either will affect ovulation and/or the body’s ability to implant or support a developing embryo.

Secondly, Clomid ensures the ovary gets higher doses of follicle-stimulating hormone (FSH). In the right circumstances, this ensures the release of at least one, mature egg. In some cases, extra FSH might cause the ovary to release more than one egg, which can result in twins or – very rarely – triplets. Accurate infertility diagnosis and Clomid dosage will minimize the chances of a multiples birth.

This is one of the reasons fertility specialists are fans of Clomid. Multiples pregnancies are considered high risk pregnancies, and that’s the last thing you want after all your hard work to get pregnant. Unlike with injectable fertility meds, there is absolutely zero risk of having high levels of multiples because Clomid simply doesn’t have that type of effect on the body – it requires injectables to do that.

Currently, women using oral fertility medications (Clomid, Letrozole or Tamoxifen) have a 7% of 8% chance of having twins and only a 0.5% chance of having triplets (that’s less than a 1% risk).

Another reason we love Clomid is because all but the very most rare side effects are completely temporary and cease immediately when you stop taking the medication.

What are the side effects associated with Clomid?

Some women take Clomid with zero to very minimal side effects, others can be more sensitive. The most common, temporary side-effects associated with Clomid are:

• Hot flashes. Clomid tricks the brain into thinking there’s an estrogen shortage, causing the body to produce more. But, as you might know, low estrogen levels are also associated with menopause. Thus, hot flashes are one of the most common side effects. These rarely last for more than a week and the use of a fan or kicking the AC up a notch or two should be enough to counteract them.
• Night sweats (aka “more serious hot flashes”). Sleepy time is a busy time for the body’s biochemical production, including the production of hormones. This can make for even more dramatic hot flashes at night, causing you to sleep fitfully and wake up drenched in sweat. Interrupted sleep patterns can lead to grouchiness and irritability – so be prepared (and ensure your partner is prepared as well…). Again, this will only last for a week at the most.
• Temporary ovarian cysts. These are a more rare side effect, but they do happen. We’ll see these on the ultrasounds and, if they cause you discomfort, we’ll stop the Clomid treatment for a cycle or so and try again. If cysts grow large enough, it’s called ovarian hyperstimulation syndrome (OHSS) and the ovary can even twist (ovarian torsion). This is extremely rare, thankfully, and close monitoring by a fertility specialist should prevent it entirely.
• Thick cervical mucous and/or a reduction in the endometrial lining. Every once in a while (less than 1% of the time) we have a patient whose body responds to Clomid by thickening up the cervical mucous (which can prevent the sperm from meeting the egg if you’re timing intercourse at home) and/or preventing the endometrium from thickening up like it should to accommodate the fertilized egg. Again, routine ultrasound monitoring should be used by the physician throughout the Clomid course to make sure everything is going as planned. If we notice you fall into the category of women with thinner endometrial lining, we’ll note that and make adjustments for the next Clomid cycle.

If you’re currently working with an OB and taking Clomid as a fertility medication, you shouldn’t have any obvious infertility diagnosis, including PCOS, endometriosis, tubal factors or irregular/skipped periods. Any of those specific infertility diagnoses indicate you should be working with a fertility specialist.
Women with unexplained infertility, or no obvious reason for their inability to conceive, should only take Clomid under the supervision of an OB/GYN for one to three cycles. After that, they should consult with a fertility specialist to begin infertility testing and accurate diagnosis.

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