Origins of Clomid
Clomid—the generic name is clomiphene—has been around since the late 1950s and is a common first step in infertility treatments. According to Dr. Mark Leondires, medical director of Reproductive Medicine Associates of Connecticut, it was originally thought of as a breast cancer treatment drug because of its anti-estrogenic properties. While treating patients for breast cancers, it was accidentally discovered that the drug also helped induce ovulation. "So for the past 40 years Clomid has been the tried-and-true bargain-basement fertility drug to augment natural ovulation in millions of women," Dr. Leondires says.
Your doctor may prescribe Clomid if you:
- Have been diagnosed with polycystic ovary syndrome (PCOS). Women with this condition do not ovulate on a normal cycle, says Dr. Judith Albert, medical director of Reproductive Health Specialists in Pittsburgh, Pennsylvania. Clomid has its highest success rates when PCOS is the reason for the infertility because it increases frequency and predictability of ovulation.
- You suffer from unexplained infertility. In other words, if "you've been trying for at least a year to become pregnant, the woman is under 35, all the tests have been done and come back normal," Dr. Albert says. In that case, Clomid is used to augment natural ovulation and can increase the odds of pregnancy in the first few cycles compared to giving no treatment.
These are meant to be guidelines for informational purposes only. Always follow your prescribing doctor's recommendations.
- Clomid is taken for five days at the beginning of the menstrual cycle—days three through seven, or days five through nine.
- Take one pill per day at the same time. (Dr. Leondires recommends bedtime.)
- Clomid does not have to be taken with food.
- The usual dosage ranges from 50 to 150 milligrams. Generally 50 will be the starting dosage, and if that doesn't affect ovulation, the dosage may be increased.
Positives of Clomid
- A baby. The chances of conceiving a child with Clomid in any given cycle is around 10 to 12 percent. This seems low, but Dr. Albert reminds us that percentages can be misleading because they include everyone who takes Clomid—even those who may not be the best candidates for this particular treatment. "If you start with the statistic that any healthy, fertile couple trying to conceive only has a per cycle conception rate of 20 to 25 percent, it puts it in perspective," she says.
- It's inexpensive. Everyone knows that infertility treatments can be pricey, but a cycle of Clomid can cost as little as $10. It's an inexpensive first step.
- It's safe. Clomid has few side effects and risks.
Negatives of Clomid
- Possible side effects, which could include hot flashes, mood changes, bloating, vaginal dryness, and decreased cervical mucus. Also pay close attention to any visual changes. Dr. Leondires says black spots in front of the eyes may indicate a more serious side effect. Notify your doctor if you're having issues with your vision.
- Getting pregnant with two or more babies. Multiple pregnancies occur in about 10 percent of all births, most commonly twins. Triplets and quadruplets are rare. Multiples may seem like a dream come true to an infertile couple, solving their problem in one fell swoop, but as Dr. Albert points out, there are increased risks with multiples. "We're better as humans to have one baby at a time," she says. "People underestimate how risky multiples can be to both Mother and Baby."
- There is an increased risk of an ectopic pregnancy (tubal) occurring with Clomid. Watch for warning signs of ectopic pregnancy.
Who Can Prescribe It?
- OB-GYNs can prescribe, but usually will not do a full fertility workup first. The drawback is that in cases where the infertility is caused by a problem not related to ovulation—such as male infertility or tubal infertility—valuable time can be wasted. In general, the OB-GYN should refer the patient to a specialist if there is no pregnancy after three to four cycles, or if the woman is over 35.
- Reproductive specialists will generally do a full fertility workup first, making an initial determination of the possible reason for the infertility. They will also monitor more closely to watch for side effects, such as a decrease in cervical mucus, which can work against conception. In that case, they can recommend and perform intrauterine insemination (IUI) to increase the chances of conception. In addition, a reproductive specialist is best equipped to help a couple avoid multiple conceptions and its attendant risk.