Ovulation Induction with Clomiphene Citrate

If you have been diagnosed with a disorder of ovulation as a possible cause of infertility, there are many medications which have been used to attempt to induce ovulation. Most are powerful injections that are given and monitored very closely by infertility specialists. They can have significant side effects and, thus, are tried only if necessary.

The medication that your doctor is recommending is called clomiphene citrate. It is a medication taken by mouth with relatively few side effects. These include hot flushes, abdominal distension, bloating, breast discomfort, nausea and vomiting, headache, and visual symptoms (such as blurring, visual spots or flashes). Other than hot flushes, the incidence of the above side effects is 5% or less.

Most notable medical complications include:

1) Ovarian cysts (5%) which almost always resolve and rarely cause delay in further cycles or other persistent problems.

2) Twins (5-10%), with the general population risk of 1.2%

3) Possible association with ovarian cancer. This was found in very small studies which were not well performed. Recent studies suggest no increased risk. It is currently under further investigation. Most experts feel that it may be infertility itself which may increase this risk and not the medication. Also, experts believe there is little risk with clomiphene, especially if used less than 12 cycles.

4) Possible decrease in cervical mucus quality.

Clomiphene is taken in the following way:

1) Day 1 is the first day of the menstrual period.

2) Clomiphene is taken on days 5-9 of the cycle.

3) Intercourse every 1-2 days from days 12-20 of the cycle.

4) If no menses occurs by about day 35 of the cycle, you either did not ovulate or are pregnant. You can check a urine pregnancy test or call for a blood test to evaluate.

Things to note:

1) Your doctor will want to examine you after the first cycle and at other times to rule out ovarian cyst formation.

2) Your doctor may follow you with ultrasound to document ovulation/pregnancy.

3) Ovulation kits can be used. Recommend start use around day 13-14 of cycle.

4) Other lab tests or infertility work-up may be performed prior to clomiphene or during subsequent cycles.

5) Your doctor may change the clomiphene dose to obtain optimal ovulation.

6) You may need progestin medication to induce a period prior to taking clomiphene.

7) About 70% of people will ovulate with this medication and 40-50% will become pregnant. If this doesn't work, referral to an infertility specialist may be the next step.

8) No increased risk of miscarriage or birth defects have been reported with this medication.