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Clomiphene Citrate (Clomid)

Clomiphene citrate, sold under the brand names Clomid and Serophene, is an anti-estrogen drug used to induce ovulation, correct irregular ovulation and luteal phase deficiency, and to increase egg production. It was one of the first fertility treatments available, and since its introduction in 1968 has been the first choice for ovulation induction with most women because of its relative safety, effectiveness, and low cost.

Clomid works by tricking the brain into thinking there is an estrogen deficiency in the bloodstream, which causes the pituitary gland to begin producing an increased amount of FSH (follicle stimulating hormone) in an effort to stimulate the ovaries back into working order. As estrogen levels rise, the pituitary gland then rapidly releases LH, or luteinizing hormone, which causes ovulation to occur - usually about five to eight days after the last Clomid pill is taken. On average, a woman's body produces two or three times as much estrogen in a single cycle on Clomid as normal.

Clomid has a 60 to 80 percent success rate for inducing ovulation and approximately 30 percent of women on Clomid will become pregnant. However, there is only a 20 to 25 percent chance of conception in each cycle during the first three to four treatment cycles, so patients should stay on Clomid for at least four to six cycles to determine its efficacy.

Your doctor will probably monitor you for signs of ovulation when you are taking Clomid using either ultrasound or a blood test. An ultrasound will allow your doctor to visually confirm that an ovarian follicle has ruptured and pinpoint when ovulation occurred. A blood test is used to detect the hormone progesterone during the luteal (post-ovulation) phase of your cycle, which would also confirm ovulation had occurred.

There are potential side effects associated with Clomid, and approximately 10 to 20 percent of patients will experience one or more, although they are generally mild and subside as soon as the medication is stopped. Symptoms include mood swings, hot flashes, blurred vision, nausea, bloating, poor development of the endometrium, ovulation pain, breast tenderness, and headache. About half of patients experience decreased or hostile cervical mucus production which can impede sperm from traveling through the cervix and uterus. There is also a slightly higher incidence of twins, accounting for 10 percent of births, but triplets occur in only 1 in 400 births.

As with most ovulation-inducing drugs, there is a risk of ovarian hyperstimulation, which causes the ovaries to become enlarged and cysts to erupt. Approximately 5 percent of women using Clomid develop ovarian cysts, which usually resolve within a few weeks without treatment; however, on an extremely rare occasion, the cysts may twist or cause internal bleeding, requiring surgery and removal of the affected ovary. There is no clinically significant increased risk of miscarriage or congenital birth defects associated with Clomid; however, women with PCOS may be at higher risk for miscarriage when using Clomid. PCOS and obesity may also decrease the response to Clomid.

The average cost for Clomid is $10 per pill or approximately $50 per month, depending on your dosage. It is generally prescribed in 50 mg tablets that are taken orally once a day for five days - usually days 5 through 9 of your cycle. If the lower dose does not induce ovulation, the dosage can be increased up to 200 mg daily; however, doses greater than 150 mg/day for five days are contrary to manufacturer recommendations and side effects tend to be more severe at higher doses. Most experts agree that continuing Clomid for more than six ovulatory cycles is not likely to increase the chances of success.

Women with preexisting liver disease should not take Clomid as it is processed through the liver. In addition, women with enlarged ovaries should not take Clomid because of the risk of ovarian hyperstimulation.

A study conducted several years ago suggested that Clomid may increase a woman's chance of getting cervical cancer; however, the data associated with that study have since been found to be flawed, and many physicians discredit the researchers' conclusions. In addition, some women have reported they were unable to purchase private health insurance after taking Clomid. We were unable to confirm or discredit this claim, so you should check with your insurance company to determine their policy on past or present Clomid usage.



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