Clomid, Clomiphene Citrate
Clomid was one of the first fertility drugs developed and it enjoys wide usage by OB/GYNs and infertility specialists (reproductive endocrinologists). As discussed in the fertility drug introduction section, the hypothalamus regulates the production of various hormones including FSH and LH. Clomid is known as an ovulation induction agent and it is used in women who do not ovulate (anovulatory), or ovulate irregularly.
FSH products cause follicular development by directly stimulating the ovaries. Clomid works at the level of the hypothalamus and "competes" for estrogen binding sites.
As follicles develop, they increase production of estrogen, which travels to the hypothalamus and signals a corresponding reduction in FSH production. Clomid binds to estrogen sites making it "appear" that estrogen levels are low, or not increasing, thus FSH production by the pituitary continues.
Unlike FSH, increasing the dose of Clomid does not correspondingly increase follicular development. Once ovulation is occurring regularly on Clomid, there is no advantage to further increasing the dosage.
Numerous scientific studies demonstrate that Clomid pregnancies usually occur during the first three months of administration. There is generally no advantage to using Clomid for longer than 3-6 ovulatory cycles, or increasing the dose, in women who are ovulating regularly. All women receiving Clomid need careful monitoring with ultrasound.
Unfortunately, many women are maintained on Clomid for prolonged periods without understanding the other infertility issues that may be involved. Clomid therapy is often continued, by non-specialists, without a plan to optimize future fertility treatments. If mild male factor is present, treatment with Clomid should be combined with intrauterine insemination (IUI), however, treatment should not continue indefinitely. Severe male factor infertility is usually best treated using IVF with intracytoplasmic sperm injection (ICSI).
Clomid is not without side effects, which can include persistent ovarian cysts, poor cervical mucus, ovarian enlargement, adverse effects on the endometrium (lining of the uterus), and psychological effects including depression and anxiety.
Reproductive endocrinologists conduct a complete workup and if Clomid is indicated it is usually, administered for 3-6 months. If other fertility issues are discovered in the female or male, they will be resolved prior to Clomid therapy.