From the Guidelines
Clomiphene is the recommended first-line medication for ovulation induction in women with Polycystic Ovary Syndrome (PCOS) who are trying to conceive. According to the American College of Obstetricians and Gynecologists (ACOG) guidelines, as reported in the American Family Physician journal 1, clomiphene citrate is effective in inducing ovulation in about 80% of women with PCOS, with approximately half of these patients conceiving.
Key Points to Consider
- The ACOG recommends treatment with clomiphene citrate due to its effectiveness, based on good and consistent scientific evidence 1.
- The typical treatment regimen starts with a low dose, which can be adjusted as needed to minimize side effects and maximize effectiveness.
- Alternative treatments, such as gonadotropins, may be considered if clomiphene treatment fails, with low-dose gonadotropin therapy preferred to reduce the risk of ovarian hyperstimulation 1.
- Regular monitoring during treatment is crucial to assess response, adjust dosage as needed, and minimize potential risks.
Treatment Approach
The approach to treating PCOS with clomiphene involves:
- Starting with a low dose, typically 50mg daily for 5 days, beginning on day 3-5 of the menstrual cycle.
- Increasing the dose up to 150mg daily in subsequent cycles if ovulation does not occur.
- Limiting treatment to 3-6 cycles to balance effectiveness with potential risks.
- Monitoring for side effects, such as hot flashes, mood swings, and visual disturbances, although clomiphene is generally well-tolerated.
Evidence-Based Decision
The recommendation to use clomiphene as a first-line treatment for ovulation induction in women with PCOS is based on the most recent and highest quality evidence available, as reported in the 2003 ACOG guidelines 1. This guideline provides a comprehensive approach to the diagnosis and management of PCOS, emphasizing the importance of individualized treatment plans and regular monitoring to optimize outcomes.
From the FDA Drug Label
Clomiphene citrate is indicated for the treatment of ovulatory dysfunction in women desiring pregnancy. Impediments to achieving pregnancy must be excluded or adequately treated before beginning clomiphene citrate therapy Those patients most likely to achieve success with clomiphene therapy include patients with polycystic ovary syndrome Clomiphene citrate should not be used in patients with ovarian enlargement except those with polycystic ovary syndrome
Key Points:
- Clomid (Clomiphene) is used for the treatment of ovulatory dysfunction in women desiring pregnancy.
- Patients with Polycystic Ovary Syndrome (PCOS) are among those most likely to achieve success with Clomiphene therapy.
- Clomiphene citrate can be used in patients with ovarian enlargement due to PCOS.
From the Research
Clomid (Clomiphene) Use in Polycystic Ovary Syndrome (PCOS)
- Clomiphene citrate is accepted as a first-line method for ovulation induction in patients with PCOS associated with infertility owing to anovulation 3.
- Studies have compared the effectiveness of clomiphene citrate with other treatments, such as letrozole and low-dose FSH, for ovulation induction in PCOS patients 4, 5, 6.
- Clomiphene citrate has been shown to be effective in inducing ovulation in PCOS patients, but other treatments, such as letrozole, may have higher pregnancy and live birth rates 4, 6.
- A study found that combination treatment of clomiphene citrate with letrozole may potentially improve fertility outcomes in PCOS subfertility in terms of the likelihood of ovulation and higher post-ovulatory progesterone levels 6.
- Another study compared the effectiveness of clomiphene citrate, tamoxifen, and letrozole in ovulation induction in infertility due to isolated unovulation, and found that clomiphene citrate had a higher pregnancy rate, but also a higher miscarriage rate 7.
Comparison of Treatments
- Low-dose FSH has been shown to be more effective than clomiphene citrate in achieving pregnancy and live birth in PCOS patients 3, 5.
- Letrozole has been shown to be more effective than clomiphene citrate in achieving pregnancy and live birth in PCOS patients, and may have a lower miscarriage rate 4, 6, 7.
- Tamoxifen has been shown to have a lower pregnancy rate than clomiphene citrate, but also a lower miscarriage rate 7.