From the Guidelines
Clomid (Clomifene) is an effective treatment for infertility due to anovulation, and the standard treatment regimen begins with 50mg of Clomid taken orally once daily for 5 days, typically starting on day 3,4, or 5 of the menstrual cycle. The most recent and highest quality study, 1, recommends the use of Clomiphene citrate or tamoxifen as acceptable alternatives to low-dose gonadotrophins for low multiple pregnancy and birth rates, and with lesser costs. Key points to consider when using Clomid for infertility due to anovulation include:
- Starting with a dose of 50mg daily for 5 days, with the option to increase by 50mg increments in subsequent cycles up to a maximum of 150mg daily
- Limiting treatment to 3-6 cycles due to declining pregnancy rates with longer use and potential increased risk of ovarian cancer
- Monitoring follicular development and timing of ovulation with ultrasound
- Timing intercourse every 1-2 days during the fertile window
- Being aware of potential side effects, including hot flashes, mood swings, breast tenderness, headaches, visual disturbances, and multiple pregnancy risk (5-8%)
- Considering further evaluation or alternative treatments if pregnancy does not occur after 3-6 cycles, as suggested by 1. It's also important to note that, according to 1, about 80 percent of women with PCOS ovulate and one half of these patients conceive when treated with Clomiphene citrate. Overall, Clomid is a viable option for treating infertility due to anovulation, and its effectiveness and safety profile make it a recommended choice, as supported by the evidence from 1 and 1.
From the FDA Drug Label
Clomiphene citrate is indicated for the treatment of ovulatory dysfunction in women desiring pregnancy. Properly timed coitus in relationship to ovulation is important A basal body temperature graph or other appropriate tests may help the patient and her physician determine if ovulation occurred. Once ovulation has been established, each course of clomiphene citrate should be started on or about the 5th day of the cycle.
The treatment for infertility due to anovulation using Clomid (Clomifene) is clomiphene citrate therapy.
- Key points to consider when using clomiphene citrate include:
- Properly timed coitus in relationship to ovulation
- Basal body temperature graph or other tests to determine ovulation
- Starting each course on or about the 5th day of the cycle
- Important considerations:
- Patients should have adequate levels of endogenous estrogen
- Clomiphene citrate therapy cannot be expected to substitute for specific treatment of other causes of ovulatory failure
- Long-term cyclic therapy is not recommended beyond a total of about six cycles (including three ovulatory cycles) 2
From the Research
Treatment for Infertility due to Anovulation using Clomid (Clomifene)
- Clomifene, also known as Clomid, is a medication used to treat infertility in women with anovulation 3, 4, 5.
- The standard therapy for women with unexplained infertility is gonadotropin or clomiphene citrate, with clomiphene being a common first-line treatment 3.
- Clomiphene citrate has been traditionally used as the drug of choice in treating women with anovulatory infertility, but letrozole has emerged as an alternative ovulation induction agent 4, 5.
- Letrozole has been shown to have a definitive role in anovulatory women who have not responded to clomiphene therapy, but its role as an alternative to clomiphene as first-line therapy continues to be debated 5.
Comparison with Letrozole
- Letrozole has been compared to clomiphene citrate in several studies, with some showing similar or superior pregnancy rates with letrozole 4, 6.
- Letrozole has been shown to have fewer side effects and a shorter half-life than clomiphene citrate, with no demonstrable effect on the receptivity of the endometrium 4.
- Letrozole may be an effective ovulation option for patients with polycystic ovary syndrome who are resistant to clomiphene, with similar ovulation and pregnancy rates to gonadotropin but reduced risk of ovarian hyperstimulation syndrome 6.
Use in IVF Treatments
- Clomiphene citrate and letrozole have been used in combination with gonadotropins in IVF treatments to reduce the amount of gonadotropins used and prevent ovarian hyperstimulation syndrome 7.
- Letrozole use with gonadotropins in IVF cycles may increase endometrial receptivity by increasing integrin expression in the endometrium and lowering estrogen concentrations to more physiologic levels 7.