What is the use of Clomiphene (Clomid)?

From the Guidelines

Clomiphene citrate is an acceptable alternative to low-dose gonadotrophins for infertility treatment, with lower multiple birth rates and costs, although at a lower live birth rate, as supported by the most recent and highest quality study 1. The use of Clomiphene, also known as Clomid, is a common practice in treating infertility in women who do not ovulate regularly.

Key Points

• Clomiphene citrate works by stimulating the release of hormones needed for ovulation, and the typical dosage is 50-100 mg daily for 5 days, usually starting on day 3, 4, or 5 of the menstrual cycle.
• Treatment with Clomiphene generally should not exceed six cycles, and common side effects include hot flashes, mood swings, breast tenderness, and abdominal discomfort.
• According to the study by Cohlen et al. 1, Clomiphene citrate or tamoxifen are acceptable alternatives to low-dose gonadotrophins for low multiple pregnancy and birth rates and with lesser costs.
• The study also found that when gonadotrophins are used in IUI, regimens with 75 IU or lower should be used because higher doses have similar pregnancy rates but increase multiple pregnancy rates.

Recommendations

• Clomiphene citrate should be considered as a first-line treatment for infertility in women who do not ovulate regularly, due to its lower multiple birth rates and costs, although at a lower live birth rate, as supported by the study by Reindollar et al. 2.
• Patients should be monitored during treatment with ultrasounds and hormone level tests to ensure proper response and minimize risks.
• The dosage of Clomiphene should be individualized, and the treatment should be carefully monitored to prevent multiple pregnancies and ovarian hyperstimulation syndrome.

Important Considerations

• The use of Clomiphene citrate should be carefully considered in patients with a history of ovarian hyperstimulation syndrome or multiple pregnancies.
• The treatment should be discontinued if the patient experiences any severe side effects, such as visual disturbances or abdominal pain.
• The patient should be informed about the potential risks and benefits of Clomiphene citrate treatment and the importance of careful monitoring during treatment.

From the Research

Uses of Clomiphene (Clomid)

• Clomiphene can be used to treat anovulation due to hypothalamus or pituitary gland dysfunction, and it normalizes the luteal phase in stimulated patients 3
• It can be used to estimate ovarian follicle reserve, and may be predictive of ovulation in women aged ≥35 years or with failed IVF 3
• Clomiphene is effective in patients with polycystic ovary syndrome (PCOS) 3, 4, 5
• It is used for ovulation induction in women with anovulatory infertility, including those with PCOS 3, 6, 4, 5
• Clomiphene can be used in combination with other medications, such as human menopausal gonadotropin (HMG) or recombinant FSH, for stimulation in assisted reproduction 3, 6

Comparison with Other Medications

• Clomiphene has been compared to letrozole, an aromatase inhibitor, in intrauterine insemination (IUI) cycles, with letrozole showing higher pregnancy rates and lower rates of ovarian hyperstimulation 6
• Tamoxifen has been shown to be a good alternative to clomiphene in women with PCOS and clomiphene-resistant cases 4
• Letrozole may be a better choice for ovulation induction in women with PCOS, as it does not deplete estrogen receptors and has fewer antiestrogenic effects 5

Side Effects and Contraindications

• Clomiphene may impair fertility through its effects on cervical mucus and endometrial dysfunctions 3
• Contraindications include risk of congenital anomalies, chronic liver disease, and visual disorders 3
• Side effects include multiple pregnancies, an increase in the rate of multiple births, ovarian hyperstimulation, and unsubstantiated claims of ovarian cancer 3