From the Guidelines
Clomiphene citrate is primarily used to treat infertility in women by inducing ovulation, with a standard dosage of 50 mg daily for 5 days, and is a recommended first-line treatment for unexplained infertility and anovulatory infertility, including polycystic ovary syndrome (PCOS) 1.
Mechanism of Action and Usage
Clomiphene citrate works by blocking estrogen receptors in the hypothalamus, which tricks the body into thinking estrogen levels are low, stimulating the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland, promoting follicular development and ovulation. The medication is typically started on day 3-5 of the menstrual cycle, with potential increases to 100 mg daily if needed, and treatment usually continues for up to 6 cycles, with monitoring for ovulation and potential pregnancy 1.
Side Effects and Risks
Side effects may include hot flashes, mood changes, breast tenderness, and visual disturbances, and in some cases, it can cause ovarian hyperstimulation syndrome or increase the risk of multiple pregnancies 1. Regular monitoring with ultrasound and hormone tests is recommended during treatment to ensure appropriate response and minimize risks.
Recommendations and Guidelines
The American College of Obstetricians and Gynecologists (ACOG) recommends treatment with clomiphene citrate for women with PCOS who wish to conceive, due to its effectiveness, with about 80 percent of women ovulating and one half of these patients conceiving 1. Clomiphene citrate is also a recommended alternative to low-dose gonadotrophins for low multiple birth rates and lower costs, although at a lower live birth rate 1.
Key Points
- Clomiphene citrate is a selective estrogen receptor modulator (SERM) used to treat infertility in women by inducing ovulation.
- Standard dosage is 50 mg daily for 5 days, with potential increases to 100 mg daily if needed.
- Treatment usually continues for up to 6 cycles, with monitoring for ovulation and potential pregnancy.
- Side effects may include hot flashes, mood changes, breast tenderness, and visual disturbances.
- Clomiphene citrate is a recommended first-line treatment for unexplained infertility and anovulatory infertility, including PCOS.
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, amenorrhea-galactorrhea syndrome, psychogenic amenorrhea, post-oral-contraceptive amenorrhea, and certain cases of secondary amenorrhea of undetermined etiology.
The use of Clomiphene (Clomid) citrate is for the treatment of ovulatory dysfunction in women desiring pregnancy, specifically for conditions such as:
- Polycystic ovary syndrome
- Amenorrhea-galactorrhea syndrome
- Psychogenic amenorrhea
- Post-oral-contraceptive amenorrhea
- Secondary amenorrhea of undetermined etiology 2
From the Research
Use of Clomiphene Citrate
- Clomiphene citrate is used as a first-line treatment for ovulation induction in anovulatory women with polycystic ovary syndrome (PCOS) 3, 4, 5.
- It is also used for infertility treatment due to oligo-ovulation or anovulation, often in combination with intrauterine insemination (IUI) 6.
- The drug works by stimulating ovulation, increasing the chances of pregnancy in women with anovulatory infertility 3, 6, 4, 5.
- Clomiphene citrate has been shown to be effective in inducing ovulation, with pregnancy rates similar to those expected in a normal fertile population 3.
Comparison with Other Treatments
- Clomiphene citrate has been compared to letrozole, another ovulation induction drug, with letrozole showing higher pregnancy rates and lower risk of ovarian hyperstimulation 6.
- Tamoxifen citrate has been shown to be a safe and effective alternative to clomiphene citrate for anovulatory infertility in women with PCOS 4, 5.
- Clomiphene citrate has also been compared to no treatment or placebo for unexplained subfertility, with no evidence of clinical benefit found 7.
Side Effects and Risks
- Clomiphene citrate is associated with an increased risk of multiple pregnancy and ovarian hyperstimulation 3, 6.
- There is also a concern that prolonged use of clomiphene citrate may be associated with an increased risk of ovarian cancer 3, 7.
- The drug can cause side effects such as increased body mass index, which can decrease the response to treatment 3.