Can a woman who is already ovulating start on Clomid (clomiphene citrate)?

Clomiphene Citrate Use in Women Who Are Already Ovulating

Clomiphene citrate should not be used in women who are already ovulating, as it is specifically indicated only for patients with demonstrated ovulatory dysfunction who desire pregnancy. 1

Indications for Clomiphene Citrate

• Clomiphene citrate is indicated exclusively for the treatment of ovulatory dysfunction in women desiring pregnancy 1
• Patients most likely to benefit include those with:
  • Polycystic ovary syndrome
  • Amenorrhea-galactorrhea syndrome
  • Psychogenic amenorrhea
  • Post-oral-contraceptive amenorrhea
  • Certain cases of secondary amenorrhea of undetermined etiology 1

Contraindications and Patient Selection

• Clomiphene should not be used in women with normal ovulatory function 1
• Patients must meet specific criteria before starting clomiphene:
  • Not pregnant
  • No ovarian cysts (except in polycystic ovary syndrome)
  • No abnormal vaginal bleeding
  • Normal liver function 1
• Adequate endogenous estrogen levels are required for successful treatment 1

Risks of Using Clomiphene in Ovulating Women

• Multiple follicular development can occur, increasing the risk of:
  • Multiple pregnancy, including higher-order multiples 2
  • Ovarian hyperstimulation syndrome 1, 3
• Long-term cyclic therapy beyond approximately six cycles (including three ovulatory cycles) is not recommended 1
• Prolonged use may be associated with increased risk of borderline or invasive ovarian tumors 3

Alternative Approaches for Fertility Enhancement

• For women who are already ovulating but experiencing fertility issues, consider:
  • Evaluation for other impediments to pregnancy such as:
    • Thyroid disorders
    • Adrenal disorders
    • Hyperprolactinemia
    • Male factor infertility 1
  • Aromatase inhibitors may be an alternative treatment option for superovulation in patients with unexplained infertility or endometriosis 4

Common Pitfalls and Caveats

• Using clomiphene without confirming ovulatory dysfunction can lead to unnecessary exposure to medication risks 1
• Ultrasound monitoring is important to minimize risks of hyperstimulation and multiple pregnancy when clomiphene is used 3
• Weight reduction should be an important part of therapy in anovulatory women with increased body mass index, as this is consistently associated with decreased response to clomiphene 3
• Clomiphene can have antiestrogenic effects on cervical mucus and the endometrium, which may create a discrepancy between ovulation and conception rates 4

In conclusion, clomiphene citrate should be reserved for women with confirmed ovulatory dysfunction who desire pregnancy. Using it in women who are already ovulating provides no benefit while exposing them to unnecessary risks of multiple pregnancy and ovarian hyperstimulation.