Clomid should be used exclusively for ovulation induction or to regulate the menstrual periods. It is one of the first medications employed as an ovulation-inducing agent and enjoys widespread use by obstetrician/gynecologists and reproductive endocrinologist/infertility specialists. Clomid exerts it actions at the hypothalamus, which is a small gland at the base of the brain. The hypothalamus can be thought of as the “reproductive hormone production” regulator. It monitors the levels of various hormones including estrogen, FSH, and LH and adjusts production accordingly. For example, as levels of estrogen increase the hypothalamus signals a corresponding reduction in FSH production. This relationship is known as the “hypothalamic pituitary adrenal axis”.
Clomid works by “blocking” estrogen receptors at the hypothalamus thus causing increased production of GnRH, which stimulates continued FSH production by the pituitary. Increased FSH stimulates follicular recruitment and development.
Clomid is often overused. Many well controlled studies have demonstrated that pregnancy is most likely to occur during the first 3-6 ovulatory cycles of Clomid and therapy beyond that time is not recommended. Yet, we still see women who have been on Clomid for much longer times, sometimes without a semen analysis. No therapy of the female should be initiated until a semen analysis has been performed.
Clomid is used primarily in women who ovulate irregularly or not at all and in some cases of unexplained infertility. For women aged 35 and older, it is advisable to undergo a complete fertility evaluation prior to beginning Clomid therapy. Sometimes fertility declines very rapidly in this age group.
Rarely, women using Clomid will have ” thin” cervical mucus or a poorly developed endometrial lining during stimulation. This can be easily overcome with the use of injectable medication (such as Gonal-F, Follistim, Repronex, Bravelle, Menopur) in combination with clomiphene citrate. The combination of clomiphene citrate and injectable medication will quadruple the pregnancy rates while minimizing the monitoring with pelvic ultrasound and blood levels of estradiol.
Most women experience no side effects with Clomid therapy. See the Clomid manufacturers Web site for a complete listing of potential side effects. Compared to FSH IUI cycles clomid offers the lowest chances of pregnancy.