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Infertility and PCOS: Clomid

Author: Angie Boss
Published on: January 17, 2000

What is it?

The first line of defense for women with PCOS and infertility is clomiphene citrate, also known by its brand names, Clomid and Serophene.

What does it do?

Clomiphene is used to induce ovulation, to correct irregular ovulation, to help increase egg production and to correct luteal phase deficiency. It is one of the selective estrogen receptor modulators that acts as an anti-estrogen and tricks the pituitary into producing more FSH and LH, which stimulates the ovary into producing more eggs and follicles.

How do I take it?

Clomiphene citrate comes in 50 mg tablets, which are taken on days 5-9 of your cycle, or less typically, on days 3-7. Doses range from 50 mg to 200 mg. A few doctors will prescribe 250 mg, but it is rare and goes against manufacturer's suggestions.

Side effects?

Hormone hell is probably the best way to describe it. Actually, some women have very few emotional side effects, but many do. It feels like severe PMS. Personally, I had a tough time at 50 mg when I started, was fine at 100 mg, but had a tough few days (6-9) on 150 mg. Mood swings, hot flashes, breast tenderness, and thinning of the uterine lining may occur. Multiple gestation pregnancies may occur (about an 8-10% occurrence in those who get pregnant).

Can I afford it?

It is one of the more affordable fertility drugs, and it has a generic available. A five day supply of 50 mg can run from $15 to $35. It gets obviously more expensive when you triple the dosage.

How long can I take it?

Generally, research shows that if it doesn't work in 4 -6 cycles, it isn't going to work. However, if you take a break and start over, perhaps adding the HCG, then you start the 4-6 cycles over again.

What are the risks?

As with most ovulation-inducing drugs, there is a risk of overstimulation. This drug should not be taken if you are pregnant or have a history of liver disease. Several years ago, there was research reported that clomid increased a woman's chance of getting cervical cancer. The data has since been found to be flawed, and many physicians discredit its conclusions. If you have concerns, talk to your physician about them.

How will I be monitored?

Many physicians will not do an ultrasound on a clomid cycle unless an HCG is added. However, on or around cycle day 21, a progesterone check (blood draw) is often done. Ideally, clomiphene would trigger higher progesterone production, which can improve the quality of the uterine lining and/or lengthen the luteal phase of the cycle. An ovulation predictor kit can be used to test for an LH surge. Each kit is different and you may need to test on a different day when on this drug--do read the instructions carefully. It can create hostile cervical mucus or dry up the mucus, in which case a postcoital test may be done. This would not be necessary if an IUI were being done.


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