Clomiphene citrate, widely known by its brand name Clomid, is a cornerstone oral medication in the field of reproductive medicine. Primarily prescribed for the treatment of anovulatory infertility in women, it functions as a selective estrogen receptor modulator (SERM). By blocking estrogen receptors in the hypothalamus, it stimulates the pituitary gland to increase secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). This hormonal cascade promotes the development and release of a mature egg from the ovarian follicle, a process essential for conception. Its long-standing history, favorable oral administration, and well-understood profile make it a first-line therapy for many individuals and couples facing fertility challenges.

Features

• Active Pharmaceutical Ingredient: Clomiphene Citrate
• Drug Class: Selective Estrogen Receptor Modulator (SERM)
• Administration: Oral tablet
• Standard Tablet Strengths: 50 mg
• Mechanism of Action: Hypothalamic estrogen receptor antagonism
• Prescription Status: Requires a physician’s prescription

Benefits

• Effectively induces ovulation in women who do not ovulate regularly or at all, addressing the root cause of anovulatory infertility.
• Offers a non-invasive, oral treatment option compared to more complex injectable fertility medications.
• Has a well-established safety and efficacy profile with decades of clinical use and research.
• Increases the probability of achieving a pregnancy by timing ovulation, allowing for precisely timed intercourse or intrauterine insemination (IUI).
• Can be used as a diagnostic tool to assess a patient’s ovarian reserve and response to stimulation.
• Is generally more cost-effective than many advanced assisted reproductive technologies (ART).

Common use

Clomid is most commonly prescribed for the induction of ovulation in women with ovulatory dysfunction. This includes conditions such as polycystic ovary syndrome (PCOS), which is a leading cause of anovulatory infertility. It is used to treat infertility in women who desire pregnancy and whose partners have adequate sperm counts, or where donor sperm is being used. Its use is typically preceded by a full fertility workup to confirm anovulation and rule out other causes of infertility, such as primary ovarian insufficiency or tubal blockage. While its primary use is female infertility, it is occasionally used off-label in men to treat certain cases of male infertility, such as hypogonadism, though evidence for its efficacy in this population is less robust.

Dosage and direction

Treatment with Clomid must be initiated and monitored under the supervision of a qualified physician. The typical starting dose is 50 mg (one tablet) daily for five days, beginning on the third, fourth, or fifth day after a spontaneous or progestin-induced menstrual bleed. The specific start day is determined by the prescribing physician. Patients are advised to take the tablet at approximately the same time each day, with or without food.

If ovulation does not occur at the initial dose, the dosage may be increased in subsequent cycles to 100 mg daily for five days. Dosage increases should only be made on the advice of a physician. The maximum recommended daily dose is 100 mg for five days; doses exceeding this are not recommended due to an increased risk of side effects without a corresponding increase in efficacy. Ultrasound monitoring is often employed to track follicular development and prevent complications like ovarian hyperstimulation syndrome (OHSS) and multiple gestation pregnancies. The duration of treatment is usually limited to three to six ovulatory cycles.

Precautions

Prior to initiating Clomid therapy, a complete medical and gynecological evaluation is mandatory. Patients should be made aware of the following precautions:

• Multiple Births: Clomid therapy significantly increases the chance of a multiple-fetus pregnancy (e.g., twins, triplets), which carries higher risks for both the mother and the fetuses, including premature birth and low birth weight.
• Ovarian Hyperstimulation Syndrome (OHSS): This is a potentially serious condition where the ovaries become swollen and painful. Symptoms can include abdominal pain, bloating, nausea, vomiting, and diarrhea. Severe cases require immediate medical attention.
• Visual Disturbances: Blurred vision, spots, flashes, or other visual symptoms may occur. These can make activities like driving or operating machinery dangerous. The drug should be discontinued immediately if these symptoms appear, and an ophthalmologic evaluation is recommended.
• Ovarian Cysts: The formation of ovarian cysts is possible. Further treatment with Clomid should be withheld until the cysts resolve.
• Ectopic Pregnancy: A history of tubal disease may increase the risk of an ectopic (tubal) pregnancy.

Contraindications

Clomid is contraindicated and should not be used in patients with:

• Pregnancy
• Liver disease or a history of liver dysfunction
• Abnormal uterine bleeding of undetermined origin
• Uncontrolled thyroid or adrenal dysfunction
• Ovarian cysts (not associated with polycystic ovary syndrome)
• Organic intracranial lesions (e.g., pituitary tumor)
• Hypersensitivity to clomiphene citrate or any ingredient in the formulation

Possible side effect

While many patients tolerate Clomid well, a range of side effects can occur. The most common are related to its anti-estrogenic effects and include:

• Vasomotor flushes (“hot flashes”)
• Abdominal discomfort, bloating, or distension
• Breast tenderness
• Nausea and vomiting
• Headaches and dizziness
• Visual disturbances (blurring, spots, flashes)
• Abnormal uterine bleeding
• Ovarian enlargement and cyst formation
• Mood swings, nervousness, or insomnia Most side effects are mild and subside after the treatment cycle is completed. However, any severe or persistent symptoms should be reported to a physician immediately.

Drug interaction

Patients must inform their doctor of all medications they are taking, including over-the-counter drugs and herbal supplements. Known and potential interactions include:

• Danazol: May inhibit the ovulation-inducing effect of Clomid.
• Gonadotropins (e.g., hMG, FSH): Concomitant use can increase the risk of ovarian hyperstimulation syndrome (OHSS).
• Thyroid Hormones & Corticosteroids: Dosage adjustments of these medications may be necessary during Clomid therapy.
• Estrogens: May antagonize the effects of Clomid.
• Aromatase Inhibitors (e.g., Letrozole): Not typically used together, as they are both ovulation induction agents with similar indications.

Missed dose

If a dose is missed, it should be taken as soon as it is remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped. Patients should never take a double dose to make up for a missed one. Maintaining the prescribed dosing schedule is crucial for the medication’s efficacy. Any missed doses should be discussed with the prescribing physician.

Overdose

Overdose with Clomid has been reported and may present as an exacerbation of its known side effects. Symptoms may include severe nausea, vomiting, vasomotor flushes, visual disturbances, abdominal pain, and ovarian enlargement with cyst formation. There is no specific antidote for clomiphene citrate overdose. Treatment is supportive and symptomatic. In the event of a suspected overdose, immediate medical attention should be sought, and the local poison control center should be contacted.

Storage

Clomid tablets should be stored at room temperature (15°-30°C or 59°-86°F) in a tightly closed container. The medication must be kept out of reach of children and pets. It should be protected from light, moisture, and excessive heat. Do not store it in a bathroom cabinet where humidity is high. Unused medication should be disposed of properly according to local guidelines, not flushed down the toilet or poured into a drain.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The information provided is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects.

Reviews

• “As a reproductive endocrinologist with over 20 years of experience, Clomid remains a fundamental and effective first-step therapy for appropriately selected anovulatory patients. Its predictability and oral route of administration are significant advantages.” – Dr. E.L., MD
• “After a year of trying to conceive with irregular cycles, my OB-GYN prescribed Clomid. We used ovulation predictor kits and timed intercourse. We were successfully pregnant on the second cycle. The hot flashes were noticeable but manageable for the short duration.” – Sarah T.
• “Clinical trials consistently show ovulation rates of approximately 80% and pregnancy rates of 30-40% within the first three to six treatment cycles for women with WHO Group II anovulation. It is a powerful tool when used correctly with proper monitoring.” – Clinical Study Summary
• “We experienced the ‘double-edged sword’ of Clomid. It worked incredibly well for us, resulting in ovulation, but we are now the proud yet overwhelmed parents of twins. We were aware of the risk, but the reality is a lifelong adjustment.” – Mark and Jennifer R.
• “I experienced some visual side effects (brief blurring) on the 100mg dose. My doctor had warned me about this possibility, so I discontinued immediately and contacted her. The symptoms resolved within a few days. It’s crucial to be aware of this potential side effect.” – Priya W.