[FONT=Arial, Helvetica, ] CLOMID[/FONT]
- Clomid (clomiphene citrate) is one of the most common fertility medications used to regulate or induce ovulation. Clomid (50 mg tablets) is taken orally on days 3-7 or 5-9 of the menstrual cycle. If no follicular development occurs (with or without ovulation), dosages can be increased by 50 mg increments (up to 200-250 mg), Once follicular development and ovulation has occurred, there is no advantage to further dosage increases.
- To understand how Clomid works, it is necessary to have a basic understanding of the hormonal feedback mechanism operating in the ovulatory cycle. The hypothalamus is a small gland at the base of the brain which indirectly regulates the levels of follicle stimulating hormone (FSH), luteinizing hormone (LH) and others via the pituitary gland. It can be thought of as a thermostat that varies hormonal levels based primarily upon the levels of FSH and estrogen.
- Gonadotropin releasing hormone (GnRH) is produced by the hypothalamus and travels to the pituitary where it stimulates the production of FSH. FSH directly stimulates the recruitment and growth of the ovarian follicles, each of which contains an egg. If FSH levels remain high, as is the case with injectable FSH medications, numerous follicles will develop and mature.
- As healthy follicles develop, they produce estrogen which travels through the bloodstream to the hypothalamus. The hypothalamus monitors the level of estrogen and varies the production on GnRH accordingly. High estrogen levels signal that the follicles are mature, which causes the production GnRH to decrease thus lowering the levels of FSH.
- Clomid works by "competing" with the estrogen receptors at the hypothalamus. It occupies receptors that would normally "sense" estrogen making it seem that estrogen levels are low. This "competing" action causes the hypothalamus to produce more GnRH with stimulates the pituitary to increase production of FSH.
- Eighty percent of patients (who do not already ovulate) that are prescribed Clomid will ovulate and 40 % of those patients will conceive. Once ovulation occurs on Clomid, there is no value in increasing the dosage.
- In general, Clomid should only be used for a maximum of six cycles, and possibly their is no significant advantage of treating for more than 4 cycles. Numerous studies demonstrate that if pregnancy will occur on Clomid, seventy-five percent will occur within three to four cycles.
- There is no medical indication for taking Clomid for longer than 6 cycles. Clomid can have side effects and extended use is never recommended. Clomid, or any other fertility drug, should never be administered until the male has had a semen analysis.
- When Clomid is being prescribed without artificial insemination (IUI), and pregnancy has not resulted after three cycles, intrauterine insemination (IUI) may be added for the remaining three cycles to increase the chance of pregnancy.
- However, when seeing an Infertility Specialist, it is usually recommended that FSH (injectable fertility drugs)be used to directly stimulate the ovaries. If the patient fails to conceive on Clomid, with IUI after a maximum of three to four cycles, gonadotropin (FSH) cycles with IUI will often be attempted. If a patient fails to conceive on FSH and IUI, in vitro fertilization (IVF) is usually the next step. Each couples treatment protocol is different and based upon the specific cause(s) of their infertility.