Clomid is also known as clomiphene citrate. It’s an oral medication that is often used to treat certain types of female infertility.

Clomid works by making the body think that your estrogen levels are lower than they are, which causes the pituitary gland to increase secretion of follicle stimulating hormone, or FSH, and luteinizing hormone, or LH. Higher levels of FSH stimulate the ovary to produce an egg follicle, or multiple follicles, that will develop and be released during ovulation. High levels of LH stimulate ovulation.

Clomid is often prescribed by primary care physicians or OB-GYNs before they refer a couple to see a fertility specialist for more specialized care. Some reproductive specialists prescribe Clomid as well.

Taking Clomid

Clomid is a 50-milligram pill that is usually taken for five days in a row in the beginning of a woman’s menstrual cycle. Day three, four, or five is typical for a Clomid start date.

Doctors will usually prescribe one, two, three, or sometimes four pills to be taken at the same time each day, depending on how they think you will respond to the medicine. It’s common to start at the lowest dose and increase each month as needed.

Some doctors will want you to come back for blood work to measure hormone levels or a transvaginal ultrasound to look at your ovarian follicles. This information can help them determine when you should begin having intercourse or have an intrauterine insemination. It can also help them determine the appropriate dose for your next cycle.

Most doctors don’t recommend that you use Clomid for more than three to six cycles, due to the decreasing pregnancy rate that occurs with continued use. Your doctor may extend this if it takes a few cycles before they find the dose that works for you.

Who should take Clomid?

Clomid is often prescribed to women with polycystic ovary syndrome, or PCOS, which is a syndrome that can cause irregular or absent ovulation.

Not everyone will respond to this medication. Women with primary ovarian insufficiency, or early menopause, and women with absent ovulation due to low body weight or hypothalamic amenorrhea are most likely to not ovulate when taking Clomid. Women with these conditions may need more intensive infertility treatment.

Cost

Clomid is usually covered by your health insurance, when other fertility medications may not be. If you do not have insurance coverage for your medication, or are having difficulty paying for it, speak with your doctor about your options.

Benefits

For women who are appropriately treated with Clomid, there are many benefits:

  1. It’s a cost-effective treatment for infertility, especially when compared with other treatments like IVF.
  2. Clomid is an oral medication, which makes it less invasive than other treatments.
  3. It can be prescribed by your OB-GYN or primary care provider, instead of needing to go to a reproductive specialist.
  4. There are relatively few side effects and it’s generally well-tolerated by women who take it.

Risks

Side effects

While this medication is generally pretty safe, there are some side effects that you should be aware of. They include:

  • hot flashes
  • headaches
  • bloating
  • nausea
  • mood changes
  • breast tenderness
  • visual changes like blurring and double vision

Multiple pregnancies

There is a slightly higher risk of having a multiple pregnancy when taking Clomid. This rate is around 7 percent for twins, and below 0.5 percent for triplets or higher order multiples. You should speak with your doctor about this risk and whether you are able to carry twins or other multiples. They may suggest more aggressive monitoring if you are unwilling or unable to carry a twin pregnancy.

Adverse effects

Because of Clomid’s effect on your estrogen levels, it can cause your uterine lining to be thin (a thick lining can help with implantation). Clomid can also reduce the amount and quality of your cervical mucus.

When exposed to estrogen, cervical mucus is thin and watery, which helps the sperm cells travel up to the fallopian tubes. When taking Clomid, estrogen levels are lower, causing the cervical mucus to be thicker than usual. This can interfere with the ability of the sperm to get into the uterus and fallopian tubes.

If you are having an intrauterine insemination, this isn’t a problem because the insemination catheter bypasses the cervical mucus entirely.

Cancer

So far, there is no conclusive data that Clomid increases cancer risk in women. But there is some research suggesting a possible increase in endometrial cancer with the use of ovulation-inducing agents.

Birth defects

To date, the research has not shown a significant risk for miscarriage, birth defects, or other pregnancy complications. You should speak with your doctor about any specific concerns.

If it doesn’t work…

If you don't become pregnant after three to six cycles of Clomid (or however many your doctor recommends), it may be time to see a fertility specialist and move on to more aggressive treatment.

It doesn’t mean that you will never become pregnant. It may just mean that you need a different form of treatment or that something additional is going on. This can include an issue with your partner’s sperm or with your uterus or fallopian tubes. Your doctor will likely suggest additional testing to identify these issues so they can be corrected before future treatment cycles.

What is ovulation?

Ovulation is the process of releasing an unfertilized egg from the ovary each month, usually around the 14th day of a woman’s menstrual cycle. This process results from a complicated series of hormonal changes that occur in the beginning of her cycle.

This egg then travels down the fallopian tube where it may or may not be fertilized by a sperm cell. If the egg isn’t fertilized, it drops into the uterine cavity, where it is shed with the rest of the uterine lining as a woman’s period. If the egg is fertilized, it may implant in the uterine lining and cause a pregnancy.

Without regular ovulation, it can become difficult to get pregnant. This is because it’s difficult to figure out when to have intercourse so that egg and sperm will meet at the right time.