Ranked among the top gynecology programs by U.S. News & World Report
Published: Sept. 26, 2008
Updated: Sept. 8, 2010
Clomiphine citrate (Clomid) is a compound that is very similar in structure to estrogen. Because of this likeness, Clomid is able to bind to estrogen receptors in the hypothalamus.
This prevents the brain from seeing the negative signal from estrogen that is being released by the ovaries. As a result, the hypothalamus continues to stimulate the pituitary gland to make follicle stimulating hormone (FSH) and luteinizing hormone (LH). These hormones stimulate follicular growth in the ovary.
Clomid is administered orally in 50 mg increments (50, 100, 150) over five days. There are two common regimens for administration.
Using the first day of menses as cycle day one, Clomid is taken on days three to seven or days five to nine.
If follicular monitoring is used, an ultrasound is usually done on day 10 (if taken on days three to seven) or day 12 (if five to nine). The actual release of the follicle using human chorionic gonadotropin (HCG) is timed when the follicles reach optimal size.
Fifty mg is the usual starting dose. With a poor response, the dose is increased in steps. Polycystic ovarian disease and obesity may decrease the response to Clomid, but this is unpredictable and a starting dose of 50 mg is still recommended.
Of the pregnancies that occur using Clomid, 85 percent will occur in three months, and 99 percent will occur within five months. Treatment beyond five months is generally not seen as useful.
There are various adjuncts that can be used with clomiphine citrate. Among these are glucocorticoids, naltrexone, avandia, and metformin. These therapies are often not utilized to their full potential due to the wide availability and effectiveness of gonadotropins.
Clomid can be used with or without monitoring of follicular growth. There are some physicians who have a bias about monitoring follicular growth with ultrasounds while others argue regular intercourse around the time of projected ovulation is adequate.
Some individuals are given a prescription for Clomid to enhance ovulation over three to four months with a follow-up visit if they are not pregnant.
Some form of monitoring, LH predictor kits, day 21 progesterone (more accurate if drawn seven days post-ovulation), or ultrasound monitoring, may be useful to demonstrate a response to the medication.
Since Clomid is a drug used for controlled ovarian hyperstimulation (COH), it may be combined with intercourse, cup inseminations, or intrauterine insemination.
Side effects are infrequent but can be serious. See medication risks for more details.
The average cost for clomiphine citrate is $10 per pill or $50 per month. Contact your pharmacy for more accurate pricing.
Learn more about fertility medications below.