Mr Anil Gudi, Mr Amit Shah &Prof Roy Homburg
Clomid (clomifene citrate) is an oral medication used to restore ovulation in women who are not ovulating or ovulating infrequently and who are suffering from infertility. It has also been used for stimulating the ovaries even in women who are ovulating but have not conceived. Clomid has now been on the market for 50 years and yet it remains the first line of treatment for women with infertility due to irregular or absent ovulation. This condition occurs most frequently in women with polycystic ovary syndrome (PCOS).
Clomifene is produced in 50 mg tablets and one tablet a day is the usual starting dose, taken from day 3 or 4 of the menstruation for 5 successive days. If 50 mg a day does not induce ovulation, then the dose is doubled in the next treatment cycle and if this does not bring about ovulation, then 150 mg a day should be attempted. A dose of greater than 150 mg is not warranted. Should ovulation be proved on any of these doses but pregnancy does not ensue then the same dose that produced the ovulation should be maintained in the next cycle. The response to treatment should be checked by ultrasound examination which can track the growth of a follicle and ovulation. Clomid has the advantage of being a simple, short treatment in tablet form which is also relatively cheap and which has almost no side effects.
In patients with PCOS, clomid will successfully induce ovulation in about 80%. About half of these will actually conceive. The main reasons for a failure to ovulate with clomid are excessive weight or very high levels of LH and testosterone. Those who ovulate with clomid but do not conceive may have a tubal problem or a male partner’s sperm defect which should be checked before starting treatment. Most commonly, those who ovulate with clomid but fail to conceive do not develop the lining of the womb (endometrium) sufficiently to accept the embryo. If this is seen on the ultrasound examination, there is little point continuing clomid treatment and the same can be said for those who either do not ovulate with 150 mg doses or those who ovulate in six cycles but have not conceived. Twin pregnancies may occur in about 8% of pregnancies conceived with clomifene.
Clomifene failure, either a failure to ovulate on 150 mg a day or a failure to conceive following 6 cycles of treatment without conceiving, demands progressing to a different treatment, usually low-dose injections of FSH.