Clomiphene Citrate (clomiphene), also known by brand names Clomid ® and Serophene ®, is used to treat infertile women who have an ovulation problem and works by helping the pituitary gland (located at the base of the brain) improve the stimulation of developing follicles (eggs) in the ovaries. Clomiphene is most often prescribed to those patients who have been found to have an abnormality with their cycle and may be used with timed intercourse or intrauterine insemination. It can also be effective in treating unexplained infertility when combined with intrauterine insemination.
Clomiphene is typically prescribed for five days each cycle, usually beginning on day 3 or 5. Of all women treated with clomiphene, 60% to 80% will ovulate normally, although pregnancy rates from clomiphene treatment is typically 10-15% per cycle. Approximately 10% of women treated with clomiphene may experience mild side effects including hot flashes, blurred vision, nausea, bloating sensation, and headaches. Serious side effects are rarely seen with clomiphene therapy.
The frequency of twins occurring in women who conceive while taking clomiphene has been reported to be as high as 10%. The American Society for Reproductive Medicine (ASRM) recommends no more than 6 clomiphene cycles be used before pursuing other treatment options, as the effectiveness of treatment decreases significantly after that point.
Follicle Stimulating Injectable Hormones
A number of studies have confirmed a significantly improved pregnancy rate with injectable medications that stimulate "superovulation." This improvement in pregnancy rate is due primarily to the increased number of eggs produced. These drugs work by stimulating the ovaries to develop multiple mature eggs These injectable medications, known by brand names Follistim® and Gonal-F®, are self administered beginning on the second or third cycle day and given for six to nine consecutive days. Response to these drugs is monitored by frequent vaginal ultrasounds and blood estrogen determinations. At a time in the cycle when the ovarian follicles reach a designated size, and estrogen levels are appropriate, an injection of the hormone HCG is given to trigger ovulation. Ovulation usually occurs 36-48 hours after the HCG injection. Thus, intercourse, insemination or egg retrieval for an IVF cycle should be timed accordingly.
Many women experience side effects such as headaches, bloating, and moodiness, while some may also experience hot flashes, nausea, and blurred vision. Another possible side effect of injectable fertility medications is ovarian hyperstimulation syndrome (OHSS), a condition in which the ovaries are tender and enlarged. In severe cases, a woman may have swelling from retaining excessive amounts of body fluid in the tissues. Fortunately, severe hyperstimulation is rare, occurring in less than one percent of treatment cycles. Any woman who suspects OHSS should contact her doctor. The physician may choose to drain fluid from the abdomen, which can easily be done in an outpatient setting. In extremely rare cases, OHSS may require a hospitalization.
Pregnancy rates with injectable medication vary depending on the treatment protocol and range from 15-20% with insemination or timed intercourse. Higher pregnancy rates can be achieved during in vitro fertilization, greater than 50% in young patients. See also IVF
Usage of injectable medications has not been shown to increase the risk of ovarian cancer.
Medical and Hormonal Remedies for Men
Medical therapy can be an effective treatment for certain male factor infertility conditions. They are used as a first line treatment option for infections, hormonal abnormalities and erectile dysfunction.