Drugs & Medications

Clomid Tablet – Dosage, Precautions, Indications and Contraindications

Infertility affects a large percentage of the population these days. While couples cannot control the potential causes of infertility, they can choose the best infertility treatments that include fertility drugs for achieving the desired results. The age of the female in a couple has remained to be one of the most crucial factors in projecting chances of success with the treatment. Women undergoing infertility treatments are well aware of the need and role of administration of fertility drugs. These medicines work by causing a woman’s body to release the crucial hormones of the body. This helps in triggering or regulating ovulation. Fertility medications are still considered to be an effective source even when used with other ART methods such as In Vitro Fertilization or Intrauterine Insemination treatments. Fertility medicines have proved to be highly successful in women as compared to men as it is being told that increasing egg production in women is easier than increasing sperm count in men. There are certain specific fertility medications which are commonly prescribed by the infertility experts to be utilized in the ongoing infertility procedures. 

This article gives detailed information about: 

  • What is Clomid?
  • How does Clomid work?
  • How to use Clomid Tablet?
  • What is the dosage and administration of Clomid?
  • Indications for Clomid
  • Contraindications of Clomid
  • What are the precautions of Clomiphene Citrate?
  • What are the success rates of Clomid tablet?
  • What are Clomid interactions?
  • Frequently Asked Questions related to Clomid tablet

What is Clomid?

Clomid – Generic Name: Clomiphene

Clomid contains a medicine called Clomiphene citrate. Clomiphene citrate belongs to a group of medicines called ovulation stimulants. It works by stimulating the release of eggs from the ovary (ovulation). Clomid medicine is used for some types of infertility, in women who are not ovulating properly. Clomid medicine, which is also known as clomiphene, is a drug used as an infertility treatment for women who do not ovulate. This includes women who have a condition of Polycystic Ovary Syndrome (PCOS). As per a research study, this condition affects over 7 to 8 percent of women. PCOS seems to have an adverse effect on the reproductive system of women. It also leads to obesity in women. The Polycystic Ovarian Syndrome is considered a common cause of infertility in women.

This medicine is consumed by mouth once a day. Common side effects of Clomid medicine include hot flashes and pelvic pain. The most common cause of infertility in women is anovulation. For ovulation induction among different cases of PCOS patients, various drugs are being used by medical specialists. The first line oral treatment in this condition is non-steroidal Selective Estrogen Receptor Modulators (SERM). Clomiphene citrate was introduced for the first time in the year 1956. Clomid (clomiphene) is a non-steroidal medicine for infertility treatments. It encourages the pituitary gland to release hormones required to stimulate ovulation (the release of an egg from the ovary). Clomid medicine is used for ovulation in women with certain medical conditions (like Polycystic Ovary Syndrome), which helps in preventing the natural occurrence of ovulation in such patients. Clomiphene is valuable for the timely progression of Assisted Reproductive Techniques such as In Vitro Fertilization (IVF) procedures. It is used by some renowned infertility clinics in combination with Menotropin. Menotropin is also known as human menopausal gonadotropin or hMG. It is a recombinant Follicle Stimulating Hormone, which consists of Gonadotropin. It is specifically recommended in case of infertility treatments.

How does Clomid work?

Clomid is an oral medication. This medication is used for stimulating ovulation. It works by blocking the hormone estrogen receptors at the hypothalamus. Hypothalamus is considered to be an important hormonal control center for the body. When ovulation occurs, the hypothalamus is stimulated for releasing Follicle Stimulating Hormone (FSH), and Luteinizing Hormone (LH). Luteinizing hormone and follicle stimulating hormone are naturally occurring ovarian stimulants. This prompts ovulation in a normal menstruation cycle. Clomiphene citrate can prove to be helpful for women having any of the following problems:

  • Irregular OvulationIt is difficult to conceive when a woman’s cycles are so irregular that the time of ovulation is challenging to be specified. When effective, the use of Clomiphene citrate produces a predictable ovulatory response to allow for timely intercourse or Assisted Reproductive Techniques such as Intrauterine Insemination (IUI).
  • Unexplained InfertilityClomid tablet has also been shown to be advantageous in increasing pregnancy rates in young healthy couples in whose cases no exact cause or type of infertility are prominently diagnosed.
  • Male factor infertility problems: When there is an issue with the semen quality, sometimes the physician may recommend Intrauterine Insemination (IUI) to maximize the chances of conception in the respective couple. Clomiphene citrate in such cases can be used to help improve the timing of insemination with the woman’s cycle. Clomid may improve sperm motilityin some males. Motility refers to the speed with which sperm travels through the female reproductive system to allow fertilization to occur.

How to use Clomid Tablet?

Clomid tablet must be taken by mouth exactly as directed by the physician in order to be effective and safe at the same time. It is important for a woman to follow her dosage schedule carefully while consuming clomiphene citrate. Clomiphene citrate dosage is based on the medical condition of a woman and her response to the respective therapy. Intake of clomiphene citrate should not be consumed for a longer time than prescribed by the physician. Long-term treatment with this medication is usually not recommended and should not exceed more than 6 cycles. Patients are directed by their physician to record the basal body temperature, conduct ovulation tests, and time of sexual intercourse for achieving best results. 

Dosage and Administration of Clomid: 

The administration of Clomid tablet should begin with a low dose, 50 mg daily (1 tablet) for 5 days. The dose should be increased only in cases where patients who do not ovulate in response to cyclic 50 mg Clomid treatment. Sometimes, unusual sensitivity to pituitary gonadotropin is suspected in some of the patients. In such cases, a low dosage or duration of treatment course is particularly recommended. This is the scenario particularly in women diagnosed with Polycystic Ovary Syndrome (PCOS). The conventional administration of Clomid tablets for ovulation induction involves consuming Clomiphene citrate for 5 days. When ovulation does not take place within two weeks, a progestin pill (similar to Provera) is prescribed for 10 days to induce periods (which normally take place within 1 week of stopping the pill). Then a higher dose of clomiphene citrate is further prescribed.

Recommended Dosage of Clomid: 

Before the administration of Clomid tablet, the case of the patient should be evaluated carefully. This evaluation is done to eliminate ovarian cyst formation, and ovarian enlargement, between each treatment cycle. If progestin-induced bleeding is intended, and in cases where spontaneous uterine bleeding takes place prior to treatment, the regimen Clomid 50 mg daily course for 5 days is started on or about the 5th day of the respective IVF cycle. This therapy is usually started at any time in cases where no recent uterine bleeding was observed. When ovulation takes place at this dosage, there is no benefit of increasing the dose in subsequent cycles of treatment. In case, ovulation does not take place after the initial course of therapy, another course of 100 mg (two 50 mg tablets given as a single daily dose) is suggested by the doctor on daily basis for a time period of 5 days. This course is started as early as 30 days after the previous course. Appropriate precautionary measures are taken to eliminate the presence of pregnancy. Increasing the dosage or duration of therapy beyond 100 mg/day for 5 days is usually not recommended by the infertility specialists to keep the patients away from any kind of adverse effects of this medication. The majority of patients usually ovulate after the first course of therapy. If ovulation does not occur even after three courses of therapy, further treatment with Clomiphene is not recommended. In such cases, the patient is usually reevaluated to find out a better solution for the same. If three ovulatory responses occur and pregnancy is still not achieved, further Clomid therapy is not recommended. Long-term cyclic therapy of Clomid is most of the time not recommended beyond a total of about six cycles. Transvaginal ultrasound is performed between cycle days 11 to 14 to check for the presence of a dominant follicle. In the absence of dominant follicle, a blood test to check progesterone level is done. Increased dose of Clomid for 5 days is started from that day. A repeat transvaginal ultrasound in one week is done to determine if there is a dominant follicle. This process is repeated at increased doses of clomiphene citrate (100 mg and 150 mg) until the presence of a dominant follicle(s) is observed.

General Considerations of Clomid tablet: 

The workup and treatment of patients for Clomid treatment should be supervised under the guidance of experienced infertility specialists. Patients should be chosen for therapy with Clomiphene medicine only after careful diagnostic evaluation. The plan of treatment should be outlined prior to therapy. Barriers to achieving the goal of therapy must be eliminated or adequately treated before starting Clomid medicine. The therapeutic objective should be balanced with impending risks and discussed with all those who are in the achievement of a successful pregnancy.

Indications of Clomid Tablet:

The major indication for clomiphene (Clomid) is to induce ovulation in women with anovulation following the hypothalamic and pituitary dysfunction. Estrogen concentrations in these women are more than 50 pg/ml. This is mainly reported in women with oligomenorrhea, Polycystic Ovary Syndrome (PCOS), and secondary amenorrhea of various etiologies with low or normal concentrations of prolactin and Gonadotropin. Clomid medicine has also been proposed for the treatment of short luteal phase. When the luteal phase lasts for about 10 days or less, it is known as the luteal phase defect or short luteal phase. Women having a short luteal phase or luteal phase defect have a hard time conceiving or staying pregnant. It is also proposed for assessing and diagnosing the function of the hypothalamus-pituitary-ovarian axis. Clomid tablet is majorly indicated for the treatment of ovulatory failure in women who are trying to conceive. It is also proposed for women in whom ovulatory dysfunction is identified.

Other causes of infertility in women must be excluded or adequately treated before recommending clomiphene medicine. In general, clomiphene medicine is recommended to women with ovulatory dysfunction who fulfill the following conditions:

  • Women who have not conceived 
  • Women without vaginal bleeding. There are chances of presence of neoplastic lesions in women having abnormal vaginal bleeding. Thus, these patients should be carefully evaluated and monitored.
  • Women without ovarian cysts. Clomid is not usually recommended to patients with ovarian enlargement except those with Polycystic Ovary Syndrome (PCOS). Prior to recommending Clomid medicine, a pelvic exam must be performed.
  • Women with normal liver function.

Contraindications of Clomid Tablet: 

  • Pregnancy: Clomid Tablets are not indicated during pregnancy as it can lead to certain congenital abnormalities in the babies or growing fetus. It is not evident that Clomid medicine has any harmful effect on the fetus. To avoid inadvertent Clomid Tablets administration during early pregnancy, appropriate test examinations should be utilized during each treatment cycle to ascertain if ovulation takes place. The patient should undergo a pregnancy test before the next course of Clomiphene medicine therapy.
  • Liver disease: Clomid medicine (Clomiphene Citrate) therapy is contraindicated in female patients having liver disease or a history of liver dysfunction.
  • Abnormal uterine bleeding: Clomid is also contraindicated in women who have hormone-dependent tumors. Women having abnormal uterine bleeding of undetermined origin are not recommended clomiphene citrate.
  • Ovarian cysts: Clomid medicine is recommended to women who have a condition of ovarian cysts, except polycystic ovary condition. Prior to each course of Clomid treatment, women should be evaluated for the presence of one or more ovarian cysts.

Clomid is also contraindicated in cases where there is a history of scotomas and blurred vision during or after previous therapy. As per certain research studies, it is not yet known that clomiphene medicine is present in human milk especially that released from a new mother. It is being told that Clomid may reduce lactation. Other common risks or complications associated with Clomid medicine are as follows:

  • Abdominal discomfort and bloating
  • Hot flashes
  • Headache
  • Breast tenderness
  • Nausea and dizziness

Precautions for Clomid:

Before purchasing and consuming Clomid, the potential risks associated with Clomid should be noticed and observed against its need. The potential adverse effects linked with other infertility therapies should also not go unnoticed. Infertility treatments, in general, can lead to mood swings and fluctuation in emotions for the female patient advised to take the same. Patients taking Clomid medicine should be prepared for severe mood swings during the regular medication schedule.

They should also be able to invest a large amount of time to go to the infertility specialist’s clinic for monitoring and testing. 

  • General precautions:

It is very important for an infertility doctor to check for how the patient’s body is responding to the treatment and should also look for any unwanted effects.

  • Carcinogenicity, Mutagenicity, and Impairment of Infertility:

Carcinogenicity is a condition of being known or suspected of being able to cause cancer. Mutagenicity is a condition of being known or suspected of causing mutations in DNA, which can lead to cancer in certain cases. Effective measures and precautions should be taken in order to prevent the occurrence of these conditions which can also result in impairment of infertility.

  • Fetal Risk Summary:

Precautionary measures should be taken prior to the administration of Clomid medicine to check for the potential risks and complications for fetal malformations associated with the exposure to clomiphene citrate.

  • Clinical Concerns:

Clinical concerns associated with clomiphene citrate suggests that more than six cycles of Clomid therapy can prove to be harmful. Such a high number of therapy cycles poses certain long-term effects on fertility levels.

  • Nursing Mothers:

Breastfeeding women are sometimes recommended to continue to take Clomid (clomiphene citrate). Women must consult their infertility expert before consuming CC as various research studies have shown that Clomid is believed to decrease the supply of breast milk.

  • Ovarian Cancer:

Although fertility medications such as Clomid are often used as a first choice in treating infertility disorders, it should be ascertained beforehand if these drugs contribute to the overall risk of ovarian cancer.

Clomid for Women:

When women first begin their period, they should call the infertility experts so that their appointments are scheduled for further tests in the next 2-3 days. In the next appointment, the patient’s pelvic examination is conducted, and her timing of Clomid cycle is predicted. Usually, the patient will be recommended to take one to three tablets a day for five consecutive days early in the cycle (cycle days 3-7, or 4-8). During this time, some women will notice hot flashes, mood swings, or sleep pattern changes. Most patients notice no symptoms at all. Ovulation usually takes place 7-8 days following completion of clomiphene citrate. Because the ovaries are stimulated, women may notice some bloating, or discomfort during intercourse. For verifying ovulation several medical methods are used. The infertility doctor will recommend the most suitable procedure based on patient’s medical condition. These methods include LH kit testing, basal body temperature testing, blood tests, and ultrasound monitoring. Patients are instructed on their visit as when to expect ovulation in that particular cycle, the right time to time for intercourse, and if and when the patient needs to return for a follicle scan/ultrasound monitoring to confirm ovulation.

Clomid Success Rates:

Of women who are having an ovulatory disorder, over 60 to 70 percent among them will ovulate when given Clomid medicine. In such scenarios, pregnancy rates consistent with a patient’s age are expected to be achieved. Women aging less than 35 years can achieve conception rates of 20-25 percent per month as long as there no other significant factors of infertility are present. Older patients may not be able to achieve success rates as their declining egg quality will become a contributing factor for anovulation. It is being stressed that success rates are highly individual and depend on a certain number of factors. The best thing to do is have a detailed discussion with one’s infertility expert in order to obtain a better understanding of the chances of success with this or any other treatment plan. The Clomid tablet has recorded the fewest multiples born per pregnancy of 5.7 percent. This percentage is lesser in comparison to 14.3 percent which is recorded in the letrozole group. The percentage of having multiples in cases where Gonadotropin was used stood at 13.4.

There are alternate infertility treatments for those who are unable to conceive with clomiphene therapy. If 3-6 complete clomiphene cycles do not result in a successful pregnancy, other methods of ovulation induction can be recommended. For older women, Gonadotropin and Intrauterine Insemination (IUI) treatments are usually recommended. For younger women, who are at an elevated risk of multiple gestations with Gonadotropin and IUI, In Vitro Fertilization is considered to be the next best step that is recommended.

Clomid Interactions:

All medicines interact differently with other medicines and their effects vary from one person to another. Below are explained some possible interactions when Clomid tablet is consumed with other medicines, disease, food, or alcohol.

  • Interaction with Diseases: Interaction of clomiphene citrate is unknown to diseases. Women should consult their doctor before starting Clomid therapy and discuss the diseases for which currently they are taking medication. 
  • Interaction with Alcohol: Interaction of clomiphene citrate with alcohol is unknown. However, women must consult with their physician about the possible risks and complications of alcohol while taking Clomid medicine.
  • Interaction with Medicines: Although, there are no particular interactions with other medicines have been observed, it is always considered to be the best idea to contact and consult a doctor before starting the intake of Clomid. Clomid, when taken with other medications (inclusive of all herbal and prescribed or non-prescribed medicines), may pose certain serious side effects. Interactions of Clomid tablet with other medicines may alter how the medications work or escalate the risk of some serious side effects. Patients should not modify, start or stop any medicine dosage without concerned doctor’s consent.
  • Clomid with Intrauterine Insemination (IUI): Intake of Clomid in conjunction with IUI has over 8 to 10 percent success rates per cycle for unexplained infertility cases of around three years duration and an 8 percent chance of having multiples.

Frequently Asked Questions Related to Clomid:

  1. How common are multiple births with Clomid?
    Women who conceive following Clomid therapy (5 to 10 percent) are at an increased risk of having multiple births when compared to the female population not consuming the respective medication. Women who do not take fertility medicines have about 1.2 percent chances of having twins. 
  2. Does Clomid cause birth defects?
    Clomid has not yet been shown to cause the development of birth defects in women.  
  3. What days do you take Clomid for twins?
    Ovulation usually takes place 5 to 10 days after taking the last Clomid drug dosage. So if a woman took Clomid on days 3 to 7 of her cycles, she is most likely to ovulate between days 10 and 16 of the entire cycles. If women are taking Clomid on days 5 through 9, ovulation is most likely to take place between days 12 and 17 of their cycles.

In today’s scenario, fertility medications are among the most important aspects for couples undergoing infertility treatments. Clomid is prescribed majorly to women having a condition of Polycystic Ovary Syndrome causing irregular or absent ovulation. It is considered to be the most cost-effective treatment for female related infertility issues. It is less invasive as it as an oral medication. Another benefit of Clomid is that this infertility drug can be prescribed by an Obstetrician or Gynecologist and the patient does not have to necessarily visit a reproductive specialist. This article presents possible indications, precautions, and contraindications related to the usage of Clomid medicine.

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