What is Clomid (Clomifene)?
Clomiphene (brand names: Clomid or Serophene) is an oral (by mouth) fertility medication to induce ovulation in women who have anovulation (not ovulating) and help them get pregnant. Many women take clomiphene citrate (Clomid or Serophene) and don't know what it does and how to take it.
The most important thing to know about clomiphene citrate (Clomid) is that it is a medication to induce ovulation. Ovulation, the BIG O. Not necessarily pregnancy. Ovulation.
When does ovulation happen after Clomid
Use this interactive Clomid Ovulation CALCULATOR and find out exactly when you ovulate on Clomid
How does Clomid work?
Clomid works on your bodies FSH - the follicle stimulating hormones - that cause your body to grow follicles and ultimately release an egg that will hopefully be fertilized.
Clomid works well for many women but it does come with side effects like headaches, mood swings, hot flashes, weight gain etc.
Clomid or Seophene is a synthetic chemical whose chemical name is Clomiphene citrate. It induces ovulation by fooling your body into believing that there is less estrogen. This leads to an increased production of a hormone called GnRH, causing the pituitary to pump out more of another hormone called FSH and LH, thus inducing ovulation.
Ovulation is the release of the egg from the ovary. The release of the egg is necessary for your regular menstrual cycle and pregnancy to begin. Ovulation is preceded by a long chain of events involving several hormones beginning in your prior menstrual cycle.
To find out how Clomid works you need to know the interaction of these 4 hormones:
- GnRH (Gonotropin releasing hormone )
- FSH (follicle stimulating hormone)
- LH (Luteinizing hormone)
Towards the end of a normal regular cycle, two hormones, estrogen and progesterone, slowly decrease. This eventually triggers in the first days of the next menstrual cycle a hormone called GnRH which is produced in a portion of the brain called the hypothalamus. GnRH stimulates another portion of the brain, the pituitary gland to produce two hormones, FSH, and LH:
LH and FSH are also called ‘gonadotropins’ and they are directly responsible for ovulation:
FSH is responsible for the growth of the follicles and eggs, and it increases the size and number of the follicles and helps to trigger ovulation.
LH actually triggers ovulation when it suddenly increases 1-2 days before ovulation.
If GnRH, LH, or FSH are not produced in the right amount and at the right time, your ovary will not release an egg.
Estradiol is a hormone that’s being produced by the ovaries and the corpus luteum, which is the area in the ovary left over after ovulation. It is responsible for many functions in your body including the development of the egg in the ovary and the uterine lining.
In some medical conditions such as polycystic ovary syndrome there is too much estrogen. Too much estogen may interfere with the body’s production of the correct amount of GnRH and LH and FSH, and is responsible for anovulation.
Although there is much information we still don’t quite know about how Clomid works, we do know that Clomid fools your body into believing that there is less estrogen. If your body believes there is less estrogen, it will produce more GnRH, causing the pituitary to pump out more of FSH and LH eventually triggering the release of an egg from the ovary.
Clomiphene citrate has been approved by the FDA in the US since 1967 for clinical use to induce ovulation, and it is being sold under the brand names of Clomid®, Serophene® Milophene®
Clomid is very powerful, and induces ovulation in over 50% of all women who take it.
Clomid is usually given as a pill once a day for 5 days. The typical starting dosage of Clomid is 50 mg/day for 5 days, and it can be increased monthly by 50 mg a day. The first pill of Clomid is usually started 2 to 5 days after the first day of you menstrual bleeding (cycle day 2-5) and ovulation usually happens 5-9 days after the last dose of Clomid.
If you don’t bleed, and after pregnancy is excluded, bleeding can be started with medication such as Progesterone.
How successful is Clomid in PCOS polycystic ovary syndrome?
Your chances of getting pregnant with Clomid are very good as long as you take it for the right reasons and have some tests done before to excluide certain problems. The majority of women iwith polycystic ovarian syndrome and with adequate ovarian reserve, good sperm count, good body weight and open fallopan tubes will be able to have a baby with Clomid treatment.
Clomid PCOS and ovulation success rates
About three fourths of women with PCOS that are not ovulating will ovulate on Clomid at some dosing level. Women under 35 with PCOS should have about a 15% chance for pregnancy per month with Clomid treatment (for about 3-4 months) - if they ovulate with Clomid (if sperm and fallopian tubes are normal).
Pregnancy success rates of Clomid and PCOS
About 50% of women that ovulate with Clomid get pregnant with it. But it also depends on a woman's age and other factors. In-vitro fertilization may improve pregnancy chances. For women with PCOS under age 35 the success rate of IVF is about 70% for pregnancy with one IVF cycle, and about 60% for live birth (miscarriages account for the different rates).
Clomid and twins and multiples
Clomid causes twins in about 10% of pregnancies. Less than 1% of Clomid pregnancies leading to triplets or higher order pregnancies.
Most twins conceived with Clomid will be so called "dizygotic" twins, twins that are not identical. That is because clomid leads to multiple ovulations, and non-identical twins are twins resulting from separate eggs and fertilizations with different sperm, while identical or monozygotic twins results from the splitting of a single fertilized identical egg and sperm.
Our recommendation to make it more successful to get pregnant before you start taking clomiphene to induce ovulation
No matter how well clomiphene works to make you ovulate, you will have difficulties getting pregnant unless you have good enough quality eggs, his sperms are OK, your tubes are open and you are at the optimal weight.
- Get a cycle day 3 FSH blood test to make sure your eggs have a good enough quality. With an elevated FSH test even Clomid is highly unlikely to work
- Do a sperm count before starting Clomid. If his sperms are not enough or in bad . shape Clomid won't make you get pregnant easier
- Make sure your fallopian tubes are open. If your fallopian tubes are closed, you won't get pregnant evn if you ovulate
- Lose weight. Having a normal BMI increases the chanes of Clomid to work and helps you get pregnant faster
Clomid and OPK ovulation predictor kit
Some women take Clomid and use ovulation predictor kits to time intercourse with ovulation. Many doctors however will monitor you using ultrasound equipment and blood work to tell you the best time to try to conceive or may combine it with a treatment like IUI.
Ovulation prediction kits are sensitive to the luteinizing hormone (LH). While most medications will have no effect on the test results, there are a certain sector of medications that can have a very real effect. These medications are often prescribed for infertility. If a woman is not producing enough LH she may not be able to conceive. For this reason, some infertility medications contain LH to improve the chances of fertility.
Clomid can cause false positive ovulation predictor Kit OPK test results
Several infertility medications can cause the ovulation kit to test falsely positive. These include Clomid, Pergonal, Humegon and Repronex. Clomid can cause an ovulation prediction kit to test positive even when the woman is not ovulating. According to the manufacturer of Clomid, three days should pass between the last day taking the Clomid and the first day testing for ovulation. For instance, if the medication is taken for 10 days, it is okay to start using the ovulation prediction kit on the 14th day.
Other medications that can cause false positive OPK
Pergonal, Humegon and Repronex are three infertility medications that contain LH and a follicle stimulating hormone (FSH). There could be enough LH in these medications to boost the natural LH levels to a point that looks like a spike. While this spike will not be the true spike noticed immediately before ovulation, the test will not be able to differentiate the difference between the two.
Other infertility medications like Gonal-F, Follistem and Fertinex contain only the follicle stimulating hormone. These should not have any effect on the ovulation prediction kit as the kit does not test for FSH.
Before starting to use an ovulation prediction kit, make sure to ask a pharmacist or your prescribing physician whether the medication causes a boost in natural LH or contains LH.
Is clomid successful to make a woman ovulate all the time?
Like all fertility treatments, there are no guarantees . Even if you do ovulate while on clomid, you still need the egg and sperm to meet, for fertilization to occur and then implantation. Some women try it for 2, 3 or more months / rounds or cycles . Some women will become pregnant and others will move onto other treatments.
Tests to do before starting Clomid
Before taking Clomid you should have some tests done to make sure you take it for the right reasons. Hot TIP: Do a sperm count before starting to take Clomid. It makes no sense taking Clomid when he has a low sperm count!
Before giving Clomid, patients should be checked to make sure
- Patient is not pregnant
- Patient has no ovarian cysts (except if there is polycystic ovary syndrome)
- Patient has no abnormal uterine bleeding (if there is abnormal bleeding a tumor should be ruled out)
- Patient has no fibroids
- Patient has no abnormal liver function (do a liver blood test).
- There is no male infertility
Clomid works best in women who produce enough estrogen and who have a low CD3 FSH blood level.
The following tests should be done before Clomid is given:
- Pregnancy test
- Sperm count
- Estrogen levels
- CD 3 FSH levels
- Thyroid function tests
- Prolactin levels
- Liver function tests
- Endometrial biopsy
Optional: Pelvic sonogram to check for fibroids and ovarian cysts
If a woman is menstruating, even if irregularly, clomiphene is usually effective. Women with irregular menstrual cycles ovulate infrequently. They are usually excellent candidates for clomiphene treatment since more frequent ovulation presents more opportunities to become pregnant.
|Ovulation test||No ovulation||Zero chances getting pregnant unless you take medication liike Clomid to induce ovulation|
|Sperm Count||He has not enough sperms||Clomid will not improve the chances of getting pregnant. You should improve his sperm count first.|
|Fallopian tube patency||Both fallopian tubes are closed||Zero chances getting pregnant, even with Clomid. Surgery to open the tubes or in-vitro fertilization (IVF) will help you get pregnant.|
|Bad quality of eggs||Test shows severly elevated FSH||Clomid unlikely to improve pregnancy chances. In-vitro fertilization (IVF) will help you get pregnant.|
If you don't get pregnant on clomiphene that doesn't mean it did not work. It may have worked and it may have made you ovulate but pregnancy in and by itself is not the only measure that clomiphene worked.
Getting pregnant is more complicated than just ovulation. In order to get pregnant the following has to happen:
- You need to ovulate and your egg quality has to be good
- He has to have enough and good enough sperms
- You fallopian tubes must be open for sperms and egg to meet
How do you know that Clomid worked?
So how do you know that Clomid has worked? (Hint: Read above. What is is supposed to do? Make you ovulate).
- You ovulate on clomiphene that means it worked.
- You did not ovulate it did not work.
Yes, it's that simple. In fact, not every woman will ovulate on clomiphene and many women who ovulate will not get pregnant. With or without clomiphene.
Obviously if you get pregnant then you know that you did ovulate, but let's not get ahead of this.
Women who take clomiphene (Clomid) must first know if they ovulate or not.
How to take Clomid
You take clomiphene for 5 days (usually cycle days 5-9 but you can start taking clomiphene as early as cycle day 2). Ovulation is then supposed to happen about 5-9 days later. Check the Interactive Clomid Calculator to find out when you are expected to ovulate after taking Clomid.
What is the process for taking Clomid?
Before you start taking the first dose of Clomid you must find out exactly what "Day One" of the menstrual period is.
- Day one is counted as the first day of menstrual bleeding
- The period can be from a spontaneous menstrual period or
- The period can be from a period induced with a progestin medication such as Provera (medroxyprogesterone acetate)
Inducing a menstrual period before starting Clomid
- In order to induce a period, progetsrone or Provera is given at a dose of 5 or 10mg daily for 5 to 10 days
- The menstrual period or menstrual bleeding usually starts within 2-7 days after the last Provera pill is taken
Starting Clomid after day one of the menstrual period
- Clomid is usually started at a dose of one tablet (50mg) daily - taken any time of day
- Clomid is usually started on days 3 to 7 or 5 to 9 from day one of the menstrual bleeding period
Clomid Dosing Recommendations
Clomid works best when the lowest dose that results in ovulation is used
- If there is no ovulation on the initial 50 mg dose of Clomid then progesterone Provera is often given to induce vaginal bleeding
- Once there is vaginal bleeding then a 100mg dose of Clomid is tried
- If there is no ovulation on a 100 mg dose of Clomid, then 150mg is sometimes tried
- If a woman ovulates on 50mg then increasing to 100mg is probably of no benefit - and may result in increased side effects
- Many women will ovulate on 50 or 100mg, and some will require 150 mg in order to get an ovulatory response
- Some pregnancies will occur on clomiphene doses above 100mg. However, increasing the Clomid dose to 200mg results in very few additional pregnancies.
How long does it take to ovulate using Clomid?
For women that do not ovulate on their own, the average day that ovulation occurs is about 8 to 10 days after completing a 5 day course of Clomid.
- That means that a woman taking Clomid on days 5-9 will often ovulate on about day 16-20 of the cycle
- However, there is significant variation in how long it takes ovulate using Clomid. Some will ovulate much later - as late as two or three weeks after the last clomiphene tablet.
How to find out that you did ovulate on Clomid
'How do you know you ovulate? There are several ways to find out if and when you ovulate:
- Calculation: Ovulation and Fertility Charting and Calculator
- Temperature Charting
- Cervical Mucus Changes
- Ovulation Pain: Mittelschmerz
- OPK Ovulation Predictor Kit
- Blood Progesterone Test
- Ultrasound Exams of Ovaries
Read more about typical Ovulation Symptoms HERE.
When to Increase Clomid (Clomiphene)
Most doctors start Clomid at 50 mg a day for 5 days. If you do ovulate on Clomid (the # 1 most important information when taking Clomid!) then there is no need to increase it in the next cycle. If you do NOT ovulate on Clomid, then your doctor often increases Clomid in the next cycle. Increasing Clomid when you are already ovulating on a lower dose is not only unneccessary, but it could in fact decrease your chances getting pregnant.
How long should a woman be on Clomid before moving on to other treatment options?
While there is generally no total number of cycles of Clomid that should be done before moving on to other fertility treatments, there are several variables involved in the decision about moving on to more aggressive therapy.
If there is no after increasing Clomid Dosage
If a woman is not ovulating on a low dose of Clomid, the dose should be increased. If not ovulating at 150 mg then other therapies should be attempted
Your menstrual period and ovulation
If you ovulate then your menstrual period is supposed to come 14 days after ovulation. If you ovulate and it has not come after 15+ days after ovulation then you should do a pregnancy test.
Missed menstrual period on Clomid and negative pregnancy test
If you take Clomid and your menstrual period has not come when you expected, then do a pregnancy test. A repeatedly negative pregnancy test after a missed period and Clomid usually means that you did not ovulate, Clomid did not work, and you are not pregnant.
Three 3 scenarios you must know about Clomid pregnancy and your menstrual period
- Scenario#1: You ovulate and did NOT get pregnant: Your menstrual period will arrive about 14 days after the day of ovulation.
- Scenario#2: You ovulate and did get pregnant. Your menstrual bleeding, your period will not arrive 15+ days after the day of ovulation. Do a pregnancy test.
- Scenario#3: You did NOT ovulate. If you don't ovulate then you will usually not bleed, you may not get any bleeding or it will be irregular. You may bleed or spot irregularly but it's not a menstrual period.