Clomiphene Citrate: Patient Instructions
You are being given a medication known as clomiphene citrate (Clomid, Serophene). The purpose of using this drug may be to (a) cause you to release and egg (ovulate) each month, (b) cause you to release more than one egg each month if you ovulate on your own, (c) help synchronize the lining of your uterus (endometrium). Clomiphene is a very safe drug, but like any form of treatment, it does have risks and occasionally there may be side effects.
Mechanism of Action: clomiphene is an estrogen antagonist, that is, it opposes the actions of estrogen. It works by competing with estrogen for the estrogen-receptors in your brain (at the hypothalamus and pituitary gland). Your hypothalamus and pituitary gland interpret this as the body not having enough estrogen. This results in the pituitary gland releasing the hormones FSH (follicle-stimulating hormone) and LH (luteinizing hormone), which then go to the ovary to stimulate follicle growth and estrogen secretion. Usually the follicles selected by the clomiphene continue to grow and ovulate a normal manner.
Side effects: Although most patients have no symptoms while on clomiphene, you may notice mood swings, abdominal discomfort, hot flashes or visual disturbances. These symptoms are usually brief and mild when present and do not require treatment. If you experience any unusual problems while taking clomiphene, please feel free to call us at the office numbers listed below.
Risks: The major risk of clomiphene citrate is the risk of conceiving more than one baby. The risk of having a multiple pregnancy is about 8-10%. Of the few multiple pregnancies, about 90% will be twins and 10% more than twins. On occasion, the anti-estrogen effects of clomiphene can make the lining of the uterus too thin. This can be treated by medication or by simply stopping the clomiphene and moving on to other medications (e.g. the gonadotropins). Rare complications include twisting of an enlarged ovary ("torsion") and ovarian hyperstimulation syndrome. There is no increased risk of birth defects, miscarriage, or tubal (Ectopic) pregnancy compared to the general population. There are no other reported complications with pregnancy due to the medication, although, of course, no pregnancy can ever be guaranteed to be "perfect".
Precautions: You should not take clomiphene if you have significant ovarian cysts, think you are pregnant, have liver disease, or significant visual symptoms on the medicine.
How a Clomiphene Cycle Works.
Monitoring:
1. It is essential that appropriate monitoring with ultrasound and blood tests (estrogen and progesterone) be done to reduce the chances of adverse consequences and to increase the chances of success. In some cases, you will be asked to use and ovulation predictor kit (OPK) to aid in the monitoring. In some cases, the hormone hCG will be given to assist in ovulation.
2. Please call the office when your period starts (day 1 of your cycle). If your period starts after 9:00 pm, day 1 is the next day. Clomiphene can be started on day 3, 4 or 5 of the cycle. A baseline ultrasound and blood-work are required before starting the medicine. You should call to arrange testing as soon as your period starts. If your period starts on a weekend, please leave a message at 973-971-4600. Your doctor will determine when to start your cycle after review of the baseline studies.
3. The tests that will be done initially and at subsequent visits will be an ultrasound and two blood tests: estrogen and progesterone. The ultrasound determines how many follicles are developing and how mature they are, based on their size. The estrogen level is a reflection of the follicle's activity. The progesterone level also reflects follicular activity and is a tip-off of ovulation starting to occur spontaneously.
4. After the baseline tests, you will take the clomiphene for 5 days. In the middle of the cycle, monitoring will be done to determine when the follicle(s) are mature, so that inseminations (or intercourse) may be appropriately timed. Your monitoring will be as follows:
a. _______Return for an ultrasound and blood tests on _____________________. Timing of the inseminations will be based on the results of these tests.
b. _______Start your ovulation predictor kit (OPK) on __________. Call the clinic when the kit turns (+). Anticipate coming to the office the next day for and ultrasound and possibly an insemination.
c. _______Other_______________________________________________________
___________________________________________________________________
d. Note: Lab results are reported late in the afternoon after the physicians have reviewed them. You will be called at your home number by a nurse or physician and informed of the plan.
e. If you have not been called with your results and plans by 7:30 pm, please call our emergency number at (973) 971-4600. Our answering service will contact a physician for you.
5. We generally do two inseminations (IUI's) because we feel that it increases the chances of conception. The inseminations will be about 12 and 36 h after the hCG injection or the OPK is positive. If inseminations are not used, timing of intercourse will be discussed with you.
6. Five to 7 days after ovulation, you may be asked to come in to have a progesterone level checked to confirm that ovulation did occur.
7. Cycle lengths may vary from your normal cycle length. The earliest a pregnancy test may be done is 16 days after the hCG was given or the OPK was (+). Please call if you get your period sooner or have not gotten a period 20d after expected ovulation.
Office Phone Numbers:
Englewood Office: 201-569-8143
Somerset Office: 732-537-0631
Morristown Office: 973-971-4600
West Orange Office: 973-325-2229
