Clomid for Infertility: How It Works, Success Rates, & Alternatives

by Apr 6, 2021

Clomid, or clomiphene citrate, is an oral medication given to stimulate ovulation. It’s one of the most frequently prescribed drugs for infertility treatment and often the first one tried. In this post we will explore how Clomid works, who it’s for, and what alternatives are available if it doesn’t work for you.

drug capsule and flowers

Understanding Clomid

Clomid is often one of the first drugs recommended by doctors when it comes to infertility – not only is it more affordable than other treatments but its successes are well documented.

It works either on it’s own (known as assisted reproductive technology “ART”), or in combination with other fertility treatments, such as in-vitro fertilization (IVF) to help women restart ovulation so that they are more likely to conceive.

Who Is Clomid For?

Clomid is specifically designed for women who have issues ovulating. If you suffer from irregular periods or menstruation without ovulation (anovulatory cycles), Clomid could be a good choice. Unlike stronger fertility drugs, it can be prescribed by your OB and is taken in pill form instead of being injected.

If you are just starting your fertility journey and you have unexplained infertility, Clomid might be the first step along the way to conceiving. Couples often choose Clomid as an alternative to more expensive or invasive treatments at the beginning of their infertility journey. For women with polycystic ovary syndrome (PCOS), Clomid is also a common first-line fertility treatment.

Of women having anovulatory cycles, Clomid successfully restarts ovulation for 80 percent. However, not all women respond well to treatment with Clomid. Women with hypothalamic amenorrhea (lacking a menstrual period due to being underweight) or primary ovarian insufficiency may be less likely to ovulate with Clomid treatment.

How Does Clomid Work?

In order to coax the body into ovulation, Clomid makes your body think your estrogen levels are lower than they really are. This decreased estrogen causes the body to increase the secretion of FSH (follicle-stimulating hormone) and LH (luteinizing hormone). The increased FSH stimulates follicle development and the increased LH stimulates ovulation.

While using Clomid, you can use a Mira Fertility Tracker to measure the increase in LH and find your fertile window.

Treatment usually starts with taking the same dosage for five days in a row at the same time of day. After a cycle (five days), your doctor may have you come back to measure hormone levels. Using your hormone levels as a guide, they can help you time intercourse or decide if further infertility treatment is needed. They will also decide what the dosage should be for your next cycle of ART.

Even though Clomid is less expensive and less invasive than other treatments, it isn’t a long-term fertility solution. Side effects and possible decreased fertility with long-term use mean it is important to time intercourse to increase your chance of conceiving and minimize the length of use of the drug.

Doctors only recommend using Clomid for a maximum of six cycles as pregnancy rates are lower with extended use. Extended use of the drug can actually lead to thickened cervical mucus making it harder for sperm to get through to the egg. Using Clomid for more than six cycles is also loosely linked to higher rates of uterine cancer.

Are There Any Side Effects?

Like any medication, Clomid comes with the risk of side effects. The medication is generally considered safe — but because it affects your hormone levels, you might experience certain symptoms, such as:

  • Hot flashes
  • Headaches
  • Bloating
  • Nausea
  • Mood changes
  • Breast tenderness
  • Vision changes

There is also a slight risk of adverse effects with the use of Clomid. For example, there is a somewhat increased risk of carrying a multiple pregnancy with the use of Clomid. This is because Clomid stimulates the growth of multiple follicles, which sometimes leads to the release of more than one egg. If these eggs are all fertilized, you might have twins — or more! The rate of twinning is about 7 percent with Clomid.

Using Clomid for too long is associated with the greatest risks. Clomid thickens the cervical mucus and thins the uterine lining or endometrium. Over time, these changes can actually make it more difficult for you to get pregnant. This risk is low with fewer than three to six cycles of Clomid, but using Clomid for extended periods of time can decrease fertility. Using Clomid for too long could also raise your risk of certain cancers, such as uterine cancer.

Your doctor will try to minimize your risk of adverse effects by using as few cycles of Clomid as possible and potentially by combining Clomid with intrauterine insemination (IUI) or IVF to make your treatment quicker and more effective.

Getting Pregnant with Clomid

While it doesn’t work for everyone, many women are able to have a successful pregnancy with the use of Clomid, even if they have fertility issues. Clomid has helped women with PCOS, anovulatory cycles, and other fertility problems conceive in the past.

 

Clomid Success Rates

Just how easy is it to get pregnant with Clomid? Unfortunately, Clomid alone isn’t a cure-all for fertility woes. With or without intrauterine insemination (IUI), only 10-12 percent of patients conceive during each cycle of Clomid. Your chances of pregnancy may increase with more cycles — but so do the long-term risks of using the medication.

Clomid appears to be most successful for women with PCOS and anovulatory cycles. Women under 35 with PCOS have a 15 percent chance of getting pregnant each cycle. When it comes to women with anovulatory cycles, 80 percent of women will successfully ovulate on Clomid — and of those women, half will become pregnant in a given cycle.

Combining Clomid with other fertility treatments — particularly IVF — also appears to make these treatments more successful. In one study of women undergoing IVF with Clomid, women under age 34 had a 70 percent cumulative live birth rate after the third cycle of Clomid. Clomid may be an especially good option for use with IVF since it is less expensive than injectable fertility medications.

If you’re about to start treatment with Clomid, watching success stories can be uplifting and give you hope on your fertility journey. Check out Emily’s and Nicole’s stories on YouTube if you want to be inspired!

What Does The Treatment Plan Look Like?

Using Clomid can feel complicated the first time you go through a cycle of ART, but it is worth it to potentially be able to conceive. Clomid is taken on specific days of the month during each menstrual cycle and requires additional steps to make sure it is successful.

If you have regular menstrual cycles, you will start taking Clomid for five consecutive days beginning on the third day of your cycle. If your cycles are irregular, you may need to take a drug called Provera around the 40th to 45th day of your cycle to stimulate your period before you can take Clomid. You won’t ovulate while taking Clomid, but the drug works to stimulate the processes that put ovulation into action.

After taking Clomid five days in a row, you will have sex (at least) every other day from days 10 to 16 of your cycle to try and conceive. You’ll need to wait until day 21 of your cycle to have a blood test. This blood test measures your hormone concentrations to see if you have ovulated. If you have ovulated, you will go through the two-week wait (TWW) to be able to take a pregnancy test. If not, your doctor might instruct you to take another dose of Clomid.

Usually, your doctor will start you on a lower dose of Clomid, around 50 mg. They may double or triple the dose for consecutive cycles if you are not having success with the smaller dosage, meaning you’ll need to take two or three tablets to get the full 100 mg or 150 mg. Make sure to follow your doctor’s directions closely when it comes to the dosage and timing of Clomid.

Clomid Alternatives: What If It Doesn’t Work?

Even though Clomid successfully jump-starts ovulation in 80 percent of women, it definitely isn’t for everyone. You might be hesitant to take Clomid or have fears about what you should do if Clomid doesn’t work.

About one in four women are Clomid-resistant, meaning ovulation doesn’t restart on Clomid alone. Depending on why your doctor believes the drug isn’t working, they might start you on a second medication in conjunction with the Clomid or move on to a different fertility treatment.

If you suffer from primary ovarian insufficiency or hypothalamic amenorrhea, Clomid most likely won’t work for you and you might want to consider alternative fertility treatments. For example, Femara or Letrozole are oral alternatives to Clomid that have similar ovulation success rates. Letrozole saw slightly higher pregnancy rates than Clomid, but this drug isn’t sold as a fertility drug. It is actually used as a cancer treatment to lower estrogen production and comes with its own set of side effects.

Remember Clomid is often just a first step in your fertility treatment journey. If it doesn’t work, there are many other options to try and steps to take. Take your time, discuss your options with a trusted specialist, and get to know your own body during this journey.

✔️ Medically Reviewed by Dr Roohi Jeelani, MD, FACOG and Lauren Grimm, MA

roohi jeelaniDr Roohi Jeelani is Director of Research and Education at Vios Fertility Institute in Chicago, Illinois. Dr Jeelani earned her medical degree from Ross University School of Medicine in Portsmouth, Dominica. She then completed a residency in Obstetrics and Gynecology and a fellowship in Reproductive Endocrinology and Infertility at Wayne State University, Detroit Medical Center, where she was awarded a Women’s Reproductive Health NIH K12 Research Grant. She is board certified in Obstetrics and Gynecology. Dr Jeelani has authored numerous articles and abstracts in peer-reviewed journals, and presented her research at national and international scientific meetings. A Fellow of the American College of Obstetrics and Gynecology, Dr Jeelani is a member of the American Medical Association, the American Society of Reproductive Medicine, and the American Association of Gynecologic Laparoscopists.

Lauren Grimm is Research Coordinator at Vios Fertility Institute in Chicago, Illinois. Lauren earned her bachelor’s degree from Loyola University Chicago, where she also completed her masters in Medical Sciences. Lauren has worked alongside Dr. Jeelani for the last 3 years, authoring a number of abstracts and articles in peer-reviewed journals, and presented her research at national and international scientific conferences. Lauren will be continuing her education this fall at Rush University Medical College in Chicago, IL as an MD candidate.

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