Learn more about Clomid

For ovulation to occur, it is not sufficient for the pituitary gland merely to produce its stimulatory hormones FSH and LH. It must produce these hormones in a specifically synchronized, properly timed fashion. The first requirement for proper ovulation is an adequate amount of FSH stimulation in the very beginning of the menstrual cycle. If there is not an adequate production of FSH by the pituitary gland on the first day of menstruation, the early follicle may not get an adequate growth start, and this sets the stage early in the cycle for poor ovulation. Clomid is a very mild ovulatory stimulant. The object of administering Clomid is to increase the pituitary’s production of FSH so that the follicle gets a good boost in the early stage of the cycle. The way this happens is quite fascinating. Clomid is an antiestrogen, which blocks the pituitary’s recognition of your body’s own naturally circulating estrogen. It gives the pituitary the false message that your ovary is not making estrogen, and this causes the pituitary to increase its FSH production dramatically. If the follicle gets this necessary boost by an early increase in FSH, it will develop properly and release enough estrogen around mid-cycle to trigger the pituitary gland on day fourteen to release LH, which causes the follicle to rupture and ovulate. A high level of early FSH production by the pituitary gland, stimulating the follicle to grow in the early portion of the menstrual cycle, is the key to successful ovulation.

Clomid has traditionally been given only on days five through nine in the cycle. Some doctors prefer days three through seven. Clomid is needed only during the first five to eight days, when maximum FSH stimulation is necessary. After that, it has already done its job and has set the stage for the proper subsequent hormonal clockwork to take place.

Because Clomid is an anti-estrogen, it blocks the effect of estrogen on the cervix and frequently makes the cervical mucus too sticky to allow sperm penetration. The basic problem with Clomid is that it does not have a “dean” effect. On one hand, it stimulates ovulation by increasing FSH early in the cycle. On the other hand, it counteracts the effects of estrogen on the cervix and the endometrium. Thus, if Clomid does not result in a pregnancy by three months, it is best to stop using it.

The benefit of Clomid is that it is such a mild drug that it can be prescribed without the need for close monitoring. The incidence of twins in clomiphene-treated women is only about 6 percent. Triplets, quadruplets, and quintuplets are extremely rare with this relatively gentle and mild fertility agent. It is a safe, easy-to-prescribe drug. Clomid is probably the most popular drug used for enhancing fertility because it is so simple to administer, and patients can take it with very little supervision. It is passed around like popcorn to millions of infertility patients as a first line of treatment.

But it is certainly overused, and many patients have been on Clomid for years and years with no pregnancy. The doctor may add an HCG injection at mid-cycle, or perform artificial insemination with the husband’s semen. But if Clomid does not produce a pregnancy in the first several months, it’s not likely to do so over the next several years. It is a very mild agent that is not adequate for most cases. But if it does work, it will work right away.