Clomiphine Citrate
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
248-619-3100. 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:
Troy Office: 248-619-3100
Toledo Office: 248-619-3100
