Clomid is one of the most popular fertility drugs and is widely prescribed in the UK.
However, its popularity means that some women have admitted to buying the drug online and administering it themselves, rather than having it prescribed and being overseen by a specialist.
It goes without saying that drugs purchased over the internet could be extremely harmful in themselves, but these women buying Clomid online could be potentially at risk of serious allergic reactions, multiple births and developing life-threatening Ovarian Hyper Stimulation Syndrome (OHSS).
Professor Dr Geeta Nargund, Medical Director of CREATE Fertility, explains exactly what Clomid is and why it needs to be properly administered and treated with caution.
What exactly is Clomid and how does it work?
Clomid (Clomifene Citrate) acts like an anti-oestrogen. It stimulates ovarian follicular growth and is used for ovulation induction in anovulatory women (women who do not naturally ovulate).
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When is Clomid used?
In women with Polycystic Ovary Syndrome (PCOS) who do not ovulate naturally
As the first line of ovulation induction and in insemination cycles where ovulation induction is needed
For ovarian stimulation in IVF cycles with or without a small dose of follicle-stimulating hormone (FSH) injections. It is one of the methods used in "Mini or Mild” IVF to reduce cost, discomfort of injections and prevent health risks of FSH stimulation
Clomid comes in a tablet form and at CREATE Fertility, we use Clomid for women who want to avoid injections during the IVF process, have "needle-phobia" or want to reduce cost of their treatment.
An alternative called Tamoxifen (used in treating breast cancer) is equally effective for ovarian stimulation and can help with thickening of lining of womb in some women.
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Who prescribes Clomid? Should it be a GP or a fertility specialist?
Clomid should only be prescribed by a fertility specialist who knows your medical history. Dosages need to be carefully tailored and the patient’s response to the drug monitored in order to achieve an optimal outcome and avoid side effects like OHSS and multiple births.
OHSS is a clinical condition resulting from overstimulation of ovaries. Women with PCOS are oversensitive to stimulating drugs and can develop OHSS with low dose stimulation. Most cases of OHSS are mild and can include symptoms such as nausea and abdominal bloating, but in rare cases the condition can become severe and lead to hospital admission and can be potentially fatal.
What sort of dose is given and how is it monitored?
Lower doses of Clomid should be used initially to avoid the risks of OHSS and multiple births, and then cycles should be monitored with ultrasound scans to assess the response of ovaries and lining of womb (at least for the first cycle) and day 21 blood tests for progesterone.
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What should be ruled out in advance of Clomid being used?
Other causes for anovulation should be excluded before Clomid is used. These can include bodyweight issues and other hormonal disorders. In particular, women with PCOS who are overweight are advised to lose weight before treatment.
Crucially, pregnancy must also be ruled out before Clomid is prescribed.
Who does it not suit?
Clomid is not useful in women who are ovulating naturally or those who have unexplained infertility. Success rates for those with unexplained infertility are not higher when using Clomid, so alternative treatment pathways should be sought.
Women who have ovarian cysts, fibroids, endometriosis, liver disease or adrenal or pituitary conditions need further medical attention before considering Clomid. In addition it is not suitable for women with blocked or damaged fallopian tubes.
Clomid may not be effective in women with low ovarian reserve for ovulation induction purposes, only as the time is of the essence. However, as mentioned earlier it can be successfully used as part of stimulation in IVF cycles.
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What happens if there is no response to Clomid?
Women who do not respond to Clomid may need low dose FSH injections to induce ovulation.
What are the success rates for Clomid?
Most women who are not naturally ovulating will ovulate when taking 50 mg Clomid per day for five days per cycle. For women who have ovulate with 50 mg Clomid, cumulative conception rates are around 50% after three months and 62% after six months.
Higher doses are required in women with higher BMI but step up regimens are done carefully as dosages higher than 100 mg per day can add very little to success rates.