Clomiphene Citrate (clomid) induces ovulation in women who don't regularly ovulate, or causes multiple ovulation (2-3 eggs) in women who ovulate regularly but aren't conceiving. Clomid, introduced in the 1960's, was the original "fertility medication." It causes the body to release more of its "egg producing hormone" (FSH). We usually start this medication at 50 mg. (one tablet) daily on days 3-7 of your menstrual cycle (please see instructions below) and expect ovulation to occur 5-9 days after the last pill. Ovulation may be accompanied by insemination or timed intercourse, depending on your particular situation.
Instructions for your calendar:
When your period begins, mark this as "day 1" on your calendar and call the office to schedule an appointment to start the cycle.
Clomid is a fertility medication. One important side effect is the possibility of multiple births. The probability of having twins while taking this medication is 7% (meaning 7 out of 100 women who get pregnant with clomid will have twins). It is rare to have more than twins (higher order multiples) with clomiphene citrate.
Ovulation Induction, Gonadotropins
Follistim, Gonal-F, Bravellele, Repronex, Menopur, Ovidrel
Gonadotropins (LH and FSH), also known as the "injectable medications," are hormones produced by the pituitary gland which are used to stimulate ovarian follicular development. During a regular menstrual cycle, one follicle is naturally selected to grow, resulting in ovulation and release of only one egg. With the use of gonadotropins, multiple follicles are stimulated to grow, resulting in ovulation and release of more than one egg. Gonadotropins can be "urinary," meaning they are extracted from the urine of postmenopausal women, or "recombinant," meaning they are produced by bacteria that are genetically altered to produce LH and FSH specifically. These drugs can't be ingested orally and are, therefore, administered by injection, usually subcutaneously. Occasionally, intramuscular administration is necessary.
Injections usually begin on day 3 of the menstrual cycle and continue for several days until the developing follicles are approximately 16-20 millimeters in diameter. Daily dosage and the length of time needed for adequate stimulation, vary from patient to patient and cycle to cycle. Most patients will receive injections for 7-9 days.
During the stimulation with gonadotropins, patient's follicles are monitored closely with ultrasounds and estradiol levels (blood tests). Medication dosages are adjusted based upon these results as well as a myriad of factors, including but not limited to; the patient's response to treatment, age, appearance of her ovaries and medical diagnosis. When the ultrasounds and estradiol levels indicate that the follicles are ready, an injection of another hormone called HCG is given to induce ovulation.
Gonadotropins are used in women who do not normally ovulate, or in those who do not ovulate in response to clomiphene citrate. Additionally, gonadotropins may be used to produce multiple follicles for insemination or an ART procedure such as in vitro fertilization.
There are two types of treatment cycles in which gonadotropins are used
- Controlled Ovarian Hyperstimulation (COH) – during a COH cycle gonadotropins are used to stimulate the ovary to produce ~ 2-4 eggs. Ovulation is usually induced with the injection of HCG (known as the "trigger shot") followed by either intrauterine insemination (IUI) or timed intercourse.
- IVF – during an IVF cycle, a higher dose of gonadotropins is used to induce the growth of multiple follicles.
The gonadotropin medications are usually well tolerated since these hormones are identical to those produced naturally by the pituitary gland. They are excreted quickly from the body and do not leave long lasting effects on the menstrual cycle.
Two main risks associated with the use of gonadotropins are:
- Ovarian hyperstimulation syndrome (OHSS): this syndrome is characterized by ovarian enlargement, followed by abdominal pain, abdominal distention, weight gain and circulatory problems. To reduce the risk of severe OHSS close monitoring of follicle development as well as estradiol levels are required.
- Multiple gestations: Twins occur in about 20 to 25% of COH cycles and in up to 40% of IVF cycles depending on the number and quality of embryos transferred. The risk of multiple gestations can be significantly reduced by limiting the number of embryos transferred during an IVF cycle, or by canceling a COH cycle in which too many follicles develop.