How Does Clomid Work: Treating Infertility - Healthline

Maybe your like

HealthlineSubscribe

Parenthood

How Does Clomid Work for Fertility?

Medically reviewed by Amanda Kallen, MD — Written by Nicole Galan, RN — Updated on October 13, 2022

Benefits
Risks
Takeaway
FAQs

Clomid is also known as clomiphene citrate. It’s an oral medication that is often used to treat certain types of female infertility. It stimulates the secretion of follicle-stimulating hormone (FSH), which triggers the ovary to produce one or more egg follicles.

Clomid also helps stimulate the production of estrogen, which eventually triggers a surge of luteinizing hormone (LH). High levels of LH stimulate ovulation or the release of an egg.

Clomid is often prescribed by primary care physicians or OB-GYNs before they refer a couple to see a fertility specialist for more specialized care. Some reproductive specialists prescribe Clomid as well.

Taking Clomid

Hands holding a pack of pills. — Kathleen Finlay/Getty Images

Clomid is a 50-milligram (ml) pill that is usually taken for five days in a row after day 1 of a female’s menstrual cycle. Day 3, 4, or 5 is typical for a Clomid start date.

Doctors will usually prescribe one, two, three, or sometimes four pills to be taken at the same time each day, depending on how they think you will respond to the medication. It’s common to start at the lowest dose and increase each month as needed.

Some doctors will want you to come back for blood work to measure hormone levels or a transvaginal ultrasound to look at your ovarian follicles.

This information can help them determine when you should begin having intercourse or have intrauterine insemination (IUI). It can also help them determine the appropriate dose for your next cycle.

You may also wish to use an ovulation predictor kit to see if the medication is helping you ovulate and better time your sexual intercourse.

However, doctors don’t recommend using Clomid for more than three to six cycles due to the decreasing pregnancy rate that occurs with continued use.

Your doctor may extend this if it takes a few cycles before they find the dose that works for you. Most doctors will treat you for up to 6 cycles, but a doctor may consider up to 12.

Are sex and gender the same thing?

People often use the terms sex and gender interchangeably, but they have different meanings:

“Sex” refers to the physical characteristics that differentiate male, female, and intersex bodies.
“Gender” refers to a person’s identity and how they feel inside. Examples include man, woman, nonbinary, agender, bigender, genderfluid, pangender, and trans. A person’s gender identity may differ from the sex they were assigned at birth.

Who should take Clomid?

Clomid is often prescribed to females with polycystic ovary syndrome (PCOS), which is a syndrome that can cause irregular or absent ovulation.

Not everyone will respond to this medication. Females with primary ovarian insufficiency or early menopause and females with absent ovulation due to low body weight or hypothalamic amenorrhea are most likely to not ovulate when taking Clomid. Females with these conditions may need more intensive infertility treatment or need to use donated eggs.

Cost

The out-of-pocket cost of Clomid varies. It may be between $20 and more than $100 depending on whether you have insurance and the pharmacy you use to fill the prescription.

Medicare does not cover medications that promote fertility. Among state Medicaid programs, New York is the only state that currently provides coverage for fertility medications, including Clomid.

If you have a private health insurance plan, your plan is likely to cover the medication. At least 15 states have laws requiring insurance companies to cover fertility treatments, and many plans cover these medications regardless.

Benefits

For people who are appropriately treated with Clomid, there are many benefits:

Can be the most cost-effective option in some cases, especially when compared with other fertility treatments such as in vitro fertilization (IVF).
It is an oral medication, which makes it less invasive than other treatments.
It can be prescribed by your OB-GYN or primary care provider, so you do not need to see a reproductive specialist.
There are relatively few side effects, and many of the possible ones are rare, so Clomid is generally well-tolerated by females who take it.

Risks

Some minor side effects may occur if you take Clomid, and some complications are rare.

Side effects

While this medication is generally pretty safe, there are some side effects that you should be aware of. They include:

hot flashes
headaches
bloating
nausea
mood changes
breast tenderness
visual changes like blurring and double vision

Multiple pregnancies

There is a slightly higher risk of having multiple pregnancies when taking Clomid.

Researchers say Clomid has a multiple pregnancy rate of approximately 8-10%, though a 2021 study found it to be less than 3-4%. A twin pregnancy appears to be more common with Clomid than triplets or higher-order multiples.

Though the risk of multiple pregnancies is not so high, you may wish to request more aggressive monitoring if you are unwilling or unable to carry a multiple pregnancy.

Adverse effects

Because Clomid’s effect on your estrogen levels can cause your uterine lining to be thin (a thick lining can help with implantation). Clomid can also reduce the amount and quality of your cervical mucus.

When exposed to estrogen, cervical mucus is thin and watery, which helps the sperm cells travel up to the fallopian tubes. When taking Clomid, estrogen levels are lower, causing the cervical mucus to be thicker than usual. This can interfere with the ability of the sperm to get into the uterus and fallopian tubes.

If you are having an IUI procedure, thick cervical mucus isn’t a problem because the insemination catheter bypasses the cervical mucus entirely. However, having a thin uterine lining is associated with a lower pregnancy rate after IUI.

Cancer

Living with infertility raises a person’s risk of developing breast, endometrial, and ovarian cancer.

The medication label for Clomid also warns that ” prolonged use of clomiphene may increase the risk of a borderline or invasive ovarian tumor.”

However, this complication appears to be quite rare. In addition, the research on whether taking Clomid and similar medications increase cancer risk is inconclusive.

Many research studies and meta-analyses have found that hormonal infertility treatments do not increase the risk of breast cancer. Similarly, there does not seem to be much evidence that these drugs raise the risk of ovarian cancer.

One 2017 review of four studies found that taking Clomid may raise the risk of endometrial cancer, but the researchers could not determine whether the increased risk was really due to the Clomid or other factors such as having PCOS.

Birth defects

While some studies have reported associations between Clomid use and birth defects, these studies had small numbers of cases and inconsistent results.

it is also difficult to separate any effects of Clomid use from possible effects related to infertility. Newer studies have not shown an association between Clomid and birth defects.

That being said, some clinical trials on Clomid have found a small chance of less than 1% developing fetal abnormalities during pregnancy. These include:

Down syndrome
congenital heart lesions
club foot
microcephaly
cleft palate
conjoined twins
umbilical hernia,
spina bifida occulta

A similarly tiny risk was found regarding neonatal or fetal death (stillbirth).

Takeaway

Clomid is a fertility medication that helps stimulate the production of egg follicles. Doctors often prescribe it before they refer a couple to more specialized fertility treatments. It is relatively cost-effective and has a low risk of adverse effects. The side effects tend to be minor as well.

However, Clomid may not work for everyone. If you haven’t become pregnant while taking Clomid, it doesn’t mean that you will never become pregnant. It may just mean that you need a different form of treatment or that something additional is going on.

This can include an issue with your partner’s sperm, uterus, or fallopian tubes. Your doctor will likely suggest additional testing to identify these issues to correct them before future treatment cycles.

Frequently asked questions

The following are answers to additional questions about Clomid and infertility.

What do I do if Clomid doesn’t work?

If you don’t become pregnant after three to six cycles of Clomid (or however many your doctor recommends), it may be time to see a fertility specialist and move on to more aggressive treatment.

What is ovulation?

Ovulation is the process of releasing an unfertilized egg from the ovary each month, usually around the 14th day of a female’s menstrual cycle. Without regular ovulation, it can become difficult to get pregnant. This is because it’s difficult to figure out when to have intercourse so that the egg and sperm will meet at the right time.

Learn more about ovulation.

Can Clomid be used for male infertility?

Clomid is only approved by the Food and Drug Administration (FDA) for treating females. However, doctors may prescribe it off-label to treat male infertility and secondary hypogonadism. In males, Clomid can help induce the production of sperm.

Learn more about Clomid for males.

Share on Pinterest

Parenthood
Pregnancy

How we reviewed this article:

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Carson SA, et al. (2021). Diagnosis and management of infertility.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9302705
Chapter 6 – part D drugs and formulary requirement. Medicare prescription drug benefit manual. (2016). fhttps://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/193421_Part%20D%20Manual%20Chapter%206.v.01192016.pd
CLOMID- clomiphene citrate tablet. (2022).https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2ca373c1-4dba-4126-8616-5c533d606fe5
Gadalla MA, et al. (2017). Effect of clomiphene citrate on endometrial thickness, ovulation, pregnancy and live birth in anovulatory women: Systematic review and meta-analysis.https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/uog.18933
Garthwaite H, et al. (2021). Multiple pregnancy rate in patients undergoing treatment with clomifene citrate for WHO group II ovulatory disorders: A systematic review.https://pubmed.ncbi.nlm.nih.gov/33451262/
Mbi Feh MK, et al. (2022). Clomiphene.https://www.ncbi.nlm.nih.gov/books/NBK559292/
Peeraer K, et al. (2017). Cost-effectiveness of ovarian stimulation with gonadotrophin and clomiphene citrate in an intrauterine insemination programme for subfertile couples.https://pubmed.ncbi.nlm.nih.gov/29395750/
Practice committee of the American society for reproductive medicine. Fertility drugs and cancer: A guideline. (2016).https://pubmed.ncbi.nlm.nih.gov/27573989/
Sharma S, et al. (2014). Congenital malformations among babies born following letrozole or clomiphene for infertility treatment.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4182712
State laws related to insurance coverage for infertility treatment. (2021).https://www.ncsl.org/research/health/insurance-coverage-for-infertility-laws.aspx
Weigel G, et al. (2020). Coverage and use of fertility services in the U.S.https://www.kff.org/report-section/coverage-and-use-of-fertility-services-in-the-u-s-appendix-2-medicaid/
Weiss NS, et al. (2014). How long should we continue clomiphene citrate in anovulatory women?https://academic.oup.com/humrep/article/29/11/2482/2427159

Share this article

Medically reviewed by Amanda Kallen, MD — Written by Nicole Galan, RN — Updated on October 13, 2022

Health Conditions

Condition Spotlight

Wellness Topics

Product Reviews

Featured Programs

Featured

Lessons

Newsletters

Lifestyle Quizzes

Health News

This Just In

Top Reads

Video Series

Find Your Bezzy Community

Follow us on social media