We always want to document how many follicles developed and the endometrial thickness. Common Clomid side effects include hot flashes, headache, blurry vision, mood swings, and can induce a change in cervical mucus. Clomiphene works directly on the pituitary gland and also affects many tissues with estrogen receptors. This is in contrast to injectable gonadotropins like Gonal-F that targets primarily just the ovary. Therefore many patients will notice changes in their body during the Clomid cycle.
Fortunately, none of these is a long-lasting side effect, and there are no long-term effects. While some concern was raised regarding ovarian cancer, there is no conclusive evidence that considerate use of Clomifen increases the risk. Rarely, a patient can develop ovarian hyperstimulation syndrome OHSS. Such a condition needs immediate medical attention and is considered a severe side effect.
Usually, these patients have high AMH levels. Another side effect is ovarian cysts that can occur weeks after treatment! The cysts are often discovered once we see the patient for another treatment cycle start or in cases of pelvic pain.
The reason behind this is that Clomiphene may remain active in the woman's body for several weeks. The ovaries may continue to stimulate, increasing the occurrence of ovarian cysts. We sometimes see extreme responses , and we have had patients develop too many eggs - as high seven or eight eggs! Some patients develop the hyperstimulation syndrome and ovarian enlargement and need immediate care by a fertility specialist.
While higher-order multiples are rare, patients have conceived triplets using Clomifene alone. Fortunately, the majority of patients develop follicles with the right dose.
Some patients with very severe PCOS show resistance to the medication. While very useful in patients who do not ovulate eggs, some patients show no response because their condition is too severe. Another frequently used term is " Clomid resistant. In such cases, we need to use injectable gonadotropins like Gonal-F or Follistim to restore the ovulatory cycle. A woman can start taking Clomid tablets between cycle day three and cycle day 5.
Each tablet contains 50mg of Clomiphene Citrate. Typically patients take tablets daily for a total of five days. The medication remains effective in the body even after all tablets are consumed since the half-life is very long. In some cases, when used as an adjunct to mini-IVF, it can be given over an extended period of time. Typically your physician will bring you back after about a week to evaluate the ovarian follicles with an ultrasound.
You might be instructed to test for natural ovulation or might use an ovulation-inducing trigger shot instead. You will be notified to have timed intercourse or undergo intrauterine insemination. Your doctor might monitor your progesterone blood level. A pregnancy test is done about 14 days after ovulation. Yes, there are other oral medications that can stimulate the ovaries by the gonadotropin-releasing effect.
Some of them are Letrozole and Tamoxifen. Ultrasound monitoring at this stage also serves to measure the endometrial uterine lining and to make sure the clomiphene itself is not having any adverse effects on the endometrium see Clomiphene side effects, below , At this stage, patients are also asked to use an ovulation predictor kit to test for a surge in LH hormone, indicating imminent ovulation.
In most cases, patients are given an injection of hCG human chorionic gonadotropin also known as Ovidrel. This hormone initiates the release of the egg ovulation and the development of the corpus luteum, which will help the body to produce progesterone.
Ovulation usually occurs approximately hours after the hCG injection. After ovulation, a form of the hormone progesterone is given via vaginal tablets or gel in order to support the endometrial uterine lining and prepare it for the fertilized egg.
Patients are asked to take a home pregnancy test urine test two weeks after ovulation. If the home test is positive, a blood test will be performed to confirm the results. Clomiphene can sometimes decrease cervical mucus production, which may make it impossible for the sperm to swim through the cervix into the uterus.
To get around this potential problem, intrauterine insemination IUI may be advised so that cervical mucus may be bypassed altogether. If the lining is too thin, the embryo cannot implant successfully. This side effect tends to occur with repeated use or with higher doses of medication. Endometrial thinning will stop once clomiphene treatment concludes. An alternative therapy often recommended in these situations is a medication called Letrozole, which has a milder effect on the hormonal system.
Letrozole temporarily lowers estrogen levels, prompting the pituitary gland to increase FSH and LH production and promote ovulation. While letrozole is not yet FDA-approved for ovulation induction, widely conducted studies indicate that there is no detriment to this treatment option.
This condition is rare in clomiphene treatment, and more common with use of gonadotropin medications. Ovarian hyperstimulation syndrome is marked by abdominal bloating, nausea and diarrhea, and in more severe cases, symptoms including shortness of breath, difficulty with urination and chest pain. Adjustments can be made for those who hyperstimulate by decreasing medication and shortening the treatment cycle. The symptoms of hyperstimulation begin about a week after ovulation.
Mild cases last about a week and usually respond to hydration and careful monitoring. In general, ovarian hyperstimulation is highly unlikely, given careful monitoring of follicle development.
Multiple pregnancy may be a risk with clomiphene treatment. If an ultrasound scan reveals 3 or more mature follicles eggs indicating that a high multiple pregnancy is possible, patients may be advised to consider whether or not they would undergo embryo reduction, should a triplet pregnancy occur. If this procedure is not desired, or if multiple pregnancies would pose a physical or emotional challenge, patients may be recommended to forego attempts to conceive during this cycle.
Let's Connect. Learn About Pacific Fertility Center. Enter search terms Close search form. Translate page. Patient education: Ovulation induction with clomiphene Beyond the Basics. American journal of obstetrics and gynecology. Use of ovulation predictor kits as adjuncts when using fertility awareness methods FAMs : a pilot study. Kumar P, Sait SF. Luteinizing hormone and its dilemma in ovulation induction.
Journal of human reproductive sciences. Fertility awareness-based methods: another option for family planning. Procreative sex in infertile couples: the decay of pleasure?
Health and quality of life outcomes. Clomid Drug Information Sheet. Updated September 24, Your Privacy Rights. To change or withdraw your consent choices for VerywellFamily. At any time, you can update your settings through the "EU Privacy" link at the bottom of any page. These choices will be signaled globally to our partners and will not affect browsing data. We and our partners process data to: Actively scan device characteristics for identification.
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