How does Clomid work?

It's one of the very first medications that a woman struggling with infertility might take, but why?

Clomid (Clomiphene) is an oral medication that stimulates the ovaries to produce eggs. As with all things fertility related, when it comes to Clomid, timing is everything.

With pregnancy being the #1 goal, Clomid can be prescribed by an OBGYN and taken in tandem with timed intercourse at home. A fertility doctor may also prescribe it as part of an IUI, IVF or mini IVF treatment plan. But how exactly does Clomid work?

Below, we cover just a few reasons why it’s a drug you might want to embrace  - and reasons why you might want to avoid it all together. Should you lean towards the latter, we also investigate some of the best alternatives to Clomid out there. As with anything fertility related, always check with your doctor first. In the meantime, here’s a Cliff’s Notes version of what you can expect from this legendary TTC drug.

What is Clomid?

Clomid and Serophene are brand names for the drug Clomiphene Citrate, a medication most often prescribed to women who have difficulty getting pregnant. However, it can also be used to treat a number of other issues and, in some cases, it might even be prescribed to men to treat male infertility.

Usually, Clomid is taken orally - 3-4 days after the start of a woman’s menstrual cycle for 4-5 days straight. Depending on your individual body, your doctor may put you on an incrementally increasing dosage while closely monitoring how your body reacts to it. Again, every woman is different and so is every doctor.

How does Clomid work?

In a nutshell, Clomid is used to induce ovulation by tricking the body into thinking that it is producing less estrogen than it actually is in reality. There is a delicately balanced cycle that occurs in a woman’s body where FSH (Follicle Stimulating Hormone) literally “signals” to the ovaries to grow eggs. As these grow and mature, they put out estrogen. This estrogen determines how much FSH is then made. When Clomid is on the scene, it actually toys with your body’s ability to detect estrogen so it puts your body into an artificial FSH overdrive; stimulating your ovaries and eventually triggering ovulation. Pretty clever, Clomid.

Who takes Clomid?

As we mentioned above there are quite a few reasons why a woman (or a man) might be prescribed Clomid. Here, we dive a bit deeper into the pre-existing health conditions, how they can impact one’s fertility and how Clomid might be able to help the problem.

Women

Clomid can be used by women who do not suffer from any known reproductive challenges other than “unexplained infertility”. Because it stimulates the ovaries, it can be used to get your cycle on track and kick the ovaries into high production mode.

For women who suffer from the below conditions, Clomid - or a similar drug - is often their only option for starting a family. Such ovulatory disorders include:

• PCOS - Polycystic Ovarian Syndrome is a hormonal disorder in 1 out of 10 women of child-bearing age. It’s causes are unknown. Due to the imbalance of reproductive hormones, a woman with PCOS may have eggs that do not develop appropriately or ones that are not released at the proper time. Common symptoms of PCOS include irregular periods and the presence of small fluid-filled sacs on the ovaries. Thanks to its ability to help a woman’s eggs develop and trigger ovulation, Clomid can help a woman with PCOS get her cycle intact and back on track in an attempt to facilitate pregnancy.
• Hypothalamic Dysfunction - The brain’s hypothalamus regulates many things in the body - including how the pituitary gland produces and releases hormones. Get where we are going here? Any disruption to the hypothalamus can inturn, cause a disruption to a woman’s reproductive hormones and, in turn, her ability to ovulate.
• Premature Ovarian Failure (POF) - This condition also goes by the name of Primary Ovarian Insufficiency. In very basic terms, this is when the ovaries fail to function properly even though a woman is still of child-bearing years or under the age of 40. If the ovaries do not produce any or enough estrogen it can impact the ability for a woman to grow or release eggs. For this reason, Clomid can come into play, helping to restore those estrogen levels and increasing the chance of pregnancy.

Men

Surprise, surprise! Clomid is not just for the ladies. It can actually be prescribed to men who suffer from low sperm count. In men, the drug triggers production of the hormones that cause an increase in testosterone. And, testosterone levels are the #1 factor when it comes to sperm production. Let’s take a look at what might cause doctors to prescribe Clomid to men:

• Low Sperm Count - While Clomid is not actually approved by the FDA to treat low sperm count, it is commonly prescribed precisely for that reason.  Low sperm count can be attributed to a number of causes. If it is due to hormone imbalances then Clomid can be very effective in countering those imbalances by boosting testosterone levels.
• Non-obstructive Azoospermia - With this condition, a man’s body is unable to produce sperm all together. This can be caused from traumatic injury, exposure to radiation, reproductive tract infections, sexually transmitted disease and more. However, it is rare and affects only about 1% of the male population. By boosting sperm production, Clomid can help facilitate a spontaneous pregnancy or successful sperm extraction for future IUI or IVF treatment.

Side Note: Because it aids in Testosterone production, Clomid is also used by men to improve their physical appearance (a.k.a reduce “man boobs”) and performance. It is known to be one of the first drugs used by male bodybuilders to compensate for the drop in testosterone commonly experienced when using anabolic steroids.

Who should avoid taking Clomid?

This is a fantastic and important question. Of course, your OBGYN or Reproductive Endocrinologist should be aware of any pre-existing conditions you may have before prescribing medication. In particular, there are a few that might result in serious reactions. Here are our top 3 “If you” reasons to avoid Clomid:

• If you are pregnant Just to be on the safe side, most doctors will have you take a blood test and even do an ultrasound to make sure that you are not pregnant before they prescribe Clomid. Why? Studies published by the New England Journal of Medicine show a link between women who have taken Clomid during the first month of pregnancy and an increased risk of having a baby with a birth defect. They are also more likely to have multiples - which can be dangerous.
• If you have liver disease - When you take Clomid, it is metabolized by the liver. For those who have issues with their liver, it can increase the concentration of Clomid and up the time it is present in your system - making it difficult to determine correct dosages.
• If you have Uterine Fibroids/Endometriosis - Because clomid creates a cycle that triggers more estrogen to be released in the body, it can be dangerous for women who suffer from uterine fibroids, causing them to grow. Large fibroids can not only impact the shape of the uterine cavity and increase a woman’s chance of infertility, but it can also impact pregnancy resulting in an increased risk of miscarriage. The same goes for women with Endometriosis - tissue that grows around and outside of the uterus.

In both of these cases, taking clomid is very much a Catch-22: you want to aid ovulation and egg production, but to do so, you risk aggravating pre-existing conditions that can lessen your chances of successfully getting pregnant. The key here is frequent monitoring and good communication with your doctor.

Who can prescribe Clomid?

Technically, any licensed physician can prescribe Clomid. If you are having trouble getting pregnant, turn to your OBGYN or find a qualified Reproductive Endocrinologist to discuss your options. These are your best options for making sure you are taking it safely and effectively.

What are the side effects of taking Clomid?

Side effects from taking clomid range from nothing whatsoever to serious complications of the thyroid, liver or ovaries. This includes OHSS (Ovarian Hyper Stimulation Syndrome). Here is a list of common side effects in women that, although unpleasant, should not necessarily raise any red flags. However, as always, if anything feels “not right” it’s always a good idea to check with your fertility doctor or nurse practitioner.

• Breast tenderness
• Bloating
• Hot flashes
• Nausea
• Dizziness
• Weight gain

How do I know if I am having an allergic reaction to Clomid?

If your hands, lips, face and/or other body parts begin to swell up suddenly, you may be having an allergic reaction to clomid. This might also be accompanied by trouble breathing and the appearance of hives - a red rash, that can be itchy, on patches of skin.