Approximately 80 percent of women who do not ovulate on their own will ovulate on clomiphene citrate. Women who do not spontaneously ovulate are often treated with up to six cycles of clomiphene citrate therapy.
Clomiphene citrate is often prescribed for couples with unexplained infertility. Intrauterine insemination (IUI) is often performed in conjunction with clomiphene citrate ovulation induction. In such situations, clomiphene citrate is typically prescribed for two to four months before consideration is given to more advanced therapies.
Infrequent side effects of clomiphene citrate include headache, visual changes, moodiness and hot flashes. Clomiphene citrate can thin the uterine lining, which may result in diminished uterine receptivity. Should the uterine lining be too thin, subsequent cycles use lower clomiphene citrate dosing. Clomiphene citrate can also dry up cervical mucus, a common indication for intrauterine insemination.
The risk of multiple pregnancies (twins or higher) is low with clomiphene citrate. Approximately seven to eight percent of pregnancies will be twins. Although triplets and quadruplet pregnancies have been reported with clomiphene citrate, the chance is extremely remote. Ovarian cysts may result from clomiphene citrate therapy, but typically resolve within one cycle.
Injectable medication to trigger the release of the egg(s) is often used in conjunction with clomiphene citrate, including commonly prescribed medications such as Novarel, Ovidrel, Pregnyl and Profasi. Commonly prescribed clomiphene citrate medications include Clomid, Milophene and Serophene.
These medications are typically used in conjunction with intrauterine insemination (IUI). FSH or FSH/LH medication is commonly started on the third day of a menstrual period and is continued for approximately 10 days. Ovarian response to medication is monitored with blood work and ultrasound while on medication, in order to individualize therapy. Most patients are seen in our office every two to three days during the course of therapy.
The majority of pregnancies from gonadotropin therapy are single babies. Twins occur in approximately 25 percent of pregnancy cycles. Multiple gestations, including triplets, quadruplets and quintuplets occur in fewer than five percent of pregnancies.
Frequent monitoring of the patient while taking injectable infertility medications is designed to maximize the likelihood of pregnancy while minimizing the risk of multiple pregnancy and hyperstimulation. Pregnancy rates with injectable FSH or FSH/LH and intrauterine insemination are as high as 20 percent per cycle. Most couples undergo two to four cycles of injectable FSH or FSH/LH therapy prior to moving on to in vitro fertilization (IVF).
Commonly prescribed injectable infertility medications include Bravelle, Follistim, Gonal-F and Menopur.
Injectable medication to trigger the release of the egg(s) is used in conjunction with gonadotropins. Commonly prescribed medications include Novarel, Ovidrel, Pregnyl and Profasi.