Fertility Treatment

 


Clomiphene Citrate with Estrogen Supplementation

Clomiphene citrate is an oral fertility medication.  It can be used to induce ovulation in women who don’t ovulate, or to produce multiple eggs in women who already ovulate on their own.  It is one of the safest, least expensive and most widely used fertility drugs in the United States.  Recent evidence suggests that adding an estrogen supplement increases the pregnancy rate.  Estradiol is a natural estrogen and has few side effects when used in short episodes; it should not be used if you are a heavy smoker or have a history of blood clots, heart attack or stroke. 

You will take two tablets of clomiphene citrate daily, starting on Cycle Day 3 and ending on Cycle Day 7. You will then use one estrogen pill inserted vaginally on Cycle Days 8 through 12.

An ultrasound is required during your first treatment cycle to check the effectiveness of the medications.  It is also used to time an insemination (IUI). You will need to call the office to schedule the sonogram for cycle day 12.  Once the follicles have reached the size of 18mm or greater, you will be given an injection of hCG to trigger ovulation and the IUI will be scheduled the following day.  Keep in mind 2-3 days of abstinence is recommended (but not longer than 1 week).

If you are timing the IUI by ovulation predictor kit, you should start checking your urine early in the morning with the kit on Cycle Day 11.  Most women will have a positive test around Cycle Day 13 or 14.  Once the test is positive, call the clinic to schedule the IUI.  Semen collection is scheduled in the clinic the following day and the IUI is usually performed approximately 1 - 2 hours later. If you have a positive surge on a weekend you will need to leave a message early in the morning no later than 9:00 am so that we may call you back to schedule your IUI for the following day.  You may collect the specimen at home if you live less than 60 minutes from the office and have a sterile container that we have provided for you.  If your test has not turned positive by Cycle Day 15, call the clinic for assistance. 

There is a 5-10% risk of twins with the use of clomiphene citrate; the risk of triplets or higher order pregnancies is <1%.  Side effects include hot flashes, bloating, breast tenderness, stomach upset, visual changes and headaches.  Visual changes or headaches that do not respond to Tylenol or aspirin should be reported immediately.  Ovarian cysts can appear with the use of clomiphene citrate, which may cause pelvic pressure or pain with intercourse or exertion.  They are usually self-limited and resolve without any further treatment except withholding the next cycle of clomiphene.