Clomiphene Citrate has been used to induce ovulation since the 1960’s. Given orally in a tablet form at doses of 50 to 200 mg daily for five days each month (usually on days five to nine of the cycle), it is the most commonly prescribed ovulation medication. Clomiphene is a synthetic medication that acts as an anti-estrogen and stimulates production of LH and FSH, pituitary hormones that induce the ovary to ovulate. Approximately 80 percent of patients who do not normally ovulate will ovulate on clomiphene. Approximately 40 percent of these will conceive.

Indications:
Clomiphene is indicated in patients who do not ovulate. These patients usually have chronic anovulation (often associated with polycystic ovarian syndrome [PCOS]). Patients who do not ovulate because of ovarian failure (premature menopause), thyroid abnormality, elevated prolactin hormone, or hypothalamic causes are unlikely to respond to this medication. On special occasions, the medication may be used in normally ovulating patients in order to increase the number of eggs that ovulate.

Contraindications and adverse effects:
Clomiphene treatment must be monitored closely, usually with an examination (or an ultrasound) in the early part of the cycle before the medication is taken. A basal body temperature chart and /or ovulation predictor monitor should be used to assess ovarian response. A mid-cycle ultrasound may be suggested.  Pregnancy (diagnosed or undiagnosed), the presence of large ovarian cysts, or estrogen-dependent cancer are absolute contraindications to clomiphene. Common side effects include hot flashes, mood changes, headaches, or mid-cycle lower abdominal pain. Common adverse effects include reduction in cervical mucus (dryness) and reduction in the thickness of the uterine lining (endometrium). Clomiphene increases the risk of multiple births (primarily twins) to seven to ten percent of deliveries. If the medication is to be used for more than three consecutive cycles, a one-month break may be advisable before the next treatment cycle. The medication is usually not effective after six cycles.