South Florida Institute for Reproductive Medicine

When considering or taking clomiphene (Serophene or Clomid)

THERE ARE FOUR IMPORTANT THINGS TO KEEP IN MIND

Clomiphene is a drug to induce ovulation. Therefore, additional steps should be taken to monitor whether ovulation is taking place.

Once an ovulatory dose is documented, higher doses are not recommended or practical.

Higher doses can have additional adverse effects on cervical mucus making it more difficult to conceive.

A therapeutic trial on clomiphene is 3 to 6 ovulatory cycles. The chance of pregnancy beyond this is very minimal. More advanced therapy should be considered.

HOW DOES CLOMIPHENE WORK?

Ovulation induction is the therapy given for a condition called Ovulation Disorder. Ovulation requires a delicate balance of hormones. It happens when there is a proper regulation of the hormones FSH and LH: the "hypothalamus-pituitary-ovarian axis". The hypothalamus and pituitary are next door neighbors in the brain and work together to ultimately induce production of follicles from the ovaries. (For this explanation they will be referred together simply as the "brain").

The brain monitors how much estrogen is in the body. If it is low, it sends FSH to the ovaries, which helps them develop a follicle, which secretes estrogen. Once there is sufficient estrogen in the body, the brain assumes there is a follicle that is ready to release an egg (ovulation). To cause this rupture, the brain sends a hormone called LH.

Clomiphene is a drug that fools the brain into thinking that estrogen levels are low. As a result, the brain releases more FSH than it normally would to the ovaries to develop a follicle. If clomiphene doesn't work, the next level of therapy involves the fertility drugs which actually contain FSH. If the brain won't make FSH in adequate supply, we simply inject FSH into the system and carefully monitor the body's reaction with ultrasound and estrogen tests.

HOW DO INJECTABLE FERTILITY DRUGS WORK?

Injectable fertility drugs have been in use for almost 40 years. They help a woman produce her own eggs to have her own biological child. The children conceived through the use of fertility drugs have no greater risk of birth defects than in the general population.

The therapy involves daily injections for about 10 days. After 5 days of injections, we begin to monitor the body's response from the drugs with ultrasound and estrogen tests. The ultrasound helps us see how many follicles are developing. The estrogen tests gives us an indication of the rate of response to the drugs. The monitoring helps us adjust the dose to help the cycle be most effective, with the least amount of risk for multiple births.

Multiple births occur in about 20% to 25% of the cases. The vast majority of these births are of twins. Higher order multiple births can be significantly minimized with the proper monitoring of an experienced team.

Fertility drug ovulation induction is successful for about 15% of each attempted cycle. After 4 or 5 cycles, IVF should be considered. The cost for fertility drug ovulation is about $2000 per attempt. Your own actual cost will vary with the quantity of fertility drugs and amount of monitoring that is necessary.

For more information see our Q&A section.