14 Feb 2020

Feedback Friday: How does Clomid Work?

by | posted in: Feedback Friday, Ovulation DIsorder, Ovulation Induction, Starting Out, Treatment | 0

Dear Eggsperts–Hello! I have a question. Could you give some insight and information into Clomid? My doctor prescribed it to help me ovulate? I guess? She explained it, but I’m still not grasping it completely. –Bewildered in Birmingham

Dear Bewildered–You aren’t alone here. This is one of the most common questions we answer in the fertility clinic. I think I talk to patients about this a dozen times a day. It’s both simple and complicated at the same time. I try to keep it as simple as possible. Sure, there are some subtle nuances in the physiology that I don’t get into, because really, at the end of the day, you want an idea of how it works, but don’t really want all the weedy details? Right? I’m making those assumptions for you.

Some background: Clomid (Clomiphene Citrate) was the first drug approved by the FDA for treatment of infertility in 1967. So, it’s been around awhile. Would you believe me if I told you it was first tested as a contraceptive agent? No way, right? Well, that’s because Clomid is an Estrogen blocker…we will talk about that in a bit.

So, how does it work? I’m attaching a little video of a sketch I draw a lot in the clinic. Don’t laugh at my lack of artistic skills. And nope, I’m not tech savvy to do something cool with some of the apps these days, so it’s just a quick and dirty from my phone. And, I don’t stutter so much when I talk to my patients, but it’s weird for me being on camera.

Growing Dominant Follicle

Click Here for Link to our YouTube Video

  • The basics are:
    • The pituitary in the brain releases Follicle Stimulating Hormone (FSH)
    • FSH stimulates follicles in the ovary to grow larger
    • Follicles are the “cyst” areas in an ovary where eggs live. As the follicles get bigger, an egg is maturing
    • As the follicles grow, they produce Estrogen (and a few other hormones) that signal the pituitary (and hypothalamus) that the ovary is responding
    • Normally, this keeps the pituitary from releasing even more FSH
    • Clomid blocks the signal of FSH at the brain so the brain thinks the ovary isn’t growing follicles (maturing eggs)
    • The brain responds by sending more FSH to the ovary
    • The ovary grows one (or more) follicles
    • If everything is working well, the amount of Estrogen produced brings the FSH level back down to low levels

Does that make sense? There is a little more complexity with different hormones and parts of the brain, but I don’t think you really need to understand all the nitty gritty details. If you do want more information, let us know and we’ll get into the deep dive for you.

OK … you may ask, how should I take Clomid? And what’s the dose? Every patient is different, so I’m going to leave those details to your doctor. But, in general, you take Clomid for just a few days a month near the beginning of your menstrual cycle. Here is a little graphic that may give you a general idea.

https://www.verywellfamily.com/clomid-treatment-day-by-day-what-to-expect-1959970

Now, you may wonder about side effects and risks. Overall, Clomid is pretty low-risk. Some of the side effects and risks are due to effect of reduced Estrogen signalling in the brain, or due to the effect of stimulation of the ovaries.

  1. Common side effects include:
    • Hot flashes
    • Nausea/vomiting
    • Bloating
    • Breast tenderness
    • Moodiness
  2. More serious side effects include:
    • Blood clots
    • Ovarian Hyperstimulation Syndrome
    • Vision changes –Stop Clomid if you develop blurry vision, blind spots, flashing lights. These are usually short-lived, but can become permanent
  3. Multiple births–More eggs ovulating means more eggs can fertilize and implant

So, Bewildered, does this make a little more sense to you? We hope so.

We hope we met your Eggspectations—An Eggspert

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Disclaimer: All of the comments on this page are for basic information only. They are based on the opinions and expertise of the authors and are not meant to provide a substitute for medical care or specific treatment recommendations. Each person is unique and requires individualized diagnosis and treatment plans. Any specific questions should be directed to your personal healthcare provider.