Clomiphene (Clomid, Serophene) is usually the first fertility drug of choice for women with infrequent periods and long cycles. Unlike more potent agents used in superovulation, clomiphene is gentler and works by blocking estrogen, which tricks the pituitary into producing FSH and LH. This boosts follicle growth and the release of the egg. Clomiphene can be taken orally, is relatively inexpensive, and the risk for multiple births (about 5%, mostly twins) is lower than with other drugs.
 BRAND NAMES
 MECHANISM OF ACTION
Clomiphene is a selective estrogen receptor modulator (SERM), it blocks estrogen receptors in the hypothalamus, which tricks the pituitary into producing FSH and LH by preventing negative feedback in hypothalamus. An increased level of these hormones improves the chances of growing an ovarian follicle that can then trigger ovulation.
Clomiphene citrate is the initial treatment of choice for most anovulatory or oligo-ovulatory infertile women. Anovulation may be due to PCOS or obesity.
Women with the best chances for success with this drug are those with the following conditions:
- Polycystic ovaries (PCOS).
- Obese oligo-ovulatory women
- Ability to menstruate but irregular menstrual cycle.
Women with poorer chances to no chances with this drug have the following conditions:
- Infertility but with normal ovulation.
- Women with low estrogen levels.
- Premature ovarian failure (early menopause; when a woman's ovaries stop working before she is 40).
50 mg are taken each day for five days, usually starting two days after the period starts (one pill on Day 3 through Day 7). If successful, ovulation occurs about a week after the last pill has been taken. If ovulation does not occur, then a higher dose (100 mg) may be given for the next cycle. If this isn't successful, treatment may be prolonged or additional agents may be added. Experts usually do not recommend more than six cycles.
During a clomifene-induced cycle, there should be frequent intercourse (every other day) the week before and including the estimated day of ovulation, (cycle days 9-18).
- Pregnancy: Clomiphene should not be administered in cases of suspected pregnancy.
- Liver Disease: Patients with liver disease or a history of liver dysfunction should not receive clomiphene therapy.
- Abnormal Uterine Bleeding: Clomiphene is contraindicated in patients with abnormal uterine bleeding.
- Ovarian Cysts and Endometriosis : Use of clomiphene is contraindicated when pre-existing endometriosis and ovarian cysts not due to polycystic ovary disease.
- Uncontrolled thyroid disease
- Pituitary tumour
- Adrenal gland dysfunction
 WARNINGS AND PRECAUTIONS
- Blurring or other visual symptoms such as spots or flashes may occasionally occur during therapy with. This may increase the dangers of driving and/or increase the dangers of operating machinery. Patients with any visual symptoms should discontinue treatment and have a complete ophthalmological evaluation carried out promptly.
- Ovarian hyperstimulation syndrome can occur rarely in women taking clomiphene. In this condition, the ovaries enlarge suddenly, and fluid (called ascites) leaks into the abdominal. It should be borne in mind that maximal enlargement of the ovary, does not occur until several days after discontinuation of the recommended dose of Clomiphene. The patient who complains of pelvic pain after receiving Clomiphene should be examined with care. If enlargement of the ovary occurs, additional Clomiphene therapy should not be given until the ovaries have returned to pretreatment size, and the dosage or duration of the next course should be reduced.
- Drug interactions with Clomiphene have not been documented.
 PREGNANCY AND LACTATION
- Pregnancy Category X (US)
- Nursing Mothers: It is not known whether Clomiphene is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised if clomiphene is administered to a nursing woman. In some patients, clomiphene may reduce lactation.
 SIDE EFFECTS
Clomiphene reduces the amount and quality of cervical mucous and may cause thinning of the uterine lining. In such cases, other hormonal agents may be given to restore thickness.
Other side effects include ovarian cysts, hot flashes, nausea, headaches, weight gain, and fatigue. There is a 10% chance of having twins with this agent, and a slightly increased risk for miscarriage.