Congratulations on taking action and being proactive in learning more about getting pregnant with PCOS .
The primary goal of fertility treatment in women such as yourself with PCOS is to restore ovulation. There are multiple methods to boost ovulation, some work directly on the brain and others directly stimulate the ovary, but starting with the easiest and cheapest method is the first line treatment.
You will need to see a fertility specialist for these treatments, but do not be nervous as they do work and will help women just like you get pregnant most of the time.
In this article I will be talking about clomid in just the same way as I would talk to my patients. Giving you a simple step by step approach to what happens in treatment and chances of pregnancy
Clomiphene Citrate – also called Clomid
Clomid is considered the gold standard for inducing ovulation and is the first line of treatment of choice besides changing your lifestyle and weight loss.
It comes as a tablet and is reasonably easy to take. It is also inexpensive.
Clomid acts by fooling the brain into thinking there is no female hormone called estrogen. In response to this an area in the brain called the pituitary starts to secrete extra gonadotrophin hormone called follicle stimulating hormone -FSH.
FSH then stimulates the ovary, this leads to follicle selection and growth and estrogen production in the ovary, and subsequent ovulation.
- I start with the lowest dose of clomiphene citrate that will stimulate your follicle, and the aim is to grow only one follicle
- So a reasonable starting dose is 50mg a day and this is taken for 5 days only starting from about the second day of your cycle/period to day 6. Almost half of the pregnancies are achieved with this dose.
- Because you begin the treatment when your period occurs we can either wait for your next period, but this may be weeks or months or we can bring on a period. I do this by prescribing a 7 day hormone treatment called progesterone. This will induce your period. Then you can start
- You need to be monitored in the cycle to assess follicle development- making sure there are less than 2 follicles growing. This is done with an ultrasound around
day 12 of your cycle.
- I also organize for a blood test for the hormone level progesterone to be done about day 21-22 of the cycle. This is to confirm whether you have ovulated and therefore if the dose of clomiphene citrate you are on is the correct dose.
- I recommend the best timing for sexual intercourse are on days 12, 14, 16 and 18. But this can vary from woman to woman, and your first cycle of clomiphene citrate is often a trial as we will not know how it will go until it is finished and you sit back down with your fertility specialist to review.
We say ovulation has occurred if the blood progesterone level is > 30 nmol/l.
If you have not ovulated on the 50mg dose of clomiphene citrate then the dose is increased in each of your next cycles by 50mg up to a maximum of 150mg/day. I have had to do this with about 40 % of my women.
Usually a course of about 3 to 6 cycles is sufficient to know whether it will work and help you get pregnant
You chances of ovulation with clomiphene citrate are about 70- 80%. Your chances of pregnancy are about 60% after 6 cycles.
Side effects and risks:
- You have a 20- 30 % chance of being clomiphene resistant. that is where after 6 months of increasing doses of clomiphene citrate treatment you have not ovulated. Women who are overweight and have high androgen levels are more likely to be in this resistant group. That is why it is so important to reduce the weight.
- There is a multiple pregnancy rate mainly twins of between 5- 7% with clomid therapy as sometimes more than 1 egg may grow and ovulate on this treatment.
- I warn my patients they may have some hot flushes, and night sweats with the medication and sometimes nausea
- You may also feel your tummy is more bloated than usual as your ovaries will be larger
- Lastly a more serious side effect called Ovarian hyperstimulation syndrome can occur (OHSS). This is where the ovaries have over responded and grown many follicles. The main symptoms are bloated tummy, shortness of breath, pain or discomfort and often require admission and observation in hospital. The chance of this is less than 1 %.