Oral Medications

At Northern California Fertility Medical Center, many of our treatments involve the use of fertility medication to help our patients achieve conception, whether naturally or through In Vitro Fertilization (IVF). We feel it is important for our patients to understand how and why these prescriptions are used, what their risks are, and how they work in the body. The following is a brief description of the most common types of  oral fertility medication used at our practice. Some fertility medications are administered via injection.

Clomiphene Citrate

Due to its effectiveness and relatively low level of risk, clomiphene citrate is the most commonly prescribed fertility medication and is generally the first line of treatment for women with certain types of infertility. It can be used to stimulate ovulation to improve the chances of conception, or in preparation for a course of in vitro fertilization. It is also often used in fertility testing to determine ovarian reserve in women who are in their later reproductive years.

Indications

Aside from testing and IVF applications, women who are treated with clomiphene citrate are generally those who are anovulatory (do not ovulate), oligo-ovulatory (ovulate irregularly) or dysovulatory (ovulate irregularly due to a hormonal imbalance). This fertility medication can help to stimulate and regulate ovulation in most women. However, it is only effective if there is an adequate supply of eggs in the ovaries. Women with low ovarian reserve (generally over the age of 40) will most likely be advised to consider alternative options, such as egg donation.

Administration

Clomiphene citrate is administered orally for five days in the early stages of the menstrual cycle. Many fertility practices give this fertility medication from the fifth through the ninth day of the patient’s cycle. However, at Northern California Fertility Medical Center, we believe that earlier administration (from day three through day seven) optimizes the development of the ovarian follicles. These follicles contain the maturing eggs and release the estrogen that is necessary to prepare the lining of the uterus for implantation.

With clomiphene citrate therapy, 80 percent of pregnancies occur within the first three cycles of treatment. After three cycles, success rates decrease significantly and patients will most likely be advised to consider alternative treatments, such as gonadotropin therapy.

Effects

Clomiphene citrate mimics the chemical structure of estrogen. By blocking the estrogen receptors in the body and tricking the endocrine (hormone) system into sensing a decrease in the body’s estrogen levels, this fertility medication triggers the release of extra follicle stimulating hormone (FSH). In turn, FSH causes the ovaries to develop follicles and begin ripening eggs in preparation for ovulation. As the follicles develop, they release additional estrogen, which causes the lining of the uterus to thicken in preparation for implantation. Once estrogen levels reach a certain point, luteinizing hormone (LH) is released, which triggers the final maturation and release of the eggs (ovulation).

Risks

The risks of clomiphene citrate are extremely low in comparison to other hormone therapy options. Some women may experience mild side effects such as excess flatulence (gas), hot flashes, or minor visual disturbances. These effects will disappear after the fertility medication is no longer being taken. The occurrence of ovarian hyperstimulation syndrome (OHSS), a potentially serious condition, is extremely rare with the use of clomiphene citrate.