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Clomiphene citrate therapy: how long should we try?

Setting expectations for your treatment course

What to expect

About 25% of women with conception difficulties have problems developing or releasing a mature egg. This condition is called anovulation. Clomiphene citrate is commonly prescribed to stimulate ovulation in women who do not ovulate or ovulate infrequently and whose male partners are fertile.

During the first half of the menstrual cycle, the hypothalamus gland releases a hormone called gonadotropin-releasing hormone (GnRH). If too little or too much is released, normal follicle development will not take place and ovulation will not occur. Clomiphene citrate stimulates the release of GnRH to restore ovulation.

Some statistics to keep in mind

Clomiphene citrate brings on ovulation in 80% of appropriately selected patients.¹
Among those who respond to clomiphene citrate the average chances of getting pregnant are 15% per cycle.¹
Up to 45% of clomiphene citrate-responsive women may become pregnant within six treatment cycles.²

How long should we try?

Six ovulatory cycles is considered to be sufficient time to establish if pregnancy can be achieved with clomiphene citrate treatment. In fact, 71-88%³ of the pregnancies achieved with clomiphene citrate were reported with the first three cycles of treatment.

Fertility declines with age. If you have not been successful with clomiphene citrate treatment after six treatment cycles, it is wise to discuss with your doctor what further diagnostics and treatments should be considered.¹

Finding the right help

It requires great skill to identify the source of fertility problems and recommend appropriate treatment. A specialised clinic will be able to offer a complete diagnosis and advanced treatment options – beyond your doctor’s care. The difficulties you’re having may be due to a variety of factors affecting both you and your partner. The good news is that there’s a range of treatments available. Look at the fertility pathway and learn about treatment options.

^{1. Use of clomiphene citrate in women. The Practice Committee of the American Society for Reproductive Medicine. Fertil Steril 2006;86:S187-193 2. Medications for Inducing Ovulation. A Guide for Patients. ASRM 2006; http://www.asrm.org/Patients/patientbooklets/ovulation_drugs.pdf 3. Homburg R. Clomiphene citrate—end of an era? A mini-review. Hum Reprod. 2005;20(8): 2043-2051.}

Obstetrician/Gynaecologist

A doctor who delivers babies and specialises in the treatment of female reproductive organs.

Oestrogen

A hormone that stimulates secondary female sexual characteristics and controls the course of the menstrual cycle. Oestrogen is also produced in low quantities in males.

Oligospermia

A condition when a sperm sample contains less than 20 million spermatozoa per ejaculate. Many medical conditions reduce sperm concentration. The effects may be temporary or permanent. See also Azoospermia.

Outpatient

A Person undergoing a clinical procedure that does not require admission to hospital.

Ovarian failure

The failure of the ovary to respond to hormonal stimulation from the pituitary gland because of damage to or malformation of the ovary, or a chronic disease such as autoimmune disease or ageing process.

Ovarian follicle

The structure in which eggs are nurtured to maturation. Although in general only one egg is released at a time, somewhere between 10 and 20 follicles begin the process of maturation monthly. The excess ovarian follicles are reabsorbed before ovulation occurs.

Ovulation

The release of the matured egg or ovum from the ovarian follicle.

Ovum

A matured egg.

Ovulation Induction (OI)

Medical treatment carried out to initiate ovulation.

Ovarian Hyper Stimulation Syndrome

A condition characterised by enlargement of the ovaries, fluid-retention and weight gain. May occur when the ovaries are over-stimulated during assisted reproduction.

Ovaries, Ovary

Almond-sized organ(s) located on either side of the uterus, which produce and release mature egg cells and the hormones oestrogen and progesterone.

Hepatitis

A disease characterised by inflammation of the liver arising from various causes including a range of viruses (i.e. A, B, C, E).

Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome

A disease of the human immune system caused by the HIV virus, which can be contracted through sexual contact.

Hormonal imbalance

An abnormal hormonal balance, which may arise for example, from a deficiency or excess of oestrogen or progesterone.

Hormones

Chemical messengers produced by the body that transmit instructions from one organ to another.

Human Chorionic Gonadotrophin

A hormone released by the placenta after implantation that keeps the corpus luteum producing estradiol and progesterone, and thus preventing menstruation. The hormone is also given via injection to trigger ovulation after some fertility treatments. In men, it is used to stimulate testosterone production.

Human menopausal gonadotrophin

Natural compounds found in the urine of postmenopausal women. Once extracted and sterilised, hMG is given to women to stimulate ovulation.

Hysteroscopy

A visual examination of the uterus via the vagina using a telescopic instrument, to identify any malformations in the uterus lining, the presence of myomas, fibroid growths or damage to the fallopian tubes. If necessary, minor surgery may be performed at the same time without the need for a large incision.

Hypogonadotrophic Hypogonadism

Impaired activity of the hypothalamus or pituitary glands resulting in below-average function of the ovaries or testicles and low in low production of the hormones Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH), Oestrogen, Progesterone and Testosterone, which are necessary for reproduction.

Hypothalamus

The gland at the base of the brain that controls the release of hormones from the pituitary glands.

Fallopian tube

A funnel-shaped passage through which sperm are guided towards the egg, and fertilized eggs are conveyed to the uterine cavity.

Fertilization

The moment of conception when the genetic material contained in the sperm and egg combine to create an embryo. Fertilization usually occurs inside the fallopian tube. It may also occur in vitro during a clinical process. See also In Vitro Fertilization.

Fertility treatment

Any procedure used to enhance fertility or to help couples achieve pregnancy.

Fertility psychologist

A health specialist with professional qualifications in psychology and counselling relating to fertility issues.

Fibroid tumour

A benign (that is, not malignant or life-threatening) tumour made up of fibrous tissue that may form in the uterine wall. Fibroid tumours may be present without any symptoms, or may cause abnormal menstrual patterns or infertility.

Follicle

A fluid-filled sac in the ovary, which contains the egg released during ovulation. Each month a new egg matures and travels to the fallopian tube.

Follicle Stimulating Hormone

A hormone released by the pituitary gland in both sexes. In women, FSH stimulates the growth of the ovarian follicle necessary for egg production. In men, FSH stimulates and supports sperm production. Elevated FSH levels are associated with gonadotrophin failure in both men and women.

Freezing

(See Cryopreservation)

Cervical mucus

A natural lubricant produced by the female body that aids the transportation of sperm and helps protect against infection.

Cervix

The cervix or neck of the uterus is the lower, narrow portion of the uterus where it joins with the top end of the vagina.

Chlamydia

A sexually-transmitted infection, which may be asymptomatic or cause genital inflammation and discharge, pelvic pain and fever. Untreated, chlamydia can lead to Pelvic Inflammatory Disease (PID) and fertility problems.

Chromosomes

Structures found in the nucleus of cells that contain genes and carry heredity information, such as eye colour, blood type and vulnerability to disease. Humans have 23 pairs of chromosomes. One set of 23 chromosomes is inherited from the biological mother via her egg and the other from the biological father, via his sperm. Each sperm cell contains either male or female sex chromosomes. As such, it determines the gender of the foetus. Genetic abnormalities occur when an individual is born missing a chromosome or has more copies of a chromosomal pair.

Clomiphene citrate

A prescription drug used to bring on ovulation. It comes as a tablet and is often used as an initial treatment for women with ovulation problems. Clomiphene citrate induces ovulation in 80% of women who have trouble ovulating on their own.

Conception

The moment of fertilization when the sperm meets and penetrates the egg.

Congenital abnormalities

Physical abnormalities present at birth.

Corpus luteum

A hormone-secreting mass within the ovary that forms from the remains of a follicle each time an egg is released. The hormones it produces prepare the uterus for embryo implantation. If pregnancy does not occur, the mass is shed during menstruation.

Cryopreservation

A technique used to store human tissue at very low temperatures. Embryos that are not used in an ART cycle may be preserved in this way for future use. Also known as “Freezing”.

Cryptorchidism

A condition usually detected at birth or childhood whereby the testicles fail to descend. When a male foetus develops in the uterus, his testicles normally form inside his abdomen and descend into the scrotum shortly before birth. Undescended testicles usually descend themselves by the sixth month of life, but are unlikely to descend after this period of their own accord.