Clomiphene Citrate (Clomid) and Intrauterine Insemination
What is Clomiphene Citrate?
Clomiphene Citrate (also known as Clomid) is an oral medication that is given to promote ovulation in patients who do not ovulate regularly, or to cause superovulation (release of more than 1 egg) in patients who already ovulate on their own.
Clomid works tricking the brain into thinking that there is a lack of estrogen. As a result, the brain produces more follicle stimulating hormone (FSH), which stimulates the growth of multiple follicles.
What are the success rates with Clomid with and without intrauterine insemination (IUI)?
Success rates with Clomid and intrauterine insemination (IUI) vary depending on a woman’s age and the cause for infertility. Regardless of the cause of infertility, success rates decrease with increased maternal age, due to a higher percentage of abnormal eggs.
If the fertility issue is due to a lack of ovulation, success rates are higher: 70 to 80 percent of patients will ovulate when using Clomid.
A 2014 study in the New England Journal of Medicine showed a 27.4 percent cumulative pregnancy rate and 19.1 percent cumulative live birth rate for women with polycystic ovarian syndrome (PCOS) who underwent ovulation induction with Clomid and subsequently had timed intercourse for up to 5 cycles.
Women with unexplained infertility (where no clear diagnosis exists after a full infertility work-up) will have lower success rates with Clomid, as compared to those with ovulatory dysfunction. However, these rates improve when intrauterine insemination (IUI) is added.
The preferred treatment strategy for women with unexplained infertility is Clomid therapy with IUI. IUI can help overcome any cervical issues by directly depositing concentrated and mobile sperm into the uterus using a long thin catheter that is inserted through the cervix.
A 2015 study in the New England Journal of Medicine showed a cumulative pregnancy rate of 28.3 percent and a cumulative live birth rate of 23.3 percent in women with unexplained infertility who underwent up to 4 cycles of ovulation induction with Clomid and IUI.
What is involved in a Clomid and IUI Cycle?
Day 3 of your menstrual cycle: You’ll get bloodwork done and start taking Clomid for five days.
Your fertility doctor will monitor your response to the medication with the help of a transvaginal ultrasound.
24 to 36 hours after ovulation: On the day of IUI, your partner will produce a semen sample that is prepared in the laboratory.
If you are using donor sperm, the sperm will be thawed in the lab and prepared for the procedure using the same process. The sperm must be prepared because unprepared semen contains prostaglandins, which can cause significant cramping when placed directly into the uterus.
Does Clomid increase your risk of twins and triplets?
The risk of conceiving twins on IUI and Clomid is 8 percent. The risk for triplets is less than 1 percent.
Are there cases in which Clomid will not work?
Clomid will not work if a woman has certain conditions, including:
- hypothalamic amenorrhea, or the absence of menstruation due to a problem with the hypothalamus, the portion of the brain that links the nervous system to the endocrine system via the pituitary gland. The condition is often seen in women with eating disorders and very low body fat. Clomid requires a normally functioning hypothalamic-pituitary axis.
- blocked fallopian tubes
- problems with ovulation that are due to other hormonal disturbances (e.g. high prolactin or abnormal thyroid function)
- very low ovarian reserve
Which option is best for me?
Clomid therapy alone and Clomid therapy with IUI are options for fertility treatment that have their own specific benefits, pregnancy success rates, risks of multiples, side effects, and variable cost. It is important to discuss your particular situation with your fertility doctor to find out what is right for you.
Dr. Sydney Chang is a Fellow in Reproductive Endocrinology and Infertility at the Icahn School of Medicine at Mount Sinai/Reproductive Medicine Associates of New York. She earned her Bachelor of Arts in Human Biology at Stanford University, where she graduated with Honors and Distinction. She went on to complete her medical school education at Duke University School of Medicine. She completed her residency in Obstetrics, Gynecology, and Women’s Health at the Albert Einstein College of Medicine, where she served as an administrative chief resident.