There are various causes of infertility, one of them being anovulation (lack of ovulation) common among women with infrequent or absent periods. Such women don’t secrete enough Luteinizing Hormone (LH) and Follicular Stimulating Hormone (FSH) at the right time during the cycle resulting in an immature egg that is not released. In such cases, the most commonly prescribed drug is Clomiphene Citrate also known by its brand names Clomid or Serophene. If the lack of ovulation is the only cause of infertility, most women on Clomid treatment will achieve a pregnancy within four to six months of treatment.
Structurally similar to estrogen, Clomid works as a selective estrogen modulator, by attaching itself to the estrogen receptor sites in the brain disallowing them to bind with naturally circulating estrogen. In response, the hypothalamus releases more Gonadotropin Releasing hormone (GnRH), stimulating the pituitary to drain more LH and FSH, which then cause the ovary into producing more eggs and follicles, resulting in ovulation. Generally, a woman taking Clomid doubles or triples the amount of estrogen production in that cycle compared to pretreatment cycles.
In women with irregular menstruation, Clomid helps small and immature follicles grow to maturity (about 20 millimeters in diameter). Also, low estradiol level in a woman’s blood correlates with an inadequately stimulated, small follicle. Although she may have enough hormones to produce an egg, but if her estradiol production is low (less than 100 pg/ml), she may not get ready to accept a fertilized egg for implantation. In such candidates, Clomid augments the stimulatory signals from the hypothalamus to the pituitary to the ovaries.
Clomid is also often effective in women with luteal phase defect (LPD). LPD causes a break in the natural ovulation process in women resulting in low production of the hormone progesterone in the luteal phase of the menstrual cycle. Clomid has provably enhanced the hypothalamus and pituitary functions so as to keep producing the hormones the ovary needs to manufacture progesterone throughout the luteal phase, resulting in ovulation.
One particularly positive aspect of Clomid is that it’s an effective fertility drug and doesn’t require injections. Economically priced and easily available, Clomid is taken orally for only five days each month. Clomid therapy is usually timed to help the woman ovulate on or around day 14 of a regular 28-day cycle, the popular dose being one daily 50 mg. tablet for five days starting on cycle day three or five. If this does not work, doctors generally double the daily dose to two tablets (100 mg) in her next cycle. In candidates where double dose also fails, the daily dose can be tripled to 150 mg or taken in addition another fertility medication such as human menopausal gonadotropin (Pergonal) can be used in the next cycle.