You may be one of approximately 25% of the female population that has been told that you have an ovulatory disorder (the inability to produce and or release eggs). If so, you may have been placed on a medication called clomiphene citrate, which is the most commonly prescribed oral fertility medication.
While approximately 80% of patients will ovulate on clomiphene citrate, only 40-45% will conceive within 6 cycles. After this the rates drop sharply. It is important to bear in mind that there are other variables that impede fertility beyond ovulation. With that in mind when should you move on?
If you have not conceived on clomiphene citrate therapy in three months, it is time to move on. If the decision at this point is to add intrauterine insemination (placing a properly prepared sperm specimen in the uterus) it should be done by an FDA registered facility. There are three such facilities in the Lake Norman - Charlotte area. When you are referred to one of these facilities, the reproductive endocrinologist at the facility will evaluate your situation further and determine if that is the next step for you and your partner.
While there are other oral fertility medications, clomiphene is still the most commonly used and has been used for the purpose of correctiing ovulatory disorders for many years. The goal of this drug is to give a message to the area in the brain called the hypothalmus to release FSH (follicle stimulating hormone) which stimulates the ovaries to produce follicles which contain oocytes (eggs).
Once these follicles have been called forth the desired effect is for one of the follicles to become dominate and for the other follicles to degenerate. As the dominant follicle gets larger it secretes estrogen into the blood. This rising estrogen triggers the brain to release lutenizing hormone (LH), which triggers the process of ovulation (release of the egg). Once ovulation occurs, the egg is picked up by the follipian tube where fertilization takes place when the oocyte meets up with sperm through intercourse that has occured or through intrauterine insemination. The fertilized oocyte then starts its journey back to the uterus where implantation will take place if the conditions are proper.
It should be pointed out that there can be more than one healthy follicle produced when using this medication and that is why there is about an 8% to 10% twinning rate seen with it's use. Triplets and higher order multiples are rare at less than 1%.
Another thing you should know is that a side effect of clomiphene citrate, not often mentioned to the patient, is the anti-estrogen effect of the drug. It you experience this effect the lining may not be properly prepared to receive the fertilized egg and conception will not take place. An ultrasound mid cycle can be used to determine if the lining is being affected. Other side effects that occur commonly with this drug are bloating, breast tenderness, and moodiness. These are typical symptoms women who are fertile experience after ovulation.
If you have been taking clomiphene citrate for more than 3 months and are responding properly to the therapy it is time to ask about the next step. This becomes even more important with those patients 35 years of age and older. Remember that you have the first decrease in fertility at age 35, the second at 37 and a dramatic decrease at 40. By 45 years of age less than 1% of patients will take home a baby.
Having the knowledge you need can help you to have the family you deserve. Feel free to call us at 704-947-9000 or visit our website. You may also want to visit the American Society of Reproductive Medicine Website (ASRM.org).
Mary Todd Jutras, MSN, REIN
Advanced Reproductive Concepts
www.affordable-ivf.com
704-947-9000