Clomid & Monitoring
Clomiphene (Clomid, Serophene) is a fertility medication that is used to induce ovulation in women who do not produce an egg every month. Clomiphene stimulates a woman’s ovaries to mature an increased number of follicles every month.
Because Clomid increases the number of mature follicles in the ovaries, the drug also increases the likelihood of ovulation and pregnancy .
Clomiphene is generally prescribed for couples facing female infertility, including:
- Irregular menstruation
Clomiphene is routinely given from the 2nd full day of the period for 5 days, and the dose may vary from 50-150mg per day. If no ovulation occurs after increasing the dose over 2 to 3 months, or if no pregnancy results after 6 months of regular ovulation, alternative treatments should be considered.
Ultrasound scans are carried out 2-3 times during the treatment to check the response and pinpoint the ovulation. Ultrasound scans are combined with urine tests and blood tests to enhance the chances of pregnancy. In some cases trigger shots may be given to improve ovulation. An ultrasound scan also detects if there has been an over response to Clomid.
Potential Clomid Side Effects
Generally, Clomid side effects are mild and rarely may need to be discontinued:
- Mood swings
- Nausea and vomiting
- Breast tenderness
Like all fertility drugs, Clomid can be associated with the possibility of multiple egg development and may increase the risk of having twins and triplets.
There is no increased risk of miscarriage or birth defects after taking Clomid.
Clomid should not be used continually for over 12 months. A shorter duration of use is not associated with any risk.
FSH & Monitoring
Women who fail to respond to Clomid are often moved on to the next phase of fertility medications. These are injections called Gonadotrophins or FSH as they are popularly known. The commonly used FSH preparations are, Gonal F, Menopur, Fostimon or Merinol. Unlike Clomid, which aims to stimulate the pituitary gland, Gonadotrophins attempt to directly affect the ovaries and stimulate follicle development.
How to take the FSH injections?
The injections start between day 2 and 3 of the period, and are usually recommended daily or on alternate days. Before starting treatment, scans are undertaken on day 1 to 3 of the cycle to rule out any cysts on the ovaries.
A total of 10 to 12 daily injections are normally needed to ‘grow’ one or two eggs every month. A scan will confirm when the egg(s) are ready to be released when a trigger shot (Ovitrelle or Pregnyl) is given to help the egg(s) release.
IUI (intrauterine insemination) treatment is usually recommended with the FSH injections to improve the chances of pregnancy.
Pregnancy should result within 3 to 6 months when the injections are used during each cycle.
If the treatment fails to achieve a pregnancy or if the response to the injections is not satisfactory, IVF is the next step.
Letrozole & Monitoring
Letrozole (Femara) is an aromatase inhibitor approved for treating advanced breast cancer and has been shown to be better than Clomid for ovulation induction. Compared with Clomid, Letrozole produces both higher pregnancy rates and fewer side effects. Importantly, Letrozole also rarely stimulates more than one follicle, decreasing the risk of multiple gestations.
It is administered at dosage of 2.5 mg to 5 mg from day 2 of the period for 5 days with ultrasound scans to check for ovulation monitoring.
Risks and Side Effects of Letrozole
Many physicians will not prescribe Letrozole because of concerns from a 2005 report from some Canadian fertility doctors suggesting a possible higher incidence of birth defects in pregnancies from using Letrozole. This study was from a small group of pregnancies and the study has been severely criticized for having an improper design.
The manufacturer of the drug has apparently not filed for FDA approval to use it for infertility. However, physicians often use medications in an “off label or non-licensed ” way. When the off label use is safe and effective it is perfectly legitimate.
In a new study by Dr. Tulandi and Dr. Robert Casper from Department of Obstetrics and Gynecology at the University of Toronto examined a total of 911 babies whose mothers were treated for infertility with either Letrozole or Clomid from 2001 to 2005 and found it to be safe.
Natural Cycle Monitoring
Ultrasound examinations during a specific time of the menstrual cycle enable mapping of the egg growth in the ovary and study of the changes in the lining of the womb.
Natural cycle monitoring consists of 2 to 3 ultrasound scans starting on day 7 to day 10 and helps to pinpoint the day of natural ovulation to enable the best chance of conception. It also helps to detect potential problems and sometimes answers simple questions.
The scans are often combined with urine tests for ovulation and laboratory tests, such as measurement of progesterone hormone levels, to give a complete picture.
Ovulation Induction, Monitoring & Test
Egg growth and ovulation can be improved by medication and monitoring the changes by ultrasound scan.
This is usually used for women who do not ovulate regularly and also for women with polycystic ovaries. In these cases, ovulation induction combined with ultrasound scans and urine and blood tests may improve the chances of conception.
Usually around 2-3 ultrasounds scans may be required to see a positive response to the medications. These treatments should only be used if the fallopian tubes are open and the sperm is normal.
Tamoxifen & Monitoring
Tamoxifen is similar to Clomid in the effects on the ovary, but it tends to cause fewer side effects. It is a drug routinely used in women with breast cancer but it works very well when it comes to promoting egg growth.
It is given the same way as Clomid. It is taken between 20-60mg daily for five days, starting on the second day of the period. A scan is performed between day 10 and 12 to monitor egg growth and to predict when ovulation will occur.
Side effects are similar to Clomid:
- Mood swings
- Nausea and vomiting
- Breast tenderness
Like all fertility drugs, Tamoxifen can be associated with the possibility of multiple egg development and may increase the risk of having twins and triplets and treatment can require cancellation due to over response.