Clomiphene Citrate (Clomid or Serophene)
Clomiphene Citrate is an oral medication that is commonly prescribed for women to induce ovulation in a timely fashion. Clomiphene therapy is generally initiated between Cycle Day 3 and 5 and is continued for a total of 5 days. Cycle Day 1 is defined as the first day that vaginal bleeding occurs. The initial dose of Clomiphene is usually 50mg. Depending on the patient’s response, the Clomiphene dose may be increased by 50 mg. increments up to a maximum dose of 250 mg. Ovulation typically occurs 5 to 10 days after the last dose. If a pregnancy has not occurred within 3-6 ovulatory cycles of Clomiphene therapy, an alternative form of therapy may be considered. Generally, Clomiphene is well tolerated with minimal discomfort and less than 10% of patients experience side effects. The most common side effects are hot flushes, abdominal bloating or pain, nausea or vomiting, breast discomfort, or visual disturbance. Multiple pregnancies occur in approximately 8% of women who conceive while taking Clomiphene, with triplets occurring 0.5% of the time.
Injectable Fertility Medications (Gonadotropins)
The development and release of an egg from the ovary is controlled by two hormones, Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH). Gonadotropins act directly on the ovaries to stimulate follicular development. These medications cannot be taken orally because these proteins would be digested and inactivated in the stomach; therefore, they must be administered by injection.
If you have been advised to start a cycle with these injectable medications, you should contact our staff on the first day of your menses for further instructions. The cycle is carefully monitored with ultrasound exams and estrogen blood tests to check the status of follicle development in the ovaries so that medication doses can be adjusted daily by your physician. Usually, the medication is started on Cycle Day 3 to 5 and is generally given in the evening on a daily basis for a period of 7-12 days.
The most frequent side effects are ovarian over stimulation (hyperstimulation) and multiple pregnancies. Mild ovarian hyperstimulation is common and involves a brief period of lower abdominal discomfort. More severe hyperstimulation is infrequent (less than 2%) and may involve more severe abdominal pain, fluid retention, nausea and vomiting. The overall risk of multiple pregnancies is estimated to be 10-30% with the majority of these being twin pregnancies. With careful monitoring, the risk of these side effects is significantly reduced. Studies show that approximately 75% of women who take these medications will ovulate. It is estimated that 20-42% of patients receiving injectable fertility medications will conceive as long as their fallopian tubes are open and the sperm counts are adequate.
Human Chorionic Gonadotropin (HCG)
Human Chorionic Gonadotropin (HCG) is used to trigger ovulation of the dominant ovarian follicles in conjunction with Clomiphene or injectable fertility medications (gonadotropins). It is administered as a subcutaneous injection. Possible side effects from HCG include headache, irritability, restlessness, depression and fatigue.
Intrauterine Insemination (IUI)
This procedure is frequently recommended in the setting of decreased sperm count or motility, or when fertility medications are being used. There are several chemical reactions that naturally occur in the vagina and cervix before semen can pass through the uterus on the way to the fallopian tubes. IUI is performed at the time of ovulation. In order to place sperm directly into the uterus, the semen sample is specially prepared in the office shortly before the procedure. With a specialized catheter, the specimen is placed through the cervix and deposited inside the uterus. The procedure is sometimes accompanied by mild cramping. We usually recommend that the patient remain lying down for about 15 minutes following the procedure.
In-Vitro Fertilization (IVF)
In-Vitro Fertilization is a procedure that is performed by specialists in the field of reproductive endocrinology and involves uniting the egg and sperm outside the body in a special laboratory. The fertilized egg is then placed inside the uterus to continue its development. Your physician may advise referral to a reproductive endocrinologist for IVF during the course of your evaluation and treatment. Bedford Commons OB-GYN has professional relationships with several reproductive endocrinologists at state-of-the-art facilities in Boston and Dartmouth Medical Center. Frequently, these consultants can co-manage your recommended therapy with Bedford Commons OB-GYN physicians, and for your convenience, several tests can be performed on site at our office.