Clomiphene Citrate is the most common used fertility drug prescribed as first line treatment for fertility issues. Clomid works by impacting hormonal production, increasing the levels of Estrogen, FSH and LH that precipitate ovulation. Increased production of LH and FSH foster a mature ovarian follicle and the release of ovum, known as “Ovulation Induction.”
Ideally the use of Clomiphene should be confined to women less than 35 years of age with normal FSH and AMH levels from the second day of their periods for consecutive 5 days. Most pregnancies occur in the first 6 cycles of treatment; however, it cannot guarantee pregnancy. If used for a much longer time clomiphene is not only ineffective, but actually starts to function as a “relative” contraceptive. According to the studies, pregnancy rates with clomiphene treatment is about 10% per cycle in women under 35 years of age, about 5% between 35-40 years and 1% after the age of 40. Few reasons as to why clomid should be given under 35 years of age include:
1- The anti-estrogen effect of Clomid sends the message to hypothalamus as estrogen levels are low, the pituitary then releases large amount of FSH which stimulates the development of follicles. Unfortunately, at the same time pituitary also releases large amounts of LH which causes the ovary to produce excess male hormone, testosterone which compromises egg quality. The older the woman, the greater adverse effect of Clomiphene will be.
2- Clomiphene’s anti-estrogenic effects also cause the thickening of the cervical mucus, making sperm migration a bit difficult to the fallopian tubes and the thin uterine lining is also not capable to support a viable pregnancy. Not more than 3 consecutive cycles of Clomid should be given as the anti estrogenic effect is manifested in such a way that regardless of good ovarian reserve the results are no so positive.
3- Approx 20% of Clomiphene cycles are associated with trapped ovulation (LUF Syndrome), meaning that though hormonal changes show the occurrence of ovulation, yet the eggs are trapped in the ovaries.
Thus, in my opinion Clomiphene should not be given to women older than 35 years of age, those with diminished ovarian reserve and should be avoided in IVF treatment.