The first and foremost drug is, Clomiphene citrate which is the most popular agent for the induction of ovulation and has been in use for more than 35 yrs. It has a structure that shares key similarities with that of oestrogen.
Treatment with CC is commenced at 50mg -100mg(max 150 mg) daily for 5 days in each menstrual cycle beginning from day 3 or 4. CC should not be used for more than 12 cycles in a patient’s life time or for more than 6 cycles continuously.
Infertility specialist clinics will often add intrauterine insemination to clomiphene cycles in order to increase the chance for pregnancy. Insemination is particularly beneficial for women that already ovulate on their own and are using the Clomid to get extra egg production.
Clomiphene Side Effects
Clomid treatment has some potential for adverse effects. Side effects are definite “cons” of clomiphene use. Adverse effects are seen in some, but not all women using the drug.
- Mood swings, psychological / emotional side effects
- Hot flashes
- Abdominal discomfort
- Visual disturbances
- Ovarian cyst formation
- Thinning of the uterine endometrial lining
- Reduced production of cervical mucous – this can lower fertility (bypassed by insemination)
- Increased risks for twins and multiple pregnancy (this is sometimes a desired outcome)
- 92% singletons and around 7% twins.
- Letrozole is an a aromatase inhibitor.
- Until recently there were concerns about safety of this drug on fetus, but in 2016 DCGI, India lifted its ban on the use of this drug for ovulation induction.
- Infact there are more studies now claiming it’s superiority over clomephine for ovulation induction in obese PCOS
- It is administered in a dose of 2.5-5 mg per day for 5 days starting from day 2/3/4/5 of menses. Pyramidal regimes have also found to be effective.