Ovulation
Induction
Information Brochure
Dr Scott Salisbury
Obstetrician & Gynaecologist
Watkins Medical Centre
Level 3 225 Wickham Terrace
Brisbane Q 4000
Appointments 07 3010 2121
After Hours 07 3899 4455
©Dr Scott Salisbury 2010
Clomiphene citrate may be prescribed to you in two forms, either as Serophene or Clomid,
both of which are trade names for the same basic drug.
THE FEMALE REPRODUCTIVE SYSTEM:
In many women, the menstrual cycle takes approximately 28 days. Of course, some ladies
may have very infrequent periods. If you do ovulate, you should have a menstrual cycle
and you should menstruate 14 days after ovulation has occurred. For example, in a 35 day
cycle, this means you would ovulate around Day 21. For a standard 28 day cycle, this
means you would ovulate around Day 14. It is not always true however that ovulation
needs to occur in order for menstruation to occur, so just because you are menstruating
does not necessarily mean ovulation is occurring. During the normal course of a
menstrual cycle, the pituitary gland which is situated within the brain releases two
hormones. Initially, it releases FSH (follicle stimulating hormone) and subsequently it
releases LH (lutenising hormone). FSH stimulates the ovaries to produce follicles and
these follicles may contain eggs which will be released at the appropriate time of your
cycle. The egg during its release will often be picked up by the end or fimbrae of the
fallopian tube and the egg will be washed into the tubes. Meanwhile, the follicle that is
released will form what is called a corpus luteum and it will produce progesterone to help
support the lining of the uterus in the hope that a forthcoming pregnancy will occur.
Intercourse obviously needs to occur at the appropriate time for egg and sperm to be able
to meet up in the fallopian tube. After the egg is fertilised, it makes it way back down into
the uterus which may take 2 - 3 days in itself. Implantation of the embryo then occurs
approximately 5 days after fertilisation and hopefully all proceeds on to a normal
pregnancy.
HOW DOES CLOMIPHENE CITRATE WORK:
Clomiphene citrate is taken as a tablet on 5 consecutive days, usually at the beginning of
your cycle from Day 3 to Day 7, although it can be taken other days as well. Normally
the brain stimulates the ovary via FSH, the ovary then produces oestrogen which feeds
back to the brain to say when enough stimulation has occurred. This medication actually
tricks the brain into thinking that not enough stimulation to the ovary has occurred and
therefore more FSH is produced to stimulate the ovary a little harder. It is used in 2 areas,
firstly, to stimulate ovulation where ovulation is not occurring at all, this classically occurs
in poly-cystic ovarian disease but may occur in other conditions as well. Secondarily, it is
simply used to increase the chance of pregnancy in any one particular cycle by increasing
the number of follicles and therefore eggs that are produced. It is very important you do
not start the Clomiphene citrate if you consider there is any possibility of pregnancy or
alternatively if you have any abnormal vaginal bleeding. Equally, if you have a past
history of liver disease, you should make that known to myself. Also, it is important to
take note if you are lactose intolerant because the tablets do contain lactose. Clomiphene
Citrate is not known to interfere with the actions of other medications but if you have any
particular concerns, you should raise them with me.
©Dr Scott Salisbury 2010
WHAT SIDE EFFECTS ARE KNOWN:
Clomiphene citrate is by and large a safe drug to take but there are some mild drawbacks
to its usage. They may actually include facial flushing or hot flushes, abdominal
discomfort, mild enlargement of the ovary. You can also experience breast tenderness,
nausea, vomiting, mood disturbance and occasional allergies to it. There is also the small
theoretical risk of ovarian hyperstimulation syndrome which is incredibly rare with
Clomiphene citrate therapy. Should you however have persistent abdominal swelling,
nausea and vomiting with a reduction in the amount of urine production, then you should
make me aware of this immediately. We are not aware that pregnancies that follow from
Clomiphene citrate cause any concern in terms of birth defects or increased risk of
miscarriage, etc. There is the small risk however of cyst formation within the ovary which
usually is self limiting although may sometimes require drug use for pain relief. On very
rare occasions, it may require admission to hospital and indeed sometimes surgical
management. The other risk of taking Clomiphene citrate is the small chance of multiple
pregnancies. This is about 4 - 5% of which the majority are twins although there is the
slight risk of triplets and high order multiple pregnancy if that many follicles are produced.
HOW IS IT TAKEN
You may take either half to one tablet daily for 5 days usually from Day 3 to Day 7. I will
monitor your first cycle with a blood test +/- scan to establish that ovulation is occurring
and indeed to make sure it is not occurring too aggressively in terms of more than 2 or 3
eggs being produced. If I felt your risk of multiple pregnancy was too high, then I would
ask you to abstain from intercourse until your next period. If ovulation were not to occur,
then we would slowly increase the amount of drugs to a maximum of 3 tablets per day and
if you were still unresponsive, then we would need to consider giving you FSH injections
directly. My advice would be to try this for approximately 6 months if you were going to
persevere with this as your modality of treatment. If after that time you were unsucessful,
we would need to be considering other modalities of treatment.
STORAGE OF CLOMIPHENE CITRATE:
Clomiphene citrate should be stored below 25 degrees and away from light and certainly
kept out of reach of children.
©Dr Scott Salisbury 2010
Instruction for Clomiphene Citrate (Serophene or Clomid)
administration
Take one tablet/s of Comiphene Citrate from day 3 - 7 and follow the following
instructions:-
1. Day 1 is the first morning that your period is present
2. Please phone the rooms by Day 8 of your cycle to
inform us that your period has commenced. Please leave us with a contact number. Let us
know whether you are having a monitored cycle or insemination.
3. Commence your first blood test on day ..... (usually Day 12) of your cycle. (Blood
tests are taken on 1st floor, Watkins Medical Centre opposite the lift between 7.00am and
9.00am or with any S&N collection centre if I have stated that is possible (for
insemination cycles this may incur an extra cost.)
4. On weekdays phone the rooms between 1pm & 2pm each day on each day that you
have a blood test for further instructions (eg. to repeat the blood test the following day,
skip a day, come for insemination etc). Don't forget to ask for a collection jar if you are
coming close to insemination.
5. If you are having a blood test on the weekend (the QFG lab is open both Saturday
and Sunday and all public holidays) I will endeavour to phone you with the result that
day, if I have not rung you by 7.00pm please ring my after hours number for the result at
7.00pm. If I am not at home please follow the instructions on the answering machine
either to contact me or whoever is covering me for the weekend.
Note : Individual instructions will be given regarding the insemination procedure. Your
sample should be brought to the first floor at approximately 7.00am Monday - Friday and
at approximately 7.00am Saturday & Sunday. Samples are processed in the order that
they are received.
©Dr Scott Salisbury 2010
©Dr Scott Salisbury 2010