Clomiphene citrate is a selective estrogen receptor modulator (SERM) that blocks estrogen receptors in the hypothalamus. This action leads to increased pulsatile release of gonadotropin-releasing hormone (GnRH), which in turn stimulates the pituitary gland to release more follicle-stimulating hormone (FSH) and luteinizing hormone (LH), thereby inducing follicular development and ovulation. It is primarily used to treat anovulatory infertility in women desiring pregnancy.
Verdict
Effective for specific infertility; requires medical supervision.
HEALTHSPAN IMPACT
High Value
RISK LEVEL
Moderate
EVIDENCE GRADE
A
MONTHLY COST
$10 - $50
Protocol
- Initial dose of 50 mg orally once daily for 5 days, starting on or about the fifth day of the menstrual cycle.
- If ovulation does not occur, dosage may be increased to 100 mg daily for 5 days in subsequent cycles, up to a maximum of three treatment cycles.
Flags
- Risk of ovarian hyperstimulation syndrome (OHSS), though typically mild.
- Increased risk of multiple pregnancies (up to 10% for twins, <1% for triplets or more).
- Visual disturbances (blurred vision, scotoma) can occur, requiring discontinuation.
- Contraindicated in liver disease, ovarian cysts (not polycystic ovary syndrome), or abnormal uterine bleeding of undetermined diagnosis.
- Prolonged use beyond 6 cycles is generally not recommended due to diminishing returns and potential risks.