Clomid Resistance: Treatment options to help achieve ovulation
Around one in every four women who use Clomid will have infertility. Occasionally, you may have infertility when using Clomid if the dose is too low. Clomid is often started at 50mg and then increased to 100mg if you do not react. In certain instances, physicians may experiment with dosages up to 250mg. However, if you continue to have infertility after increasing your Clomid dose, this is referred to as Clomid resistance.
Clomid resistance is not synonymous with infertility caused by fertility medication. You may ovulate but not get pregnant in this instance, and you are not even ovulating in this scenario. If ovulation does not occur, will you need to switch to stronger medicines or more sophisticated treatments? Not always.
Clomid – What is it?
Clomiphene is an oral fertility medication used to stimulate ovulation in women who are having difficulty conceiving. The critical point to remember is that Clomid is a medicine used to stimulate ovulation, not pregnancy.
Clomid will not conceive you on its own, and all it is meant to accomplish (and it does not always do so) is induce ovulation. You cannot get pregnant until you ovulate.
Common names for Clomid
Clomid and Serophene are actually trading names, but many other names around the world know Clomid.
- Clomiphene citrate
In Australia, Clomid & clomiphene citrate are the most common names used when discussing the medications with your GP or fertility specialist.
How does Clomid induce ovulation?
Clomid is a synthetic hormone that stimulates ovulation by deceiving the body into thinking there is less estrogen present. This results in increased production of a hormone called GnRH, which stimulates the pituitary to produce more FSH and LH, so promoting ovulation.
Clomid is quite effective and stimulates ovulation in more than half of the women who take it. Clomid is effective for a large number of women, but it can have some negative effects, including headaches, mood changes, hot flashes, and weight gain. It is typically administered as a tablet once a day for five days. Clomid is often started at 50 mg/day for five days and then raised monthly by 50 mg/day. Clomid is typically started 2–5 days after the first day of menstruation (cycle day 2-5), and ovulation occurs 5–9 days after the last dose of Clomid.
What Causes Clomid Resistance?
Your doctor’s response to Clomid resistance is partly determined by the reason they believe you are not responding. The following are a few well-known, probable causes of Clomid resistance:
Increased weight: An increase in weight might reduce the likelihood of Clomid functioning well.
Hyperprolactinemia: Women with hyperprolactinemia may not react well to Clomid unless the hyperprolactinemia is treated concurrently. Naturally, there are situations when it’s unclear why Clomid isn’t assisting in ovulation induction.
PCOS: Women with PCOS often have Clomid resistance, particularly those who are insulin resistant or have hyperandrogenic levels. This means high levels of male and DHEA hormones.
Overcoming Clomid Resistance
There are many different ways to help treat Clomid resistance, below are seven common ways to help Clomid resistance and increase your chances of conception.
Treatment with the insulin resistance medicine metformin, commonly known as Glucophage, may be beneficial for women with PCOS. Metformin is often administered for a period of three to six months before attempting Clomid again. Apart from increasing ovulation rates, several studies indicate that using metformin and Clomid combined may also boost pregnancy rates and lower the chance of miscarriage.
N-acetyl-cysteine (NAC) is an amino acid and antioxidant that acts as an insulin sensitiser. Combining Clomid with NAC has been shown in certain trials to aid in the treatment of Clomid resistance.
In conjunction with Clomid, Myo-inositol can help reduce insulin resistance and lower your body weight, which will assist in improving ovarian activity and the clomiphene treatment.
Your doctor may advise you to reduce weight prior to retrying Clomid. Even if you lose 10% of your current body weight, Clomid’s effect may be enhanced. Treatment with Bromocriptine, either alone or in combination with Clomid, may enhance ovulation rates in patients with hyperprolactinemia.
Ovarian drilling is a more traditional approach to treating Clomid resistance in women with PCOS, although it is no longer widely utilised due to the hazards. If your doctor recommends ovarian drilling, you may want to query why this procedure was chosen over others that may and should be attempted first.
Clomid Resistance & Birth Control Pills
One novel strategy for overcoming Clomid resistance is to use birth control tablets for one to two months before beginning another Clomid cycle. This is advised for ladies who have elevated DHEA levels.
It may sound counter-intuitive—birth control tablets will aid in conception? However, research investigations have shown positive outcomes. According to one research on the use of birth control pills, slightly more than 65 per cent of Clomid-resistant women ovulated after using oral contraceptives for two months prior to a treatment cycle.
What to do if Clomid is not working?
Occasionally, ultrasonography will show that the follicles are developing in response to Clomid, but the midcycle LH surge is insufficient to induce ovulation. In this scenario, your doctor may prescribe Clomid in combination with an injection of human chorionic gonadotropin (hCG), such as the medication Ovidrel, to induce ovulation and increase the midcycle LH surge.
If none of these alternatives works and you are still unable to ovulate on Clomid, your doctor may consider experimenting with other ovarian stimulating drugs.
Letrozole vs Clomid
Letrozole (marketed under the brand name Femara) is another alternative for women who do not ovulate after taking Clomid. Femera has been proven in studies to induce ovulation in some women with PCOS who do not react to Clomid and some women who have unexplained infertility who are resistant to Clomid.
In one research, women who were resistant to Clomid and had PCOS were more likely to ovulate when given Letrozole (79.3 per cent ovulated) than when given Clomid in conjunction with two low-dose FSH injections (57 per cent ovulated). Pregnancy rates were also improved, with 23% of women on Letrozole obtaining pregnancy and 14% with the Clomid and two low-dose FSH injections combo.
However, letrozole is not marketed as a fertility drug. There is considerable debate concerning its safety. If used during pregnancy, letrozole may cause birth abnormalities. Many think that the medicine is safe and that it should be eliminated from the body by the time pregnancy occurs; however, further study is needed.
Other therapeutic options for Clomid resistance include low-dose gonadotropin therapy, either alone or combined with IUI. This category includes medications such as Gonal-F, Ovidrel, and Follistim. (Or, more precisely, recumbent FSH and LH fertility medications.) These medications are more costly and have a higher risk of adverse effects than Clomid, but they may stimulate ovulation in cases when Clomid does not work.
Final Thoughts on Clomid Resistance
Clomid is often the first fertility medication prescribed after an infertility diagnosis. By the time this treatment cycle begins, you may have been trying to conceive for almost a year. When it fails, you may be concerned that this is a portent of worse things to come. You may be concerned that this implies you’re doomed to further costly therapies, like IVF.
The fact is that Clomid is merely the first step in treating infertility. Avoid panicking if you do not ovulate on your first or second period or if you do not get pregnant. There are many stages involved before you are urged to explore more advanced reproductive treatments.