(Also known as Serophene or Clomid)
Clomiphene is a fertility medication used for the following purposes.
Clomiphene comes in 50 mg tablets. The normal starting dose would be either 1 or 2 tablets (50 – 100 mg) taken every day for 5 days, starting on day 3 of the menstrual cycle. Day 1 is the first day of menstrual flow.
The response to clomiphene is very variable depending on a woman's age, weight and ovarian reserve. In some cases the response expected or hoped for may be less or more than actually occurs. For this reason it may be recommended that your ovaries are monitored by ultrasound to see exactly what response occurs. Although eggs are microscopic they grow in little capsules of fluid called follicles, which are easily monitored by ultrasound
Side effects are quite common and occur in at least 50% of patients who take clomiphene. Side effects include the following:
There is a very small risk of ovarian hyperstimulation syndrome (OHSS - There is more information about this on website). However this is very rare on clomiphene alone.
One of the most significant risks that every patient taking clomiphene should be aware of is of multiple pregnancy. There is further information about multiple pregnany below.
Patients who are prescribed Clomiphene will have their ovaries monitored by ultrasound. You will therefore be informed of how many eggs will be releasing so will have a more definite idea of the risk of multiple pregnancy.
If you have any further questions about this you should speak to Dr. Cepeda or one of the health care professionals at HART Fertility Centre.
The term "multiple pregnancy" refers to a pregnancy that includes more than 1 fetus (baby) most multiple pregnancies are twins. However, higher order multiple pregnancies such as triplets and quadruplets can also occur.
The incidence of naturally occurring twins in the general population is about 1 in 80. There does tend to be a familial risk – in that if you have a family history of twins, your risk may be higher. The risk of naturally occurring triplets is about 1/80 squared = 1/6400. The risk of naturally occurring quads is 1/ 80 to the power of 3 = 1/512,000.
However – the risk of multiple pregnancies is significantly increased with the use of fertility treatments. The risk with fertility drugs that induce ovulation (i.e. stimulate the ovaries to release more than 1 egg) of inducing a multiple pregnancy may be related to a number of factors. These include maternal age, the number of eggs being released (this is something that can be monitored by ultrasound), the quality of the sperm (i.e. the chances of sperm fertilizing the eggs) the length of fertility difficulties, etc.
Generally speaking there are 3 forms of fertility treatments that may put you at risk for a multiple pregnancy.
There are many risks related to multiple pregnancies, and obviously the risks are increased with higher order multiple pregnancies e.g another more than twins.
These risks are divided in to 2 groups:
Due to the quality of peri natal care today, the chances for babies surviving if they are born prematurely (after 25 weeks gestation) is high – but the risk of long term complications increases the earlier they are delivered and the lower the birth weights.
In our attempts to help couples to overcome infertility and get pregnant – with the use of fertility drugs, IUI and IVF – there will be an increased risk of multiple pregnancy. We do everything we can to maximize your chance of getting pregnant and reduce the chance of multiple pregnancy.
If a multiple pregnancy was to occur, and if there were more than twins, one option to improve the outcome for both mother and babies is a selective reduction. This is a procedure whereby one or more of the fetuses is "sacrificed". It is like having a selective abortion so that the number of fetuses in utero is reduced. It is usually done at about 10 12 weeks gestation by a procedure similar to an amniocentesis. It is an emotionally difficult thing to go through – and apart from the emotional distress, can also cause a risk of miscarriage. i.e. the procedure itself may risk the entire pregnancy being miscarried. The risk of miscarriage related to a selective reduction is 6%. Although selective reductions are seldom performed – they are sometimes necessary.
If you have risk of a high order multiple pregnancy and feel that a selective reduction is something you could NOT under any circumstances consider, then you should discuss this Dr.Cepeda and perhaps consider cancelling the cycle.