Clomiphene Citrate Therapy

Clomiphene Citrate Therapy 

Patient Information

Fertility Fusion

The Patient Information Leaflets page on the Trust website is available on the link: https://www.wwl.nhs.uk/patient-information-leaflets or scan the QR code.

Introduction

Clomiphene (clomid) tablets are used to induce ovulation (egg production) in patients who are not ovulating. They may be used in patients who have polycystic ovaries, or in those whom the cause of anovulation (not producing eggs) is unknown.  Patients on Clomiphene are four times more likely to have twins.

Benefits

The benefits of taking Clomiphene tablets are to encourage or regulate ovulation to achieve a pregnancy.

Alternatives

Alternatives to Clomiphene tablets are:

• Letrozole tablets
• Gonadotrophin injections
• Intrauterine insemination
• IVF

Risks

• Ovarian hyperstimulation
• Increased risk of multiple pregnancy
• Failure to conceive.

Possible side effects:

• Hot flushes are common, as are mood swings and occasional nausea or vomiting. 

More rarely, you may experience:

• Rashes
• Dizziness
• Depression
• Painful periods
• Headache
• Weight gain
• Breast tenderness

If you experience problems with vision, pain or swelling in the abdomen or vomiting, the medication should be stopped, and medical advice sought.  Also, should you have any other questions or worries, please feel free to ring the unit and speak to a member of staff.

The starting dose is usually 50mgs a day from day 2 to day 6 of your menstrual cycle (period), day 1 being the first full day of bleeding.

You will be asked to attend for a blood test on day 21 of that cycle to check your progesterone level.  This hormone test will inform us whether you have ovulated or not.

Some patients with irregular periods may be asked to attend on different days of the cycle to try to determine whether ovulation has occurred.

It may take several days for the progesterone result to be available. Please telephone the nurses at the fertility centre for the result.  You will be advised to stay on the same dose of medication or to increase the dose if ovulation has not occurred.

If ovulation has occurred and you are not pregnant, in the next cycle you should take the same dose of Clomiphene and ring the fertility centre on day 1 of your period for a scan. (If this is a weekend, phone on the next working day). This scan will take place on or around days 8-10 of your cycle. This will enable us to advise you more effectively when it is best to try for a pregnancy.

Before starting Clomiphene treatment, the doctor or nurse will discuss the drugs with you.  If you do not understand, or have any concerns, please contact the Assisted Conception Unit for further advice.

Most patients will ovulate following treatment with one or two tablets of Clomiphene a day.  Some patients may require higher doses and others may not ovulate at all.

Under these circumstances alternative treatments will be discussed.

Once ovulation has been confirmed it is usual to continue on the same dose for the next six cycles.  If a pregnancy has not occurred after six ovulatory cycles, you will be asked to see the Consultant.

It is perfectly safe to take Clomiphene for up to 12 months. Although few pregnancies occur after 6 months of treatment

Contact telephone numbers

Fertility Fusion, Wrightington Hospital 

01257 256251 Monday to Friday 8am to 4:30pm

Swinley Ward, Royal Albert Edward Infirmary 

Out of hours or in an emergency 01942 822568

Counselling service

In line with the Human Fertilisation and Embryology Act 1990 (amended HFEA, 2008), Counselling is offered in combination with the treatment provided by Fertility Fusion.  There are many benefits to the counselling that will be offered to patients during their fertility treatment. It will always include the opportunity to talk through the implications of the treatment that have been suggested, and it will also include elements of support and therapy.

What is counselling?

Counselling takes place when a trained counsellor meets with a patient in a private and confidential setting to explore any difficulty, distress or dissatisfaction with life that the patient may be experiencing. Counselling can increase a patient’s ability to make choices and change aspects of their situation.

Counselling can give you:

• The opportunity to talk freely and openly without being judged.
• The chance to explore feelings and sensitive issues that are troubling you. 
• Help in understanding the factors that may be contributing to your difficulties. 
• Support in finding your own solutions and new ways of coping. 

Anything you share with your counsellor will be treated as confidential unless there are exceptional circumstances.

Who is seen in counselling?

Initial counselling, following the treatment information meeting with the nurse, is available for all persons involved in the treatment. Further sessions can be attended either individually or as a couple.

What is the purpose of counselling for infertility and assisted conception?

• Counselling about the Implications of treatment aims to help patients understand exactly what the treatment will involve and how it might affect them and those close to them - now and in the future.
• To provide emotional support before, during and after treatment, particularly if the person is experiencing stress, ambivalence or distress. 
• To assist people in developing successful coping strategies for dealing with both the short and longer term consequences of infertility and treatment.
• To help people to adjust to and accommodate to their particular situation.

What is the duration of counselling?

Counselling may be an ongoing process and can be continued, or take place for the first time, after a course of treatment has been completed. The duration of counselling is determined by the individual’s needs and wishes.

How to contact the service?

Counsellor: Kelly Mcevoy 

Counselling Service

Fertility Fusion

Wrightington Hospital

Hall Lane

Appley Bridge

Wigan

WN6 9EP

Telephone: 01257 256251

(Confidential answering machine service if unavailable)

All Counselling staff respect and maintain confidentiality at all times in line with the law. Counsellors are members of the British Association of Counselling and Psychotherapy (BACP), the British Infertility Counselling Association (BICA) and adhere to the HFEA licensing regulations and guidance.