What's the Deal With Clomid (For Real)?

Ah, the double-edged sword of online infertility support groups: they’re a much-needed source of solace when you’re struggling to conceive, but they can also be the web forum equivalent of Googling, “do I have a brain tumor?” every time you get a headache and going down a total rabbit hole. In other words, they’re not a reliable way to get medical info, and sometimes what you find there falls squarely into the “worst-case-scenario” category.

This is all especially true if you’re looking for legit advice about the ovulation-stimulating medication called Clomid. Maybe you’ve heard it’ll make your ovaries straight-up explode with eggs, or that your friend’s sister’s cousin got pregnant with quintuplets when she took it, or that it can even cause blindness (seriously, WTF?). So now you’re wondering if you actually want to fill that prescription your reproductive endocrinologist just handed you. 

Well, wonder no more. Here’s everything you need to know about Clomid.

Why did my doctor prescribe it to me? 

Probably because you’re not ovulating regularly (or you are ovulating, but for some reason your ovulation isn’t leading to pregnancy). According to Dr. Daniel Kort, a reproductive endocrinologist practicing at Neway Fertility in New York City, there are two types of patients Clomid works for:

• Women who don’t ovulate on their own (usually because of polycystic ovary syndrome or PCOS)
• Women who do ovulate but still have infertility

If you know your ovulation is non-existent or irregular, or if you’ve been diagnosed with PCOS, you might be a prime candidate for Clomid. But your doctor will probably check out a few other things, too—like your partner’s sperm quality and the state of your fallopian tubes—because there’s no point producing those eggs if they can’t match up with any sperm. (Remember, sperm and egg need to have a romantic-comedy-worthy “meet-cute” in order to make a baby!)

How does Clomid work?

Clomid helps your body produce more than one egg, says Dr. Jane Frederick, reproductive endocrinologist at HRC Fertility in Orange County, California. Usually, you take it as a pill for five days at the start of your cycle. It tells your body to produce the necessary hormones that trigger ovulation so one or more ovarian follicles can grow and then release an egg. 

Dr. Kort says that the exact way Clomid will work for you depends on whether or not you ovulate. If you don’t ovulate at all on your own, Clomid should make the magic happen; if you do already ovulate, Clomid will induce something called “super ovulation,” which increases your pregnancy chances by producing multiple eggs. (Yeah, you can say it: “super ovulation” sounds totally badass.)

I’ve heard about crazy side effects...is that true?

The list of possible side effects for Clomid is, admittedly, unpleasant (bleeding and nausea and vomiting, oh my!), but that’s true for almost every prescription drug out there. Dr. Frederick and Dr. Kort both say that, when prescribed correctly, most women actually tolerate Clomid really well with minimal side effects. In reality, the biggest side effect—if you can call it that?—is the chance of getting pregnant with multiple babies, since your ovaries will probably produce more than one egg.

Aside from that, Dr. Frederick says some women feel bloated because of the multiple follicles growing, and Dr. Kort says there’s a small chance of headache and low-estrogen symptoms like vaginal dryness or hot flashes. As far as vision problems go, it is technically possible that you could have some disturbances, but Dr. Frederick says they’re minor (like double or blurry vision) and also temporary—meaning they’ll go away as soon as you stop taking Clomid. 

What happens after I take Clomid?

Okay, so you took your five doses...now what?

• First, your doctor will do an ultrasound and some bloodwork to see if the Clomid worked and make sure you haven’t produced a TON of eggs. Both Dr. Kort and Dr. Frederick say they would cancel any fertility treatment cycles (or tell a patient not to have sex) if more than three eggs had developed, due to the risks associated with getting pregnant with multiples. 
• Then, if everything checks out, you’ll move on to either having timed sex (your doc can tell you what your best cycle days are for getting pregnant) or go for a round of intrauterine insemination (IUI) so sperm can be placed directly into the uterus to maximize the odds for that coveted moment between sperm and egg. 

Dr. Frederick says the combination of Clomid and IUI is a great first-treatment option because it’s low-tech and affordable; if you’re under 40, the pregnancy success rate is about 10%. She adds that in vitro fertilization (IVF) is not usually paired with Clomid because the medication doesn’t generally produce enough eggs to justify going through IVF. 

Depending on your age and medical history, your doctor will decide how many months you should try getting pregnant on Clomid before moving on to other treatments, so don’t hesitate to ask them about the timeline.

What about Letrozole? 

Letrozole (aka Femara) is another prescription drug that stimulates ovulation, just like Clomid; the only major difference between them, says Dr. Kort, is that Clomid has been around for twice as long as Letrozole so more is known about its effectiveness and side effects. 

“They work similarly and most studies show them to be fairly equivalent,” he says, “though it’s suggested that Letrozole may work better for women with PCOS and Clomid may work better for women with unexplained infertility.” 

A 2015 study in the New England Journal of Medicine supports this, showing that Letrozole resulted in higher live-birth and ovulation rates in women with PCOS than Clomid.

It sounds like maybe I don’t have to freak out?

Nope, not really. Dr. Frederick says that patients on Clomid should be carefully monitored for side effects, so your doctor is going to be pretty tuned into your body’s response to the medication while you’re on it. And he or she is not going to let you go through IUI if your “super ovulation” turns out to be even more super than you anticipated. So, educate yourself, but don’t stress about winding up with quintuplets, okay?