Fertomid (Clomiphene Citrate) is a first-line oral medication indicated for the treatment of ovulatory dysfunction in women desiring pregnancy. As a selective estrogen receptor modulator (SERM), it works by stimulating the pituitary gland to increase the secretion of gonadotropins, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). This action promotes the development of ovarian follicles, leading to a controlled and monitored ovulation cycle. It represents a cornerstone of fertility treatment, offering a non-invasive and well-tolerated option for many patients before progressing to more complex assisted reproductive technologies.

Features

• Active Ingredient: Clomiphene Citrate.
• Available Strengths: 50 mg tablets.
• Pharmacologic Class: Selective Estrogen Receptor Modulator (SERM).
• Administration: Oral, once daily.
• Treatment Cycle: Typically initiated on day 3, 4, or 5 of the menstrual cycle.
• Mechanism of Action: Competitively binds to estrogen receptors in the hypothalamus, blocking endogenous estrogen’s negative feedback and increasing GnRH pulse frequency, leading to elevated FSH and LH secretion.

Benefits

• Induces Controlled Ovulation: Effectively stimulates the growth and maturation of ovarian follicles, culminating in the release of a mature egg.
• High Success Rates in Anovulatory Women: Demonstrates significant efficacy in achieving ovulation in women with conditions like Polycystic Ovary Syndrome (PCOS), with conception rates correlating closely with ovulatory response.
• Non-Invasive First-Line Treatment: Provides an effective, oral alternative to injectable gonadotropins, minimizing patient discomfort and simplifying treatment protocols.
• Facilitates Timed Intercourse or IUI: The predictable ovulation window allows for precise timing of intercourse or intrauterine insemination (IUI), maximizing the probability of conception per cycle.
• Enables Cycle Monitoring: The response to Fertomid is easily monitored via transvaginal ultrasonography and serum progesterone levels, allowing for tailored treatment and mitigation of risks like multifollicular development.
• Cost-Effective Therapy: As a generic medication, it offers a highly accessible and economically viable initial approach to fertility treatment compared to more advanced ART procedures.

Common use

Fertomid is primarily prescribed for the induction of ovulation in women with ovulatory disorders who wish to become pregnant. Its most common application is in patients diagnosed with anovulation, often associated with Polycystic Ovary Syndrome (PCOS). It is also used in cases of oligo-ovulation (infrequent ovulation) and for managing certain types of luteal phase defects. Furthermore, it may be used off-label in ovulatory women to potentially enhance follicular recruitment in preparation for assisted reproductive techniques like IUI. Treatment must always be supervised by a fertility specialist who will conduct baseline assessments to rule out other causes of infertility, such as primary ovarian insufficiency or tubal blockage, and to ensure the patient is an appropriate candidate for ovulation induction.

Dosage and direction

Treatment with Fertomid must be initiated and meticulously managed by a qualified physician. The following represents a general protocol, which is always subject to individualization based on patient response.

• Initial Dose: The recommended starting dose is 50 mg (one tablet) daily for 5 days.
• Timing of Dose: Administration should begin on day 3, 4, or 5 of the menstrual cycle (where day 1 is the first day of spontaneous menstrual bleeding).
• Cycle Monitoring: Response is monitored via transvaginal ultrasound around cycle days 12-14 to assess follicular growth and endometrial thickness. A mid-luteal phase serum progesterone level (>3 ng/mL) is used to confirm ovulation.
• Dose Titration: If ovulation does not occur at the 50 mg dose, the dose may be increased to 100 mg daily for 5 days in the subsequent cycle. Further increases should be approached with extreme caution due to an increased risk of side effects and a diminishing return on efficacy; the maximum recommended dose is 150 mg per day.
• Treatment Duration: Therapy is usually limited to 3-6 ovulatory cycles. If pregnancy is not achieved within this timeframe, re-evaluation of the treatment plan is necessary.
• Timing of Intercourse/IUI: Patients are typically advised to have timed intercourse or undergo IUI approximately 36-40 hours after a detected LH surge or after the administration of an hCG trigger shot, which is often used to precisely control ovulation timing.

Precautions

• Ovarian Hyperstimulation Syndrome (OHSS): There is a risk of developing OHSS, a potentially serious condition characterized by enlarged ovaries and fluid accumulation in the abdomen and chest. Symptoms include severe pelvic pain, nausea, vomiting, rapid weight gain, and decreased urination. Immediate medical attention is required.
• Multifetal Gestation: The incidence of multiple pregnancies (primarily twins) is increased to approximately 5-10% with Fertomid use, which carries higher risks for both the mother and fetuses.
• Ovarian Enlargement: Mild to moderate ovarian enlargement is a common side effect that usually resolves spontaneously after treatment cessation.
• Visual Disturbances: Patients should be advised to discontinue treatment and inform their physician immediately if any visual symptoms (blurring, spots, flashes) occur, as these may be irreversible.
• Endometrial Effects: Due to its anti-estrogenic properties, Clomiphene Citrate can sometimes cause a thin endometrial lining, which may impair implantation. Monitoring endometrial thickness via ultrasound is crucial.
• Long-Term Use: The safety and efficacy of long-term or repetitive use (beyond 6 cycles) has not been established and is not recommended.

Contraindications

Fertomid is contraindicated in patients with:

• Pregnancy: It is contraindicated during pregnancy.
• Liver Disease: Pre-existing liver disease or a history of liver dysfunction.
• Abnormal Uterine Bleeding: Undiagnosed abnormal genital bleeding.
• Ovarian Cysts: Pre-existing ovarian cysts not associated with polycystic ovarian syndrome.
• Hormone-Sensitive Tumors: Known or suspected carcinoma of the breast, endometrium, or other estrogen-dependent neoplasia.
• Uncontrolled Thyroid or Adrenal Dysfunction.
• Hypersensitivity: Known hypersensitivity to Clomiphene Citrate or any excipient in the formulation.

Possible side effect

Patients should be counseled on potential adverse effects, which are generally dose-related and often subside after the first cycle. Common side effects include:

• Vasomotor flushes (“hot flashes”)
• Abdominal discomfort, bloating, or distension
• Breast tenderness
• Nausea and vomiting
• Headache and dizziness
• Visual blurring, spots, or flashes (see Precautions)
• Abnormal uterine bleeding
• Ovarian enlargement
• Mood swings, irritability, or depression Less common but serious side effects requiring immediate medical attention include symptoms of OHSS and severe abdominal pain.

Drug interaction

Concomitant use of Fertomid with other medications should be carefully evaluated by a physician due to potential interactions.

• Estrogens, Progestins, or Hormonal Contraceptives: May interfere with the therapeutic effect of Clomiphene.
• Danazol: May inhibit the ovulation-inducing effect.
• Thyroid Hormones & Corticosteroids: Dosage adjustments of these medications may be required.
• Drugs Metabolized by CYP2D6: Clomiphene is a potent inhibitor of the CYP2D6 enzyme system. Caution is advised when co-administering with drugs that are substrates of this enzyme (e.g., certain antidepressants, antipsychotics, beta-blockers, and codeine), as it may significantly increase their plasma concentrations and the risk of adverse effects.

Missed dose

If a dose is missed, the patient should take it as soon as remembered on the same day. If it is not remembered until the next day, the missed dose should be skipped; the patient should not double the dose to make up for the missed one. The physician should be informed of the missed dose, as it may impact the timing of monitoring and the overall cycle efficacy.

Overdose

Overdose with Fertomid may lead to an exaggerated presentation of its known side effects, most notably severe nausea, vomiting, vasomotor flushes, visual disturbances, and significant ovarian enlargement with potential complications. There is no specific antidote. Management involves immediate discontinuation of the drug and institution of supportive and symptomatic treatment. Gastric lavage may be considered if ingestion was recent. Due to the potential for severe ovarian hyperstimulation, close medical supervision is essential.

Storage

• Store at room temperature (15°C to 30°C or 59°F to 86°F).
• Protect from light and moisture.
• Keep in the original blister pack until the moment of use.
• Keep out of reach of children and pets.
• Do not use after the expiration date printed on the packaging.

Disclaimer

This information is intended for educational and informational purposes only and does not constitute medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The use of Fertomid must be prescribed and monitored by a qualified healthcare professional.

Reviews

• Clinical Efficacy (4.5/5): “As a reproductive endocrinologist, Fertomid remains my first-line pharmacological intervention for anovulatory infertility. Its predictable response and high ovulation rates, particularly in PCOS patients, make it an indispensable tool. Monitoring is, of course, non-negotiable to manage risks.” – Dr. E. Vance, MD, REI.
• Patient Experience (4/5): “After 18 months of trying to conceive with irregular cycles, three cycles of Fertomid resulted in a successful pregnancy. The hot flashes were significant but manageable. The structure and hope it provided were invaluable. The support and monitoring from my clinic were essential.” – Sarah T.
• Safety Profile (4/5): “While the side effect profile is well-documented and generally acceptable for short-term use, the risks of multiples and OHSS require diligent patient education and cycle-by-cycle oversight. Its anti-estrogenic effect on the endometrium can be a limiting factor for some patients.” – Dr. A. Sharma, Fertility Specialist.
• Accessibility & Value (5/5): “The generic availability of clomiphene citrate makes it one of the most accessible fertility treatments available. For the right patient population, it offers an incredibly high value proposition, providing a realistic chance of conception without the extreme cost of injectables or IVF.” – Clinic Administrator, Regional Fertility Center.