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Fertility PillsSince clomiphene indirectly stimulates a woman’s ovaries, cysts may temporarily appear in her ovary. Rarely, these cysts may rupture or twist. Usually, they resolve spontaneously within a month. We try to examine the ovaries prior to each new clomiphene cycle.

Clomid has an anti-fertility side effect that not many patients learn about until after they start taking the medication. It can thin out the lining of your uterus which may make pregnancy harder to achieve and increase your chance of miscarriage.

Clomid is cheap relative to other fertility drugs. If clomid isn’t covered by your insurance, ask your doctor to call your prescription into: Walmart, Costco or Sam’s Club. You will get each tablet for around $3-4. Your Clomid prescription should not cost more than $30. Chances of pregnancy with Clomid are in the 8-10% range. If you do get pregnant with clomid, your chance of twins is around 8-10%. Risk of having more than twins is very very small but it isn’t 0.

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The most common side effect of clomiphene is hot flashes . Another common side effect is anxiety/irritability. This feeling of nervous tension may persist throughout the clomiphene cycle. Clomiphene may cause headaches, especially in women who experience migraine at the time of their period. Nausea and abdominal pain will rarely occur on the days that clomiphene is taken. If the clomiphene succeeds in stimulating a strong ovulation, the woman will likely experience some pain at the time of her ovulation, bloating through the second half of her cycle, and/or increased cramping at the time of her period (if she has not become pregnant).

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4. Will these medications increase my risk of birth defects? No. Ask your doctor what your risk is of having a baby with a birth defect. The risks tend to be age related. Your doctor will know if you have any other medical problems that may put you in a higher risk category.

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8. How much will an ultrasound and insemination cost? Depending on your clinic and insurance coverage, this treatment plan may cost (including medications) around $900. Ask ahead of time so there are no surprises.


The latest class of fertility pills are aromatase inhibitors, drugs which temporarily prevent the body from making estrogen. In a fashion not too different from clomiphene, aromatase inhibitors initiate the release of FSH which stimulates the growth of follicles. At Main Line Fertility we use the aromatase inhibitor named letrozole (Femara).

For women who are trying to conceive, fertility formulas are available. These supplements are formulated with a blend of vitamins, minerals, herbs and antioxidants that may support reproductive health and wellness while possibly helping to maintain a healthy hormonal balance.

Femara does not work in the same way as Clomid so it doesn’t cause the symptoms described above. You may feel lower leg cramping while on Femara. Femara is in your system for less than 3 days so after the last tablet taken, by cycle day #9/10, your body won’t have any femara left circulating inside.

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Femara is FDA approved for breast cancer prevention. In the clinical trials, researchers found that Femara caused women to make follicles on their ovaries so fertility doctors starting using it to induce ovulation.

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The 20-25% risk of miscarriage associated with clomiphene is higher than the normal rate of miscarriage (15%). We attribute some increase in the rate of miscarriage to factors preexisting in women who require clomiphene that prevent fertilized eggs from developing normally. However, it is possible that clomiphene might increase the rate of miscarriage by changing the receptivity of the lining of the uterus. The condition (thickness) of the lining of the uterus can be evaluated with ultrasound just prior to ovulation.

7. What is involved in an insemination? If you are producing a sample at home, your doctor will tell you when to have the sample in the lab for processing. Processing times vary from clinic to clinic. The processing time in my lab is 30 minutes. You will have two appointments: time to drop off the sample, and time for the IUI. The IUI is similar to a PAP smear except a catheter goes through your uterus and you lie down for 10-30 minutes (depends on the clinic) after the procedure.

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Common side effects of metformin include gas and intestinal upset. Serious side effects are extremely rare. Pioglitazone has fewer common/minor side effects, but require blood test monitoring to detect liver problems. The incidence of miscarriage and, perhaps, birth defects may be reduced in PCO patients who take insulin lowering drugs.

Frequently asked questions by patients taking fertility pills: 1. Is this IVF? No. IVF is more involved and includes a procedure done to remove eggs and make embryos followed by transferring the embryos into your uterus.

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Your doctor may want to check a progesterone level 8 days after your surge (+OPK)  to see that you have responded to the fertility pills. This is something to consider if you go with monitoring option #1. I tend to prescribe progesterone to everyone who goes through fertility treatments.

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Occasionally, we employ a drug called tamoxifen as an alternative to clomiphene. This medication works through the same mechanisms as clomiphene. It is not FDA approved for use as a fertility drug, but may be used for this “off-label” indication at the discretion of the physician.

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Sometimes the composition of a woman's cervical mucus makes it harder for her to conceive. Supplements that combine vitamins and minerals important for fertility with an amino acid called L-arginine may help support reproductive function and promote healthy cervical mucus. L-arginine is converted to nitric oxide, a chemical that increases blood flow to reproductive organs. In addition, fertility supplements contain antioxidants that may reduce cellular damage. They also contain vitamins and minerals a woman needs for reproductive health. There's little doubt that good nutrition can have a positive impact on fertility. It is not certain if these supplements are effective in boosting fertility.

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Although an occasional medical journal report has described birth defects attributed to clomiphene, the majority of physicians utilizing this medication properly have failed to demonstrate any increase in the 3-5% rate of congenital abnormalities normally seen in our population. Clomiphene must not be taken by women who are already pregnant. Even if some menstrual-like bleeding has occurred, a woman should not take clomiphene if she suspects that she might be pregnant.

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The second signs of infertility thing these pills help with is to ensure that your cervical mucus levels are correct, and that they’re adequate enough. There are many women, who this is a problem for them. They’ve got the baby-making business down pat, they’ve been doing the basal body temperature and charting their cycles, so they know exactly when they ovulate and so what’s going on? Why aren’t they getting pregnant? In some cases you just aren’t producing an adequate amount of cervical mucus. That stuff

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