"What can I expect to feel like on fertility drugs? What are the side effects?” Part 1 (Clomiphene Citrate)
Joseph Peña, MD, FACOG


“Fertility drugs” can refer to any number of medications used for fertility treatment. The two most common of these are the oral medication clomiphene citrate (Clomid) and the injectable gonadotropins (e.g. Gonal F, Follistim, Bravelle, Menopur, Repronex, etc.). Some side effects and complications are common to both, while others may be unique to each group. A review of the side effects, risks, and complications of both groups is listed below.

Side effects, risks, and complications of clomiphene citrate (CC) may include the following:

· Menopausal symptoms are not uncommon such as:

o Hot flashes (~10%)

o Irritability

o Headaches (1.3%)

· Abdominal distension, bloating, pain, or soreness (5.5%)

· Ovarian cyst formation – not uncommon and temporary, resolving within in 1-2 menstrual cycles

· Thickened cervical mucus

o If present, it can be treated by bypassing the cervix with use of intrauterine insemination (IUI)

· Breast discomfort (2%)

· Nausea and vomiting (2%)

· Visual disturbances (1.5%), such as blurring, spots or flashes, double vision, intolerance to light, decreased visual sharpness, loss of peripheral vision, and distortion of space

o If present, should be cautious about driving a car or operating dangerous machinery

o Notify your doctor immediately who may modify your treatment and/or recommend a complete evaluation by an eye specialist

o Symptoms usually disappear within a few days of discontinuing the medication

· Multiple pregnancy

o 5-8% risk of multiple pregnancy with use of CC (mostly twins, 1% risk of triplets), compared to baseline of 1-2% in the general population

· Ovarian hyperstimulation syndrome

o If present, usually mild (enlarged ovaries and abdominal discomfort)

o Rarely, may be severe. Potential complications may include

§ Massive ovarian enlargement, progressive weight gain, severe abdominal pain, nausea and vomiting, fluid in abdominal cavity, decreased urine output

· Miscarriage risk?

o Some studies have noted a slightly higher miscarriage rate. However, it is not clear if this is due to an effect of the medication or related to preexisting conditions such as age or polycystic ovary syndrome (PCOS), which are found more often in women who take CC.

o Other studies have not shown an increased risk of miscarriage.

o No evidence that CC treatment increases overall risk of birth defects

· Ovarian cancer?

o No causal relationship between ovulation inducing drugs and ovarian cancer has been established



Thus, while the use of clomiphene citrate is generally safe and the benefits far outweigh the risks/side effects for a majority of women undergoing fertility treatment, it is important that while taking any of these medications, it should be done under the close supervision of a physician who is experienced in managing such treatment cycles. And if one has any questions or concerns while taking any of these medications, it is best to consult one’s physician. You can learn more about clomiphene citrate at: East Coast Fertility: ECF Blog Single[tt_news]=41&cHash=f6fa864a75e9c0f6e8982478ab2256db