Fertomid (clomiphene citrate) is a selective estrogen receptor modulator (SERM) widely utilized in reproductive medicine for the treatment of anovulatory infertility. As a first-line pharmacological intervention, it functions by antagonizing estrogen receptors at the hypothalamus, thereby increasing the secretion of gonadotropin-releasing hormone (GnRH). This subsequently stimulates the pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH), promoting follicular development and ovulation. Its established efficacy, favorable safety profile, and oral administration make it a cornerstone in ovulation induction protocols for appropriately selected patients.

Features

• Active ingredient: Clomiphene citrate
• Available in 50 mg tablets
• Selective estrogen receptor modulator (SERM) class
• Oral administration
• Typically prescribed in 5-day treatment cycles
• Requires monitoring via ultrasonography and/or hormonal assays
• Manufactured under strict pharmaceutical compliance standards

Benefits

• Effectively induces ovulation in women with anovulatory disorders, such as polycystic ovary syndrome (PCOS)
• Increases the probability of achieving monofollicular development, reducing risks associated with multifollicular growth
• Non-invasive oral formulation enhances patient compliance compared to injectable alternatives
• Cost-effective first-line treatment option for ovulatory dysfunction
• Well-established clinical history with extensive research supporting its efficacy and safety
• Facilitates timed intercourse or intrauterine insemination (IUI) cycles by enabling predictable ovulation

Common use

Fertomid is primarily indicated for the treatment of ovulatory dysfunction in women desiring pregnancy. Its use is most appropriate for patients with normogonadotropic anovulation, particularly those with polycystic ovary syndrome (PCOS) who have failed to ovulate with lifestyle modifications. It may also be used off-label for ovarian stimulation in ovulatory women undergoing superovulation for assisted reproductive technologies (ART) such as intrauterine insemination. Treatment should always be initiated after exclusion of other causes of infertility and under specialist supervision.

Dosage and direction

The initial recommended dosage is 50 mg (one tablet) daily for 5 days, beginning on day 3, 4, or 5 of the menstrual cycle (with day 1 being the first day of menstrual bleeding). In the absence of withdrawal bleeding following progestin administration, treatment may commence at any time. If ovulation does not occur at the initial dose, the dosage may be increased to 100 mg daily for 5 days in subsequent cycles. The maximum recommended daily dose is 150 mg. Treatment beyond 3-6 cycles is generally not advised due to decreased efficacy and potential endometrial changes. Ultrasound monitoring is recommended to assess follicular response and prevent hyperstimulation.

Precautions

• Ovarian hyperstimulation syndrome (OHSS) may occur, particularly in patients with polycystic ovaries
• Multiple pregnancies occur in approximately 8% of pregnancies achieved with clomiphene citrate
• Visual disturbances (blurring, scotomas) may occur and require immediate discontinuation
• Long-term use (≥12 cycles) may be associated with increased risk of borderline ovarian tumors
• Patients should be advised that the incidence of congenital malformations may be slightly increased compared to spontaneous conceptions
• Thyroid and adrenal disorders should be excluded before treatment initiation
• Endometrial thickness should be monitored due to anti-estrogenic effects on endometrium

Contraindications

• Pregnancy (category X)
• Liver disease of unspecified type or duration
• Abnormal uterine bleeding of undetermined origin
• Ovarian cysts not associated with polycystic ovarian syndrome
• Uncontrolled thyroid or adrenal dysfunction
• Hypersensitivity to clomiphene citrate or any component of the formulation
• Endometrial carcinoma
• Primary ovarian failure

Possible side effects

• Vasomotor flushes (10% of patients)
• Abdominal discomfort/bloating (7%)
• Nausea and vomiting (2%)
• Breast tenderness (2%)
• Visual disturbances (1.5%)
• Headache (1%)
• Abnormal uterine bleeding (0.5%)
• Ovarian enlargement (5-10%)
• Mood swings and depression (rare)
• Allergic dermatitis (rare)

Drug interaction

• Concomitant use with gonadotropins may increase the risk of ovarian hyperstimulation syndrome
• Warfarin efficacy may be altered due to potential changes in plasma protein binding
• Aromatase inhibitors may theoretically reduce efficacy through different mechanisms of action
• Thyroid medications may require dosage adjustments due to altered hormone levels
• Herbal supplements with estrogenic activity (e.g., black cohosh, soy isoflavones) may interfere with mechanism of action

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next dose. Do not double the dose to make up for the missed one. Contact your healthcare provider for specific guidance regarding cycle management if multiple doses are missed, as this may affect treatment efficacy and require cycle cancellation or adjustment.

Overdose

Symptoms of overdose may include nausea, vomiting, vasomotor flushes, visual disturbances, and ovarian enlargement. There is no specific antidote for clomiphene citrate overdose. Treatment should be symptomatic and supportive. Hemodialysis is not likely to be effective due to high protein binding. In cases of massive overdose, gastric lavage may be considered if presented within 1-2 hours of ingestion.

Storage

Store at controlled room temperature (20-25°C or 68-77°F). Protect from light and moisture. Keep in the original container with the lid tightly closed. Do not store in bathroom or kitchen where humidity and temperature fluctuations may occur. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Fertomid should only be used under the supervision of a qualified healthcare professional specializing in reproductive medicine. Individual response to treatment may vary. The prescriber should thoroughly evaluate each patient’s medical history and current health status before initiating therapy. Always follow the specific instructions provided by your healthcare provider rather than relying solely on general information.

Reviews

“After 18 months of unsuccessful attempts to conceive due to PCOS-related anovulation, Fertomid 50 mg resulted in ovulation in my first treatment cycle. Although pregnancy wasn’t achieved immediately, the predictable response allowed for well-timed intercourse. I appreciated the detailed monitoring and dose adjustments under my reproductive endocrinologist’s care.” - Patient, 32

“As a reproductive endocrinologist with 15 years of experience, I find Fertomid remains an invaluable first-line treatment for appropriately selected anovulatory patients. Its predictable response pattern, when combined with proper monitoring, provides an excellent balance of efficacy and safety. I particularly appreciate the ability to titrate dosage based on individual follicular response.” - Dr. E. Thompson, MD

“The affordability of Fertomid compared to other fertility treatments made it accessible for our family. While we experienced some side effects (mainly hot flashes), the trade-off was worthwhile as we conceived our daughter in the third treatment cycle. The key was working with a specialist who monitored us closely throughout the process.” - Patient, 29

“From a pharmacological perspective, clomiphene citrate’s mechanism of action as a SERM provides a sophisticated approach to ovulation induction. Its ability to stimulate endogenous gonadotropin release rather than relying on exogenous hormones offers distinct physiological advantages, though requires careful patient selection and monitoring.” - Clinical Pharmacologist, Fertility Center

“We achieved pregnancy with our first cycle of Fertomid 100 mg after failing to ovulate at lower doses. The treatment cycle was straightforward, though the emotional aspect of timed intercourse created some pressure. The support from our medical team was crucial in managing expectations throughout the process.” - Patient, 31