What Is Clomid Resistance?
Clomid is usually the first choice of doctors who are treating women with fertility issues - primarily conception problems. Clomiphene citrate, as it is also known, is used to cause ovulation in women who fail to ovulate or do not ovulate regularly. Clomid causes an increase in the number of follicles the ovary produces and as a result, more eggs are produced and released, enhancing the chances of conception. It is a very effective and inexpensive drug and the success rate for it is good. About 75 percent of women who are treated for anovulation with Clomid will ovulate and 25 percent will not. Ovulation is necessary for conception.
Traditionally, Clomid's efficacy is proven within the first three months of use. If, for some reason ovulation does not take place during that time period the doctor may increase the dosage. Usually, the initial dose is very low, sometimes too low to cause ovulation in some women. If the dose is started at 50mg, it will probably be increased to 100mg to see if there is a response. Some doctors up the ante to 250mg, which sometimes works. But, if you are not ovulating with a higher dose, then you may be determined to be Clomid resistant - simply, your body isn't responding to the Clomid the way they'd like it to.
What Causes Clomid Resistance?
There are a few reasons your body may be resistant to Clomid and the approach your doctor takes for further treatment will depend upon why you don't seem to be responding. Some of the known reasons for Clomid resistance include:
· PCOS: Women who have PCOS are often insulin resistant as well or they may have high DHEA and androgen levels. Androgens are male hormones. Women with these issues often have difficulty with Clomid.
· BMI over 25: A body mass index that exceeds 25 decreases the effectiveness of Clomid. Your doctor may suggest you go on a weight-loss program to drop some weight and then try Clomid again. Often, with even just a 10 percent drop in weight, the drug is able to do its work.
· Hyperprolactinemia: HP is the presence of abnormally-high levels of prolactin, a peptide hormone, in the blood. It can be a cause of infertility in women.
· Sometimes, the reason it isn't working isn't clear.
What Are My Options If Clomid Fails?
When Clomid doesn't work, as can be the case in women with PCOS, then treatment with the insulin resistance drug Metformin may be helpful. Usually, Metformin is prescribed for six months before Clomid is resumed. There have been studies that show improved ovulation rates at this point, and there is good evidence to show that using both Clomid and Metformin together may increase pregnancy rates and decrease miscarriage risk.
Another option is birth control pills, used for women with high DHEA levels. While that may seem counter-intuitive, it actually does seem to work quite well. During a break from Clomid, birth control pills are taken - for about two months - then Clomid is resumed. However, research has shown good results with one study revealing that just over 65 percent of Clomid resistant women ovulated after taking birth control pills for two months preceding a cycle of Clomid treatment.
What If Clomid Really Isn't Going to Work?
If Clomid still doesn't work it could be because the mid-cycle luteinizing hormone (LH) surge isn't strong enough to force the follicles out of the ovary. If this is the case, you may be prescribed an injection of human chorionic gonadotrophin (hCG) along with the Clomid to boost the effects of the LH surge and trigger ovulation.
Should it happen that after trying all of these options, you are still not ovulating on Clomid; different ovarian stimulating medications will likely be suggested. Some women with PCOS have been observed to have good response to a drug called Letrozole, known as Femara. This drug may induce ovulation in some women with PCOS who are Clomid resistant, as well as some who have unexplained infertility.
There is a wide variety of infertility treatments available for women experiencing difficulties conceiving. This section deals with many of them.