Getting Pregnant on Clomid® with PCOS

People with PCOS often face challenges when managing their fertility and wonder if PCOS affects pregnancy. Getting pregnant requires three key things: the release of a normal egg, the introduction of healthy sperm, and a clear pathway for the two to meet. Unfortunately for many with PCOS, the first step (the release of an egg, AKA ovulation) doesn’t occur regularly. This is often caused by the high levels of male hormones associated with PCOS, and is the main reason that PCOS can make TTC so difficult. The bright side is that PCOS is one of the most treatable causes of infertility, and it’s all about regulating ovulation.

There are ovulation test kits that can tell you whether or not you’re ovulating, but it’s hard to know when to start testing if you have an irregular period. It’s also possible that ovulation isn’t occurring regularly even if menstrual cycles are fairly regular. This is where general management of PCOS and some fertility treatments can be useful. Read our guide on PCOS treatment options for a more holistic overview on TTC, and let’s talk about the use of Clomid® and PCOS.

Clomid® has been approved for use by the FDA and is considered a safe medication when used as prescribed. Minor Clomid® side effects may include:

• Headaches (1 to 2%)
• Breast pain or tenderness (2%)
• Hot flashes (10%)
• Bloating (6%)
• Nausea (3%)

In less than 1% of cases, patients develop a condition known as ovarian hyperstimulation syndrome (OHSS). This is a serious and potentially life threatening condition. You should see a healthcare provider right away if you notice any of the following symptoms:

• Stomach pain
• Vomiting, diarrhea
• Rapid weight gain
• Decreased urine output
• Rapid heart rate
• Shortness of breath
• Vision problems
• Heavy vaginal bleeding

Clomid® use also increases the chance of multiple pregnancies (twins or triplets). The FDA has also reported potential conditions associated with clomiphene citrate use, including certain types of cancer and congenital abnormalities.

This isn’t a complete list of potential side effects. Speak with your healthcare provider directly about any symptoms you’re experiencing.

The typical dose for clomiphene citrate is 50 mg orally once a day for five days. In patients with regular menstrual cycles, medication should begin on or around the third to fifth day of menstruation. Clomid® should be stored at room temperature and away from moisture, heat, and light.

In some cases patients may fail to ovulate after taking Clomid®. If this occurs, larger doses may be prescribed for the second cycle of ovulation induction therapy. Speak to your prescribing clinician for specific questions about your medication.

The price of ovulation induction medications can vary based on the type of prescription. The average cash price for medications like clomiphene citrate is $15-50/cycle. You can contact your local pharmacy for more information on out-of-pocket costs.

As we know, Clomiphene works by stimulating the release of hormones that help induce ovulation. It also helps to regulate the menstrual cycle for women experiencing irregular ovulation patterns due to PCOS. The efficacy of Clomiphene can be measured in several ways, from stimulating ovulation to live births.

Research suggests that clomiphene can trigger ovulation in up to 75% of patients with PCOS, resulting in an increase of up to 40% in pregnancies after three cycles of medication. The success rate can, however, vary from person to person, due to various factors including the fertility of the male, the patient's ovarian reserve, and any abnormalities with the uterus or fallopian tubes. As individual results may vary, it’s important to consult with your healthcare provider to further discuss treatment options and potential success rates.

Ultimately, not all women find success with ovulation induction. Some women may experience what is referred to as "Clomid® resistance" - where Clomid® fails to induce ovulation as expected. In this case, your primary care provider might recommend taking various supplements in conjunction with clomiphene to increase its efficacy, or they might prescribe you a different medication altogether. 

Letrozole, originally created for the purpose of reducing estrogen levels to treat breast cancer, is increasingly prescribed for patients with PCOS to induce ovulation. While both medications have shown promising success rates in supporting fertility outcomes, some studies suggest letrozole is actually more effective at increasing the rate of pregnancy as shown in the table.

Inositol is a naturally occurring sugar that may help improve reproductive outcomes in women with PCOS. Studies have shown that taking an inositol supplement along with clomiphene can increase chances of conception and improve pregnancy success rates. Inositol has also been found to improve insulin sensitivity, reduce androgen levels, and reduce the risk of gestational diabetes in pregnant women with PCOS.

In addition to inositol, there are several supplements that may also support fertility outcomes when taken with clomiphene. These include:

• Omega-3 fatty acids: Not only can they help increase insulin sensitivity, omega-3s also produce hormones that help to reduce inflammation and lessen the absorption of LDL cholesterol. Women with PCOS may consider taking an omega DHA supplement to help support normal insulin response and cholesterol levels.
• Vitamin D: Approximately 70% of women with PCOS lack the required amount of vitamin D, which can further aggravate already existing conditions such as insulin resistance and irregular menstrual cycles. Vitamin D3 gummies are an easy way to incorporate this supplement into your diet.
• Magnesium: Magnesium deficiency can be especially detrimental for women with PCOS as it may further heighten insulin resistance and androgen levels. Women with PCOS may consider supplementing with a magnesium drink to help manage their symptoms.