Clomiphene Citrate Therapy for Ovulatory Dysfunction

Patient Monitoring and Precautions

• The American Society for Reproductive Medicine recommends documenting the number and size of developing follicles during ultrasound monitoring to assess follicular response and minimize risks of hyperstimulation and multiple pregnancy, with a reported risk of ovarian hyperstimulation and multiple pregnancy, particularly when more than 2-3 dominant follicles develop 1
• The risk of multiple pregnancy is increased, with 20-30% of clomiphene pregnancies resulting in multiple gestations when more than 2-3 dominant follicles develop, and cycle cancellation should be considered if more than 3 follicles >17mm develop 1
• Patients should be counseled extensively about complications of multiple pregnancy, and alternative treatments such as aspiration of excess follicles at time of ovulation trigger should be considered 1
• The Endocrine Society recommends screening for uncontrolled thyroid or adrenal dysfunction before initiating clomiphene therapy, as well as evaluating for pituitary tumor or hyperprolactinemia, and treating the underlying cause first 1
• The American College of Obstetricians and Gynecologists recommends performing an endometrial biopsy in women of advancing age to exclude endometriosis and endometrial carcinoma, particularly before initiating clomiphene therapy 1