Clomiphene Citrate Dosing for Female Infertility

Monitoring and Safety

The American Society for Reproductive Medicine recommends canceling the cycle if more than 2 dominant follicles >15 mm or more than 5 follicles >10 mm are present to prevent high-order multiple gestations 1

Clomiphene citrate (100 mg per day for 5 days) is an acceptable alternative to low-dose gonadotropins with lower multiple pregnancy rates and costs, though it yields lower live birth rates than gonadotropins, as recommended by the European Society of Human Reproduction and Embryology 1
The American College of Obstetricians and Gynecologists suggests that for intrauterine insemination (IUI) with ovarian stimulation, gonadotropin doses of 75 IU or lower are preferred over higher doses due to similar pregnancy rates but lower multiple pregnancy risk 1

The FDA recommends avoiding the use of clomiphene in patients with liver disease, especially decompensated cirrhosis, due to potential hepatotoxicity, as stated in the guidelines by the National Institute of Diabetes and Digestive and Kidney Diseases 2
The Endocrine Society suggests ensuring adequate endogenous estrogen levels before initiating therapy in women with functional hypothalamic amenorrhea 2