Clomiphene adverse effects

A systematic review of 4 studies in the Cochrane database concludes that clomiphene citrate (at doses between 50-250 mg per day) is an effective method of inducing ovulation and improves fertility in oligo-ovulatory women. However adverse effects include... 

In one large study, some adverse reactions in treated women were due to its ovulatory effects and others were direct reactions to the substance itself (2). The most common problem was ovarian enlargement (14%), followed by hot flushes (11%), abdominal and pelvic discomfort (7.0%), and nausea and vomiting (2.1%). Incidental symptoms were breast discomfort, vaginal changes, psychological symptoms, headache, heavier menses, and increased urinary frequency. Sporadic case-reports on clomiphene in the literature relate to fetal ovarian dysplasia or maternal psychosis (SEDA-7, 391), either of which may have been coincidental. However, it must be borne in mind that the substance is related structurally to tripar-anol, an obsolete drug that produced a series of disastrous adverse effects some 40 years ago. 

In another study, the adverse effects of the antiestrogenic effects of clomiphene citrate were hot flushes (10%), mood swings, depression, headaches (1%), pelvic pain (5.5%), nausea (2%), breast tenderness (2-5%), dryness and loss of hair (0.3%), visual symptoms, halos and streaks around lights (particularly at night), blurring, and scotoma (1.5%) (3). 

In some men taking clomiphene in the hope of improving subfertility, a non-bacterial pyospermia developed and could well have had an adverse effect on the outcome it appeared more commonly in clomiphene users than controls (5). 

The adverse effects associated with clomiphene include thickening of the cervical mucus, which creates a substantial barrier for motile sperm. A postcoital test can be performed to determine if this, in fact, represents an insurmountable hurdle. If so, an lUI is warranted to bypass this cervical challenge. Another adverse effect is endometrial thinning, which is not conducive to embryo implantation if this is the case, additional pharmacological therapies are recommended to thicken the endometrial lining. Other adverse effects include hot flashes and mood swings (95). 

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