Clomiphene citrate (Clomid) is by far the most commonly used fertility drug in the world. Used in the right circumstances and with appropriate application, it can be and is effective in assisting conception. Ideally the use of clomiphene use should be confined to younger women (under 35 years) who have normal “ovarian reserves” (as evidenced by normal day-3 FSH and AMH levels) and accordingly are likely to respond by producing the multiple follicles (at least 3), necessary to override the “antiestrogenic” effects of clomiphene (see below). In my opinion, if used for longer than 3 consecutive months, clomiphene is not only ineffective, but actually starts to function as a “relative” contraceptive! This could come as a shocking revelation to many women who have often many more consecutive cycles of Clomiphene without success.  Few realize that the rate of conception with clomiphene therapy is about 20%-30% lower than the natural fertility rate for any given age and about 25% lower than when gonadotropin stimulation is used. This problem increases significantly with advancing age.Consider the fact that in women under 35 years, the pregnancy rate with clomiphene treatment is about 10% per cycle , about 5% between 35 and 40 years and <3% after age 40Y. Here are a few reasons why this is so:

The above serves to explain why I strongly hold that Clomiphene should not be prescribed to women over 35 years of age, never to women with diminished ovarian reserve or women over 40 years, and should be avoided in IVF (alone or in combination with gonadotropins). The results are simply too poor to validate such practices.