Clomiphene
Brand names: Clomid, Milophene. Also called clomiphene citrate, clomifene, CC, Clomid.
Selective estrogen receptor modulator (SERM) 6 graded human studies Last checked
The short answer
From 11 sourcesClomiphene is an oral tablet that blocks estrogen feedback at the brain, so the pituitary releases more LH and FSH. Its label covers women with ovulatory dysfunction who want to conceive. Doctors also prescribe it to men with low testosterone from pituitary signalling, because it raises testosterone without stopping sperm production.
Key facts
Which clomiphene products are approved, and for what?
Clomiphene citrate tablets (Clomid and generics) are FDA-approved prescription drugs for ovulatory dysfunction in women who want to become pregnant. No product carries a boxed warning. Use in men to raise testosterone is off-label: the label says there are no adequate studies showing it works for male infertility.
Status by form
2 forms| Form | Status | Approved for | Boxed warning |
|---|---|---|---|
| Oral tablets 50 mgClomid, Milophene, generics | FDA-approved prescription drug12 | Ovulatory dysfunction in women who want to become pregnant | None on the current label |
| Use in men (low testosterone, male infertility) | Off-label prescribing of the same tablets; not FDA-approved for men1 | None | Not applicable; the label notes no adequate studies of male infertility |
What is clomiphene and how does it work?
Clomiphene binds estrogen receptors in the hypothalamus and pituitary and blocks estrogen's brake on them, so more LH and FSH are released. In women this can trigger ovulation. In men the same signals drive the testes to make more testosterone and sperm. It is a mixture of two isomers, zuclomiphene and enclomiphene.
How it works
Selective estrogen receptor modulator (SERM)Clomiphene competes with estrogen at receptors in the hypothalamus and pituitary, so the brain reads estrogen as low and releases more LH and FSH. It is a mix of two isomers: zuclomiphene, which has more estrogen-like activity and lingers for more than a month, and enclomiphene, which clears faster.1
What doses are on the label and in studies?
The label starts at 50 mg daily for 5 days, beginning around day 5 of the cycle, and allows 100 mg daily for 5 days if ovulation does not occur. It does not go higher and stops after about six cycles. Studies in men, a use outside the label (see chapter 1), gave 25 mg or 50 mg daily.
Label and study amounts, not a dose for you. A prescriber decides whether and how much; these show what the labels print and what trials used.
Doses by use
5 rows| Use | Form | Amount and schedule | Basis |
|---|---|---|---|
| Ovulation induction | Tablets | 50 mg daily for 5 days, started on or about day 5 of the cycle (or any time without recent bleeding)1 | Label |
| Ovulation induction, no ovulation on 50 mg | Tablets | 100 mg daily for 5 days, at least 30 days after the previous course; no higher dose or longer course1 | Label |
| Ovulation induction, total treatment | Tablets | Up to about six cycles (including three ovulatory cycles); reassess if no ovulation after three courses1 | Label |
| Men with obesity-related low testosterone | Tablets | 50 mg daily for 12 weeks in a placebo-controlled trial8 | Study |
| Men with low testosterone who want to keep fertility | Tablets | 25 mg daily for 12 weeks, compared with anastrozole 1 mg daily7 | Study |
What is clomiphene combined with?
Clomiphene is often paired with timed intercourse or intrauterine insemination. In polycystic ovary syndrome, the 2023 international guideline prefers letrozole as the first drug and ranks clomiphene above metformin alone. In men, it is compared with testosterone gel and anastrozole as ways to raise testosterone while keeping sperm.
Clomiphene or letrozole, in polycystic ovary syndrome
Both are five-day oral courses that trigger ovulation.
The 2023 international PCOS guideline recommends letrozole as the first-line drug and letrozole rather than clomiphene, based on trials such as PPCOS II (live birth 27.5% vs 19.1%). It ranks clomiphene above metformin alone and notes higher multiple-pregnancy risk, so clomiphene cycles may need ultrasound monitoring.53
Checked: Ultrasound monitoring of follicles may be used to limit multiple pregnancy.
Clomiphene and gonadotropins
Injected gonadotropins are the next step when pills fail.
In the AMIGOS trial in unexplained infertility, gonadotropins gave more live births (32.2% of cycles vs 23.3% with clomiphene) but also 32% multiple gestations, including triplets, against 9% twins with clomiphene. The clomiphene label reports hyperstimulation more often when combined with gonadotropins.41
Checked: Ovarian response by ultrasound; symptoms of hyperstimulation.
Clomiphene instead of testosterone, in men
To raise testosterone while keeping sperm production.
A 2025 meta-analysis of randomized trials found SERMs raised total testosterone by about 274 ng/dL over placebo and to levels similar to testosterone gel, with higher LH and FSH. A small trial found clomiphene raised testosterone more than anastrozole, while anastrozole lowered estradiol.97
Checked: Testosterone, estradiol and LH, as tracked in the studies.
How does clomiphene relate to fertility and pregnancy?
Clomiphene exists to restore ovulation, and multiple pregnancy is its main fertility trade-off: 7.98% of pregnancies in the label's trials were multiples, mostly twins. In men it raises testosterone without the sperm suppression that testosterone therapy causes, though the label notes no adequate studies of male infertility.
Fertility, pregnancy and breastfeeding
- Multiple pregnancy
- Of pregnancies in the label's clinical trials, 7.98% were multiples: 6.9% twins, 0.5% triplets, 0.3% quadruplets and 0.1% quintuplets.1
- Pregnancy itself
- Clomiphene is contraindicated in pregnancy; zuclomiphene can stay in the body for more than a month, so some drug may remain in early pregnancy.1
- Men
- Unlike testosterone, clomiphene raises LH and FSH, which drive sperm production; the label says no adequate studies show it treats male infertility.91
- After anabolic steroids or testosterone
- SERMs such as clomiphene are used to help restart sperm production after testosterone or anabolic steroids, with limited published data.11
What gets checked during treatment?
Women are checked for pregnancy, ovarian enlargement and cysts before each cycle, with a pelvic examination before the first and each later course; ovulation is confirmed by tests or temperature charts. Any visual symptoms mean stopping and an eye examination. In men, studies tracked testosterone, estradiol and LH.
Monitoring
5 checks| Check | When | Why |
|---|---|---|
| Pregnancy test and pelvic examination | Before the first and each later course1 | To exclude pregnancy, ovarian enlargement or cysts |
| Ovulation | 5 to 10 days after each course (tests or temperature chart)1 | Ovulation usually occurs in that window; timing intercourse matters |
| Vision | Any blurring, spots or flashes1 | Stop the drug and have a full eye examination |
| Triglycerides | Before starting; periodically with high blood fats or a family history1 | Higher doses and longer use are linked to high triglycerides; pancreatitis has been reported |
| Testosterone, estradiol and LH (men) | After 4 to 12 weeks in published studies107 | To see whether testosterone rose and estradiol stayed in range |
What does the research show?
In polycystic ovary syndrome, letrozole gave more live births than clomiphene in a 750-woman trial (27.5% vs 19.1%). In unexplained infertility, clomiphene matched letrozole and had fewer multiples than gonadotropins. In men, randomized trials and a meta-analysis show it raises testosterone to levels similar to testosterone gel.
Every graded row
6 rows from 6 studiesShowing 6 of 6 outcomes. Human trials only.
AGrade ALive birth vs letrozole in PCOSFertility (PCOS)WorsenedRCT
n 750 · 2014
Live birth 19.1% on clomiphene vs 27.5% on letrozole (rate ratio for letrozole 1.44); ovulation 48.3% vs 61.7% of cycles.
- Design
- RCT, n = 750, 2014
- Population
- Women 18 to 40 with polycystic ovary syndrome
- Form
- Oral tablets
- Dose
- Up to five treatment cycles
- Duration
- Up to 5 cycles
- Source
- Reference 3 · PubMed 25006718 (opens PubMed)
BGrade BLive birth in unexplained infertilityFertility (unexplained)MixedRCT
n 900 · 2015
Live birth per cycle 23.3% on clomiphene, 18.7% letrozole, 32.2% gonadotropins; multiples 9% (all twins) on clomiphene vs 32% on gonadotropins.
- Design
- RCT, n = 900, 2015
- Population
- Ovulatory women 18 to 40 with unexplained infertility
- Form
- Oral tablets
- Dose
- Up to four stimulation cycles
- Duration
- Up to 4 cycles
- Source
- Reference 4 · PubMed 26398071 (opens PubMed)
BGrade BTestosterone in men with functional hypogonadismTestosterone (men)ImprovedMeta-analysis · 10 studies
n 819 · 2025
Total testosterone about 274 ng/dL higher than placebo (95% CI 192 to 356); no significant difference from testosterone gel; LH and FSH higher.
- Design
- Meta-analysis, 10 studies, n = 819, 2025
- Population
- Men with functional hypogonadism in 10 randomized trials
- Form
- Clomiphene or enclomiphene
- Dose
- Various
- Duration
- 2 to 30 weeks
- Source
- Reference 9 · PubMed 41066380 (opens PubMed)
BGrade BTestosterone and body composition in obese menTestosterone (men)ImprovedRCT
n 78 · 2018
Testosterone, free testosterone, LH and FSH rose and lean and muscle mass improved vs placebo; HDL cholesterol fell.
- Design
- RCT, n = 78, 2018
- Population
- Men with BMI over 30 and testosterone 300 ng/dL or less
- Form
- Oral tablets
- Dose
- 50 mg daily
- Duration
- 12 weeks
- Source
- Reference 8 · PubMed 29777228 (opens PubMed)
CGrade CLong-term testosterone in menTestosterone (men)ImprovedObservational
n 46 · 2012
Testosterone rose from 228 to 612 ng/dL at 1 year and 582 at 3 years; symptom scores fell; no adverse events reported.
- Design
- Observational, n = 46, 2012
- Population
- Symptomatic hypogonadal men, mean age 44
- Form
- Oral tablets
- Dose
- Clinic dosing
- Duration
- Over 12 months, up to 3 years
- Source
- Reference 6 · PubMed 22458540 (opens PubMed)
CGrade CTestosterone vs anastrozoleTestosterone (men)ImprovedRCT
n 26 · 2015
Testosterone rose to 571 ng/dL on clomiphene vs 408 on anastrozole; estradiol rose on clomiphene and fell on anastrozole; semen unchanged.
- Design
- RCT, n = 26, 2015
- Population
- Hypogonadal infertile men, testosterone under 350 ng/dL
- Form
- Oral tablets
- Dose
- 25 mg daily (vs anastrozole 1 mg)
- Duration
- 12 weeks
- Source
- Reference 7 · PubMed 26176805 (opens PubMed)
What are the side effects and risks?
The label's most common effects are ovarian enlargement, hot flashes, abdominal bloating, nausea, breast discomfort and visual symptoms. Serious risks are ovarian hyperstimulation syndrome, visual disturbances that can persist, and multiple pregnancy. It is contraindicated in pregnancy, liver disease, unexplained uterine bleeding and ovarian cysts not caused by PCOS.
Regulatory status. Clomiphene tablets are FDA-approved prescription drugs for ovulatory dysfunction in women and carry no boxed warning; use in men is off-label.12
Side effects in the label's clinical studies
Share of patients; no comparison groupWarnings on the label
- Visual disturbances
- Blurring, spots and flashes rise with dose and duration; most resolve, but some have lasted after stopping and may be permanent.1
- Ovarian hyperstimulation syndrome (OHSS)
- Can progress within a day to several days into a serious illness, sometimes after cyclic use or with gonadotropins.1
- Ovarian tumors
- Epidemiology suggests prolonged use may raise the risk of a borderline or invasive ovarian tumor.1
- In men
- Testicular tumors and gynecomastia have been reported in men taking clomiphene; a causal link is not known.1
Who should not use it (label contraindications)
Pregnancy; liver disease or past liver dysfunction; unexplained abnormal uterine bleeding; ovarian cysts or enlargement not due to PCOS; uncontrolled thyroid or adrenal disease; an intracranial lesion such as a pituitary tumor; hypersensitivity.1
What does clomiphene interact with?
The clomiphene label lists no specific drug interactions. Its main pairings are clinical: with gonadotropins, where hyperstimulation becomes more likely, and in men as an alternative to testosterone rather than alongside it. The label also asks for triglycerides before starting, and periodic checks in people with high blood fats or a family history.
Interactions
1 agent| With | What happens | Evidence |
|---|---|---|
| Gonadotropins and other ovulation drugsFSH, hMG injections | Ovarian hyperstimulation has been reported when clomiphene was combined with gonadotropins.1 | Drug label |
Check your own medicines and supplements in the Interaction map: every edge is sourced, and nothing you enter leaves your browser.
How do the options compare?
Clomiphene and letrozole are both oral tablets taken for five days early in the cycle. In polycystic ovary syndrome letrozole gives more ovulation and live births; in unexplained infertility the two were similar. Gonadotropin injections give the highest pregnancy rates but far more twins and triplets than either pill.
Clomiphene, letrozole and gonadotropins for ovulation
| Clomiphene | Letrozole | Gonadotropin injections | |
|---|---|---|---|
| How it is taken | Tablet, 5 days a cycle | Tablet, 5 days a cycle | Daily injections |
| Live birth in PCOS (PPCOS II) | 19.1% | 27.5% | Not studied there |
| Live birth per cycle, unexplained infertility (AMIGOS) | 23.3% | 18.7% | 32.2% |
| Multiple gestations (AMIGOS) | 9%, all twins | 13%, all twins | 32%, including triplets |
Frequently asked questions
Common questions
6 answersIs clomiphene the same as Clomid?
How much more likely are twins on clomiphene?
Is letrozole better than clomiphene?
Can men take clomiphene for low testosterone?
How is clomiphene different from enclomiphene?
Clomiphene is a mix of two isomers; enclomiphene is one of them on its own. The other, zuclomiphene, is more estrogen-like and stays in the body for more than a month.1
What should I do about blurred vision on clomiphene?
The label says anyone with visual symptoms stops treatment and has a full eye examination promptly. Symptoms rise with dose and duration and usually reverse, but some have persisted.1
Sources
Sources cited on this page
11 sources- 1Clomid (clomiphene citrate) tablets: prescribing information (DailyMed, version effective 2025-01-31)Label Cosette Pharmaceuticals, 2025
- 2Clomiphene citrate tablets: prescribing information (DailyMed, version effective 2026-07-16)Label Camber Pharmaceuticals, 2026
- 3Letrozole versus clomiphene for infertility in the polycystic ovary syndrome (PPCOS II)RCT N Engl J Med, 2014 · PMID 25006718
- 4Letrozole, Gonadotropin, or Clomiphene for Unexplained Infertility (AMIGOS)RCT N Engl J Med, 2015 · PMID 26398071
- 5Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary SyndromeGuideline J Clin Endocrinol Metab, 2023 · PMID 37580314
- 6Clomiphene citrate is safe and effective for long-term management of hypogonadismObservational BJU Int, 2012 · PMID 22458540
- 7A Randomized Prospective Double-Blind Comparison Trial of Clomiphene Citrate and Anastrozole in Raising Testosterone in Hypogonadal Infertile MenRCT J Sex Med, 2015 · PMID 26176805
- 8Effects of clomiphene citrate on male obesity-associated hypogonadism: a randomized, double-blind, placebo-controlled studyRCT Int J Obes (Lond), 2018 · PMID 29777228
- 9Clomiphene or enclomiphene citrate for the treatment of male hypogonadism: a systematic review and meta-analysis of randomized controlled trialsMeta-analysis Arch Endocrinol Metab, 2025 · PMID 41066380
- 10Clomiphene citrate effects on testosterone/estrogen ratio in male hypogonadismObservational J Sex Med, 2005 · PMID 16422830
- 11Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid useReview Asian J Androl, 2016 · PMID 26908067
What changed
Change log
2 entries| Date | Change | Who and why |
|---|---|---|
| "Off-label" now appears only in the status box and the safety band; dose rows and key facts name the population instead of tagging it. | Writer: Kymata Health EditorialTrigger: Growth review (2026-10-23): status once or twice per page | |
| Page created: label status and dose, off-label use in men, combinations with letrozole and gonadotropins, fertility, monitoring, six graded rows, safety and a comparison of ovulation drugs. | Writer: Kymata Health EditorialTrigger: Owner request (2026-10-22): hormone library |
Kymata Health hormone library. Educational information only; it is not medical advice and does not replace a clinician. Doses are shown as labels and studies print them; a prescriber decides whether and how any hormone is used.