Clomiphene Dosage: What You Need to Know About Usage, Side Effects, and Alternatives

When it comes to clomiphene, a selective estrogen receptor modulator used primarily to trigger ovulation in women struggling with infertility. Also known as clomiphene citrate, it's one of the most common first-line treatments for women who don't ovulate regularly. Unlike hormone shots, clomiphene is taken orally, making it a low-cost, low-risk option that’s been used for over 60 years. It works by tricking the brain into thinking estrogen levels are low, which then signals the pituitary gland to pump out more follicle-stimulating hormone (FSH) and luteinizing hormone (LH)—the exact hormones needed to mature and release an egg.

Most doctors start with a clomiphene dosage of 50 mg per day for five days, beginning on day 3, 4, or 5 of the menstrual cycle. If ovulation doesn’t happen after the first cycle, the dose may be raised to 100 mg in the next cycle. Higher doses aren’t usually recommended because they don’t improve pregnancy rates and can thin the uterine lining, making it harder for an embryo to implant. It’s not a magic pill—you won’t get pregnant on the first try every time. Success depends on age, other fertility factors, and whether you’re ovulating at all. About 80% of women ovulate on clomiphene, but only about 10% to 13% get pregnant per cycle. That’s why it’s often used for three to six cycles before moving to stronger treatments.

Side effects are usually mild but real: hot flashes, mood swings, bloating, and headaches are common. A small number of women report blurred vision or dizziness—stop taking it and call your doctor if that happens. There’s also a slightly higher chance of twins (around 5% to 10%) because clomiphene can cause more than one egg to mature. It doesn’t cause birth defects, but if you do get pregnant, you stop taking it right away. Men sometimes take it off-label for low testosterone because it boosts natural testosterone production, but that’s not its approved use and should only be done under strict medical supervision.

People often ask about alternatives. letrozole, an aromatase inhibitor originally for breast cancer. Also known as Femara, it’s now preferred by many fertility specialists over clomiphene because it has higher pregnancy rates and fewer side effects. Then there are injectable gonadotropins like FSH, which work faster and stronger but cost more and carry a higher risk of multiple pregnancies and ovarian hyperstimulation. Clomiphene sits in the middle—effective, affordable, and simple. If you’re just starting your fertility journey, it’s often the smartest place to begin.

What you’ll find below are real, no-nonsense comparisons and guides written by people who’ve been there. From exact dosage schedules used by clinics, to how clomiphene stacks up against letrozole, to what side effects actually feel like and how to manage them. No marketing fluff. Just facts, experiences, and practical advice to help you make smarter choices.