A desire for twins
Q: Dear Dr Mitchell,
Is it OK for a fertile woman to take Clomiphene Citrate because she wants to have twins?
A: Clomiphene Citrate is a drug that is used to induce ovulation in a woman who does not ovulate or ovulates infrequently. Failure to ovulate or release eggs monthly is a common problem seen in women with polycystic ovaries. The drug Clomiphene Citrate (Clomid) works well on its own or in combination with Metformin to induce ovulation. There are often situations in which a woman does not release an egg monthly and Clomiphene helps to induce ovulation in these women.
Eighty per cent of women will ovulate on Clomiphene, but only about 40 per cent will conceive because there may be other fertility factors present in women who do not ovulate. In a woman who is fertile, taking Clomiphene Citrate to increase the chances of having twins is ill-advised.
There are risks associated with ovulation induction. The risks include multiple pregnancy and ovarian hyperstimulation. Ovarian hyperstimulation is a potentially life-threatening condition characterised by ovarian enlargement; ascites (the accumulation of fluid in the peritoneal cavity causing abdominal swelling); haemoconcentration (increase in the proportion of red blood cells relative to the plasma); and hypercoagulability. Hypercoagulability puts the woman at increased risk for development of clots in the veins and this can be life -threatening.
Clomiphene Citrate should not be given unless it is absolutely necessary. It is risky, as stated above, to use the drug to increase the chance of having twins. The use of Clomiphene Citrate may also alter the cervical mucus causing poor mucus production, and this causes poor sperm motility and decreases survival of the sperm, resulting in failure of the sperm to move rapidly up through the cervix and into the Fallopian tube to fertilise the egg. This can then contribute to an inability to conceive.
Having multiple pregnancies also increases your risk of an early pregnancy loss, premature labour and increased risk for need to be admitted to the neonatal intensive care unit because of respiratory distress and infection.
Your best option is one baby at a time unless you are blessed with twins from natural conception.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver. com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5 Dr Mitchell cannot provide personal responses.
DISCLAIMER: The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice from your own doctor.
