Clomid for Fat Folks

by | Feb 9, 2021

Clomid (Clomiphene citrate) is a really common medication given to folks who want to get pregnant but ovulate irregularly. It works by tricking your body into releasing FSH (Follicle Stimulating Hormone) and LH (Luteinising Hormone), which tells your body that it’s time to ovulate.

Irregular ovulation is most associated with PCOS (Polycystic Ovarian Syndrome), although it can occur in other health conditions, such as thyroid problems, early menopause or hypothalamic amenorrhea.

Unfortunately if you’ve been labeled as “overweight” or ‘obese” by your clinician then you may be having difficulty in accessing Clomid.

(NOTE AROUND LANGUAGE: The terms “overweight” and “obese” are stigmatising for folks in bigger bodies. I’ll only be using them in this blog post when discussing research)

Often healthcare providers will require you to lose weight before they will prescribe Clomid. They use the promise of fertility treatment as a motivator for weight loss (read: blackmail).

Why does this happen? There are two main reasons that your doctor may prescribe weight loss.

  1. They believe that weight loss is a safe and evidence based treatment. This is not the case. There is no evidence to support weight loss working and plenty of evidence that shows that there are many risks associated with weight loss.
  2. They are concerned about risks if you do get pregnant. I’ll be diving into these risks in a detailed blog post soon but the basics are – the research is mixed AND the risk is much lower than is often communicated AND the research doesn’t take into account the very real impact that weight bias has on people’s health during pregnancy.

So what does the research say about Clomid? Can it help fat folks ovulate? Are there additional risks?

 

Research around Clomid and BMI

There are two main drugs that are used to support ovulation induction, Clomid and Letrozole.

It is sometimes concluded that these drugs may not work as effectively for people with a higher BMI. This is often due to the fact that fat people need larger doses to produce the same effect and this difference is not taken into account in studies. Dodson (1) showed that in a group of 333 infertile ovulatory people, those with a higher BMI needed a larger dose of gonadotropins to produce a similar superovulation for IUI than those with a lower BMI.

This same effect was also seen by Souter et al (2) who found that once the medication dose was correctly adjusted for BMI, the success of gonadotropins and IUI was comparable with people with “normal” BMIs.

Looking specifically at Clomid, Lobo et al (3) showed that the dose required was impacted by BMI, with higher weight people more frequently requiring a higher dose, and that once ovulation occurred, conception rates were the same regardless of body weight. In studies where this was not taken into account (4) then a reduction in ovulation and therefore pregnancy rates for people in bigger bodies were seen. Dickey et al (5) found the dose of Clomid was significantly correlated to the patient’s weight and that doses of 100 mg or higher were required for pregnancy and birth in a significant number of patients.

 

Potential risks or side effects when taking Clomid

There are side effects of Clomid that vary from person to person. These include:

  • hot flashes
  • headaches
  • bloating
  • nausea
  • mood changes
  • breast tenderness
  • visual changes like blurring and double vision

Luckily, Clomid is well tolerated by most people and the majority of side effects do not appear to be dose related. There are some rare side effects such as visual disturbances which may be dose related and some folks with PCOS are very sensitive to Clomid, so it’s important to increase the dose slowly until you find the right dose for your body.

How to access Clomid in a bigger body

So what can you do if your doctor is refusing to give you access to Clomid?

There are a few paths you can explore if you decide you’d like to try using Clomid to support Ovulation. It’s important to note here that this should not be your work to do. It is the system that is broken, and the system that needs to be fixed. You should not have to use your energy to access appropriate and respectful healthcare, but right now, it might be the only option to get support in growing your family.

  1. Depending on your location and insurance, you could seek out another more size inclusive doctor. If finding alternative care is an option, check out my fat positive fertility clinic list for some suggestions. It may also be possible to work with a clinic further away through online consultations.
  2. You can ask for better support from your current medical team. Use the research in this blog to have a discussion about why you are unable to access Clomid.If they say “Clomid is ineffective at your size“, use the research that shows larger doses work for bigger bodies.

    If they say “Weight loss is the most effective treatment for you“, show them the research that shows weight loss is not effective and has so many risks associated with it. You can also ask them for the evidence to support their recommendation.

    If they say “It would be dangerous for you to get pregnant at your current size“, again ask them for the evidence to back up this claim with the risk factors, and say that it’s actually your decision about whether something is “risky” or not.

 

I know that these actions and conversations are hard. Please don’t feel that you have failed if you struggle to have these conversations, can’t get the words out, cry in your consultations or just end up nodding along to whatever the doctor says. We were never taught how to advocate for ourselves and advocacy, like anything else, is a skill that we need to learn and practice.

 

  1. Dodson WC, Kunselman AR, Legro RS. Association of obesity with treatment outcomes in ovulatory infertile women undergoing superovulation and intrauterine insemination. Fertil Steril. 2006;86(3):642-646. doi:10.1016/j.fertnstert.2006.01.040
  2. Souter I, Baltagi LM, Kuleta D, Meeker JD, Petrozza JC. Women, weight, and fertility: the effect of body mass index on the outcome of superovulation/intrauterine insemination cycles. Fertil Steril. 2011;95(3):1042-1047. doi:10.1016/j.fertnstert.2010.11.062
  3. Lobo RA, Gysler M, March CM, Goebelsmann U, Mishell DR Jr. Clinical and laboratory predictors of clomiphene response. *Fertil Steril*. 1982;37(2):168-174.
  4. Al-Azemi M, Omu FE, Omu AE. The effect of obesity on the outcome of infertility management in women with polycystic ovary syndrome. Arch Gynecol Obstet. 2004;270(4):205-210. doi:10.1007/s00404-003-0537-2
  5. Dickey RP, Taylor SN, Curole DN, Rye PH, Lu PY, Pyrzak R. Relationship of clomiphene dose and patient weight to successful treatment. Hum Reprod. 1997;12(3):449-453. doi:10.1093/humrep/12.3.449