Clomiphene (Clomid, Serophene) is prescribed for a female client to treat infertility. What should the nurse tell the couple?

• A. The couple should engage in coitus once a week during treatment
• B. The health care provider should be notified immediately if breast engorgement occurs
• C. If the oral tablets are not successful, the medication will be administered intravenously
• D. Multiple births occur in a small percentage of clomiphene-facilitated pregnancies

Answer: (D)

Understanding the risk of multiple gestations with ovulation induction helps when counseling a couple. Clomiphene works by blocking estrogen receptors in the brain, which reduces negative feedback and increases FSH and LH to stimulate ovulation. Because this can cause more than one ovarian follicle to ovulate in a cycle, there is a small but real chance of a multiple pregnancy if conception occurs. Therefore, the prudent message to the couple is that multiple births can occur in a small percentage of pregnancies achieved with clomiphene. This reflects the real fertility outcome linked to the medication. The other statements aren’t as accurate: clomiphene is taken orally, not intravenously; intercourse around the time of ovulation is usually emphasized rather than simply once a week; and while side effects can occur, the key point for counseling is the potential for multiple pregnancies.