For couples navigating infertility treatment, one common question is whether fertility medications like Clomid can increase the chances of having twins. In a recent Instagram reel, Dr. Ethan Melillo, a pharmacist specializing in fertility education, breaks down the science behind this common concern.
Clomiphene citrate, commonly known by its brand name Clomid, is a medication prescribed to women experiencing ovulation difficulties.
It has the molecular formula of C26H28ClNO • C6H8O7. Clomiphene citrate is a white to pale yellow, essentially odorless, crystalline powder. It is an FDA-approved selective estrogen receptor modulator (SERM) indicated to treat anovulatory or oligo-ovulatory infertility to induce ovulation for patients desiring to conceive. It is available as a 50 mg oral tablet. 1
In his Instagram reel, Dr. Melillo explains that Clomid functions by influencing the body's hormonal feedback system. The medication blocks estrogen receptors in the hypothalamus, tricking the brain into thinking estrogen levels are lower than they actually are.
The hypothalamus controls reproduction by releasing Gonadotropin-Releasing Hormone (GnRH), which signals the anterior pituitary to release Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH).
In response to this perceived deficiency, the pituitary gland increases production of FSH and LH. These hormones signal the ovaries to grow and release eggs.
Under normal circumstances, a woman typically releases one egg per menstrual cycle. However, with Clomid stimulation, the ovaries may release two or more eggs during a single cycle, thereby increasing the possibility of multiple pregnancies.
In his reel, Dr. Melillo uses a helpful analogy: "Think of your ovaries like a classroom where usually one student gets picked to answer a question. Clomid is kind of like that teacher who can't hear anyone clearly, so they choose two or three people to answer."
The statistical reality is important to understand:
The natural occurrence rate of twins is approximately 1%.
With Clomid treatment, this rate increases to roughly 5–10%.
While this represents a significant increase in relative terms, it’s crucial to recognize that Clomid does not guarantee twin pregnancies.
Reference:
1. Mbi Feh MK, Patel P, Wadhwa R. Clomiphene. [Updated 2024 Jan 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559292/
Disclaimer: This article is for educational purposes only and does not constitute medical advice. Always consult qualified healthcare professionals regarding fertility treatment decisions and medication use.
