It is one of the world's most widely prescribed fertility drugs. But internationally esteemed reproductive expert Dr Louis Keith warns that clomid is sometimes dispensed too liberally by doctors. In his opinion, some in the profession are handing it out 'like candy', regardless of potentially negative consequences.
"What people don't know is that the response to clomid is idiosyncratic," says Keith, Professor Emeritus of Obstetrics and Gynecology at Northwestern University in Chicago. "That means everyone responds differently. You give five women the same dose, one of them is going to wind up with quintuplets."
Is Keith saying clomid, a fertility drug widely used in Ireland, has a 20pc chance of multiple births? "It is significant," he says. "Even if it's only 4pc – I mean, come on. The literature is very unspecific."
He feels some in the medical profession are too quick to recommend the drug, regardless of consequences. "The practitioners who dispense it like candy don't tell their patients (of the risk of multiple births). I . . . have seen some disasters as a result of clomid. The person was not prepared to have a higher order multiple pregnancy."
We have become slightly sidetracked. Keith is in Ireland to address the rather murkier subject of male fertility. Why murky? Because many men are often unwilling to accept that they may have issues in this area. They fear being perceived as 'less manly'. Consequently, male fertility is discussed far less than the female equivalent.
"It impairs their concept of masculinity, attacks their feelings of being a man," says Keith. "As opposed to their being something else."
He says that across the world, male fertility rates are in decline. The trend started to show up in the data in the 90s and has continued since. Medical science is as a loss as to what might be happening. All that can be said with certainty is men are less fertile than a generation ago.
"Globally, sperm counts have been in decline 20 years. Nobody knows why. They impute lifestyle, obesity, drinking, smoking, hard drugs," he says. "Clearly age is a factor. Nobody knows when the actual number of sperm that are viable decline to a point where they are useless. Men in their 70s and 80s have allegedly been fathers. And nobody ever says, 'No, in fact it was his cousin or the milkman or something like that'."
A possible reason for falling fertility levels in men, he suggests, is nutritional deficiency.
"There is a mounting group of people who have written about . . . micro-nutrient deficiencies. People have always been talking about diet, but not the macro diet (ie the food types one eats). Only in the last five years have people become aware to the fact sperms respond to and need micro-nutrients."
One of the nutrients sperm require to thrive is folic acid, commonly taken by women hoping to conceive.
"Folic acid has been touted for the past 15 years to avoid neural tube defects. Women take it in the early part of pregnancy. Since 2006, there has been mounting evidence that the addition of folic acid and, secondarily zinc, will decreases the number of abnormal forms in sperm."
Research in the area is sketchy in Ireland. However, in the UK, it is known that sperm counts are declining on average 3pc every year. There, experts recommend a number of possible remedies. These include ginseng tea, as the herb is believed to increase sperm motility, pomegranate, a fertility booster that raises blood flow and libido and enhances sperm vitality and eggs, the amino acids of which are thought to stimulate sperm production.
Even that old canard about tight underpants making it harder to have children may have some validity. Because Y-fronts are relatively tight, they may well raise the body temperature higher than the point at which sperm can survive. If in doubt, you are better off with boxers (and with staying away from saunas).
Male fertility isn't black and white, Keith points out. It's not as if a man is fertile one moment, impotent the next.
"It doesn't come on or off like the turning of a light," he says. "Men who are sub-fertile represent a much larger number of men than those who are totally infertile."
In men, infertility can come in several guises: low sperm count, slow sperm motility and sperm mutation. One in 25 men are believed to be affected.
As Keith says, science has not yet elucidated the external factors impacting on male fertility. Nonetheless, it can be stated with some confidence that excessive consumption of alcohol can lead to impaired sperm production, as can tobacco smoking and use of drugs (specifically anabolic steroids, cocaine and marijuana). Obesity, meanwhile, may lead to hormonal changes that reduce fertility. Stress is also believed to be a factor.
In the past there has been a tendency to focus on a person's infertility in isolation. It has to be seen in a wider context, he says.
'You can't look at infertility as a 'his' problem or a 'her' problem. It is a couple problem. That, unfortunately, is not how much of the public sees it. They see it as a woman's problem. It is much more complex than that."
His recommendation is that a would-be father go on a course of multivitamins while he and his wife are attempting to conceive. Raising the intake of folic acid and zinc will boost sperm quality. He points to studies showing two in three women using prenatal micronutrients become pregnant, against the one in three just taking folic acid. The supplement used was Pregnacare Conception.
"I can't guarantee the success rate. I would say that men who take this . . . the studies show, their wives are more likely to get pregnant than those who don't. Remember, these are not people getting expensive fertility therapy.
"Ireland is a pro-natal society. Everyone wants babies. The grandmother wants to have grandchildren and so forth. If it doesn't happen for a couple after six months, nine months, a year . . . if they are young and healthy, rather than expensive and invasive tests, they could start with a course of vitamins. There is no side risk."