Clinical, sociodemographic, and socioeconomic determinants of clomiphene citrate use and prevalence trends: a scoping review

Objective To provide an updated review of the literature on CC utilization among women of reproductive age, with a focus on real-world utilization patterns, population-level trends, clinical and sociodemographic characteristics, socioeconomic factors, and associated infertility treatments. Evidence review A scoping review was conducted following Joanna Briggs Institute methodological guidance and PRISMA-ScR recommendations. PubMed/MEDLINE and Embase were searched from database inception to May 2026, complemented by grey literature and manual reference screening. Eligibility was based on the Population, concept, context framework and included observational, population-based studies in women of reproductive age reporting CC use or related characteristics. Two reviewers independently screened records in Rayyan. Data were extracted and synthesized narratively and graphically. Results Twenty-seven studies published between 1992 and 2025 were included, most of them were cohort-based and conducted in high-income countries. Reported CC utilization varied according to study population and denominator. Among women of childbearing age, population-level exposure ranged from 0.27% to 0.57%, whereas among women with infertility, CC use ranged from 28% to 94%. Among pregnancies, the proportion conceived following CC exposure ranged from 1% to 2.7%. Temporal trends showed increasing use during the 1970s–1990s followed by stabilization and decline in more recent decades. Women aged 30–34 years represented the most frequent age group among CC users in high-income settings, while younger ages predominated in middle-income countries. Gonadotropins were the most frequently reported concomitant fertility treatment, followed by hormonal therapies, medically assisted reproduction procedures, and letrozole in more recent studies. Conclusions CC utilization has evolved over recent decades, reflecting changes in infertility management, demographic patterns, and access to fertility treatments. Despite declining use in several high-income countries, CC remains a widely used and comparatively accessible option for ovulation induction. These findings highlight the importance of pharmacoepidemiologic research for understanding real-world fertility treatment patterns and their evolution over time.