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Female Infertility Drug Clomiphene Citrate

Female Infertility Drug Clomiphene Citrate

Brief knowledge: Clomiphene is a long trusted oral medication relied upon for its safety, effectiveness and relatively low cost. Clomiphene is used to treat absent or irregular menstrual cycles ( ovulation induction ), to address a condition called luteal phase defect by increasing progesterone...

  • Features & Specification

    Brief knowledge:

    Clomiphene is a long trusted oral medication relied upon for its safety, effectiveness and relatively low cost. Clomiphene is used to treat absent or irregular menstrual cycles (ovulation induction), to address a condition called luteal phase defect by increasing progesterone secretion during the second half of the cycle and to make menstrual cycle lengths more predictable, thus improving the timing of intercourse or artificial insemination. Clomiphene may also be used to enhance ovulation in women who are already ovulating (ovulation augmentation).

     

    How does Clomiphene Citrate work?

    Clomiphene triggers the brain’s pituitary gland to secrete an increased amount of follicle stimulating hormone (FSH) and LH (luteinizing hormone). This action stimulates the growth of the ovarian follicle and thus initiates ovulation.

    During a normal menstrual cycle only one egg is ovulated. The use of clomiphene often causes the ovaries to produce two or three eggs per cycle. Clomiphene is taken orally for 5 days and is active only during the month it is taken.  

    Clomiphene Citrate for ovulation induction. Clomiphene used in conjunction with a medication called Provera may be effective in initiating menstruation and ovulation in women who have no menstrual cycle:

    Treatment begins with a 5-7 day course of Provera, taken orally. 

    Two to three days after Provera is completed, a menstrual period should begin.

    On the 3rd, 4th or 5th day of menstrual flow, a course of clomiphene is started.

    A clomiphene citrate 50 mg tablet is taken orally for 5 days.

    On day 11 or 12 of the menstrual cycle, ultrasound monitoring is conducted to determine if an ovarian follicle or follicles have developed. Also at this time, patients are asked to use an ovulation predictor kit to test their urine for a surge in LH (luteinizing hormone) indicating that eggs have matured and ovulation is imminent. If no LH surge is detected, ovulation itself may be triggered with an injection of the medication hCG (Ovidrel), which will cause the release of the mature egg(s) from the follicle(s).

    Natural intercourse or insemination is timed to ovulation.

    If ovulation has been assisted by an hCG injection, a form of the hormone progesterone is given via vaginal tablets or gel. The progesterone hormone serves to support the endometrial (uterine) lining and prepare it for the fertilized egg. 

    Two weeks after ovulation, patients are asked to take a home pregnancy (urine) test. If the test is positive, a blood test will be performed to confirm results.

    If ovulation doesn’t occur during this initial clomiphene dosage, another course of provera will be prescribed and the dose of clomiphene increased until ovulation occurs. It may be possible to begin another clomiphene cycle immediately or, if residual cysts are present on the ovarian follicles, a ‘rest’ cycle may be advised before resuming treatment.

    If ovulation cannot be induced even with a higher dose of clomiphene, this form of treatment will be discontinued, and ovulation induction may be attempted again using a different form of fertility drug (letrozole or gonadotropins).

    Clomiphene Citrate side effects. Ovulation predictor kits detecting the LH surge may demonstrate false positive results if testing begins near the time of clomiphene citrate administration. If patients start ovulation predictor kit testing on cycle day 9 or earlier, there is a high probability of obtaining a false positive result.  For that reason, we recommend caution in testing too soon.

    If a patient is not pregnant and menses occurs, the same dose of clomiphene is given after a normal pelvic sonogram. We usually recommend up to 6 cycles for ovulation induction patients and up to 3 or 4 for ovulation augmentation patients.

    Possible side effects of Clomiphene include:

    Flushing (extremely common)

    Ovulation pain and increased sensitivity –also called “mittelschmerz”

    Blurry vision, double vision or ‘traces,’ (a complication which may cause treatment to be discontinued)

    Moodiness (requiring discontinuation in severe cases)

    Nausea

    Breast tenderness

    Headache

    Vaginal dryness

    Clomiphene can sometimes decrease cervical mucus production, which may make it impossible for the sperm to swim through the cervix into the uterus. To get around this potential problem, intrauterine insemination (IUI) may be advised so that cervical mucus may be bypassed altogether.

     

     


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