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Infertility and Clomiphene Citrate

Read more about Clomiphene Citrate.

Overview

Trade Name: Clomid

Clomiphene Citrate is the most popular fertility drug today.

Effect of Clomiphene Citrate on Infertility

Clominphene Citrate is prescribed to induce ovulation for women who have ovulatory disorders that might be the reason it is hard to get pregnant. It influences how the hormones for fertility and ovulation work in the body. Clomiphene Citrate stimulates your pituitary gland to secrete higher levels of FSH and LH-the hormones that cause the ovary to produce and release a mature egg.

The structure of Clomiphene is similar to estrogen, allowing it to bind to the estrogen receptor sites. There are estrogen receptor sites in various tissues of the body. Once these sites are filled with Clomiphene, they can no longer bind with the estrogen circulating in the blood. As a result, your body perceives estrogen level is too low. To compensate for the 'low levels of estrogen', the pituitary gland produces more FSH. The raised level of FSH will stimulate maturation of an egg within an ovarian follicle and eventually leads to the release of one or more mature eggs.

Research Evidence on Clomiphene Citrate

Clinical investigations show that Clomiphene stimulated ovulation in about 70% of the women who received the drug. These trials involved 7578 women, 30% of the women who took Clomiphene were able to conceive.

There were multiple pregnancies that occurred with Clomiphene use. The incidence of multiple pregnancies was 7.98%: 6.9% twin, 0.5% triplet, 0.3% quadruplet, and 0.1% quintuplet.

Based on the systematic review done by researchers from the McMaster University, Ontario, Canada, Clomiphene Citrate (at doses between 50 to 250 milligrams per day) appears to be effective in inducing ovulation and improving fertility in women who ovulate infrequently or irregularly.

How to Use Clomiphene Citrate

Clomiphene tablet is taken for 5 days, usually from the third day of the menstrual cycle. Your doctor may recommend one tablet (50 mg) daily for five days. If ovulation doesn't occur with 50 mg dosage, then the dose may be doubled in the next treatment cycle.

Side Effects and Warnings

Side Effects

Hot flashes and premenstrual-type symptoms such as migraine headaches and breast discomfort may occur with clomiphene use. Notify your doctor if you experience:

  • visual symptoms such as spots, flashes, blurred vision
  • nausea and vomiting
  • diarrhea
  • abnormal uterine bleeding
  • ovarian enlargement which may present as abdominal or pelvic pain, tenderness, pressure, or swelling;

Patients taking Clomiphene may suffer from a serious condition known as ovarian hyperstimulation syndrome (OHSS). Its symptoms include swelling of the hands or legs, abdominal pain and swelling, shortness of breath, weight gain, and nausea or vomiting. If you develop any of these side effects, you should inform your doctor immediately or seek emergency medical care.

Clomiphene binds to your estrogen receptors, including the estrogen receptors in the cervix. This can interfere with the cervical mucus to make fertile mucus. Lack of fertile cervical mucus on the days after ovulation can interfere with sperm penetration into the uterus and fallopian tubes.

Clomiphene is metabolized by the liver, therefore, you can not take clomiphene if you have liver disease. Clomiphene use may result in ovarian hyperstimulation, thus enlarged ovaries, ovarian cysts, or polycystic ovaries are considered as relative contraindications.

When to Discontinue Clomiphene?

Stop taking Clomiphen and seek emergency care if you experience symptoms of an allergic reaction, such as:

  • swelling of your lips, tongue, or face;
  • difficulty breathing or
  • hives.

You should stop taking Clomiphene if pregnancy does not occur within 3 or 4 months of drug treatment. You need to consult a fertility specialist about other treatment options.

References

  1. O'Dowd, M., Philipp, E.The History of Obstetrics and Gynecology. The Parthenon Publishing Book Inc. 1994.
  2. http://www.whc.ie/documents/40infertBiomedEvidSummary.pdf][1]Douglas][2], A., Flamigni, C. Ovulation Induction: Update '98. The Parthenon Publishing Book Inc. 1998
  3. Hughes E, Collins J, Vandekerckhove P. Clomiphene citrate for ovulation induction in women with oligo-amenorrhoea. Cochrane Database Syst Rev. 2000;(2):CD000056
  4. http://www.drugs.com/clomid.html
  5. http://www.tubal-reversal.net/clomid-clomiphene.htm accessed 11.10.09

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