What is Clomiphene?Clomiphene or Clomid is a drug that stimulates the ovaries to mature oocytes. Ingestion is a well-proven, effective treatment and the most widely used fertility drug.
Who can benefit from it?Women who ovulate irregularly or never, and those with polycystic ovaries or polycystic ovarian syndrome. Clomiphene is also used in cases of unexplained infertility (NCCWCH 2004: 58).
How does it work?The active ingredient in Clomifene is Clomifene Citrate, an anti-estrogen drug taken in pill form. It works by raising the level of two hormones, which on the one hand stimulate the ovaries and on the other hand cause the release of an egg.
First, it causes your pituitary gland to produce more of the hormone that causes the follicles to ripen (follicle stimulating hormone or FSH.) This encourages your ovaries to provide a number of ova. When the follicles are mature, your pituitary gland gives you a luteinizing Hormone (LH) free, which signals to your ovaries that it is time to release a mature egg from its follicle and send it to one of your fallopian tubes (ovulation or ovulation) .This is ovulation.
How long will it take? Treatment:You start taking Clomiphene from the third to the fifth day of your menstrual cycle (after the onset of menstruation) and continue taking it for about five days, usually five to six days after the last pill Ovulation Your doctor will use ultrasound to help you determine if your ovaries are preparing a follicle, how many follicles there are are and what degree of maturity they have.
Most women go through a maximum of three to six drug cycles: It may take one to two months of medication to start regular ovulation. If taking it after six months proves unsuccessful, your doctor will surely start discussing other options with you.
If you have polycystic ovarian fluid, this treatment may not help you because 15 to 40 percent of women with PCOS are resistant to clomiphene (Beck et al 2005). This is more common in women who have a BMI (body mass index) greater than 25.Even a modest weight loss of about five percent of your body weight can help improve your chances of ovulating.
If you have been proven to have insulin resistance, your doctor may also prescribe the antidiabetic metformin. Metformin can support the response to clomiphene and increase the chances of ovulation and becoming pregnant (NCCWCH 2004: 58-9).
Why can Clomifene still be prescribed?You can also take Clomiphene (and other infertility medications) before you undergo a fertility treatment such as In Vitro Fertilization (IVF) to encourage the production of multiple eggs for this procedure. Clomiphene may help men with a certain hormonal imbalance, associated with a low sperm count, poor sperm quality or mobility (sperm's ability to move).
Are there any side effects?Fertility medications can have a wide range of minor side effects, such as mood swings, slight ovarian swelling, abdominal pain, chest tenderness, insomnia, nausea and vomiting, blurred vision, headache, fatigue, irritability, depression, weight gain, and, more rarely Cysts on the ovary.
It can also be the cause of your cervical mucus becoming drier.
A study in the mid-1990s suggests that the risk of ovarian cancer increases in later years after more than six treatment cycles (Rossing et al 1994). Later studies could not find a strong link between fertility drugs and ovarian cancer. The results indicate that the risk itself is increased by the infertility problem and not by the fertility drug with which it is treated (Ness et al 2002, Brinton et al 2004, Rossing et al 2004). Women taking clomiphene with other fertility drugs, such as human menopausal gonadotropin (hMG, also referred to as menotropin), sometimes develop ovarian hyperstimulation syndrome (OHSS) (NCCWCH 2004: 67), although rarely with clomiphene alone happens (Beck et al 2005). This may be a serious condition, which is also indicated by weight gain and a feeling of fullness - triggered by water retention in the abdominal cavity and ovary. OHSS occurs when you react too well to the drugs and produce too many eggs. Usually this will be done by itself. However, you should be under the supervision of your doctor. But in very rare cases, OHSS can also be life-threatening.
What are the chances of success?
Most couples are interested in two success stories: the rate of ovulation and that of pregnancy.Infertility drugs are quite successful at stimulating ovulation: over 70 percent of women ovulate, most of them within the first three months of treatment (NCCWCH 2004: 57). And 15 to 50 percent of these women become pregnant (Beck et al 2005; NCCWCH 2004: 57).The wide range of success rates is explained by all the other factors that influence pregnancy, such as the timing of your sexual intercourse cycle, your age and weight, the speed and motility of your sperm Partners.
Are there other aspects?
There is a theory that the anti-estrogen effect of the drug makes miscarriage in women more likely. One study reported miscarriage rates of 13 to 25 percent, but also pointed out that this rate was similar to that of couples without fertility treatment (Kousta et al 1997). There is little good evidence on the rate of live births using fertility drugs such as clomiphene.Medications that stimulate ovulation can cause more than one egg to be released, increasing the chance of multiple pregnancy (NCCWCH 2004: 57-8). Women who take clomiphene have about a seven percent chance of receiving twins and a 0, 5 percent, triplets (Wolf 2000).
Want to talk to others about fertility drugs? Then go to our community.
Our expert: Dr. med. Robert Fischer from Fertility Center Hamburg. He is a gynecologist specializing in gynecological endocrinology and reproductive medicine, in particular assisted reproduction.
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Clinical Obstetrics and Gynecology 43 (4): 902-15. Show sources Hide sources