Tips about achieving Maximum Success a by a clomiphene citrate: How to achieve that?

Why CC fails? It is for the reason that many cases are prescribed in who Class I (HP axis disorder ) or who Class III i.e. Prolactin or thyroid disorder with supplementing such disorder and more over rarely monitoring is done there by LH kit or serum protestation or follicular monitoring. Therefore to summarized the lapses on the part of physician and (possible to curtail the expenses of ovulation stimulations followings are omitted).

I)                   *Intentional omission for financial reasons /or we can say mistake by physician  : Da3 scan-?basal cyst > 10mm, progesterone > 1.1 not recommended for CC).

II)                *Omission /mistake No HMG 75 on day 3 to pick up (recruitment of max no of follicles) and or day 8 of cycle another dose of HMG which contain desired LH so essential for final maturations. How many of us know that there is sub optimal rise of LH or premature rise of LH in cases of CC (100mg dally from day 3- but in deled cycles be it CC or letrozole the drug should be prescribe on day 6/day 7 of cycle not on day 3. )

III)             Omission /mistake : Day 10-serum Prog value

IV)             Omission /mistake Day 12 ET

V)                Omission /mistake Trigger When-often avoided.

VI)             Omission /mistake : no suppl of Viagra or E2 oral for thin ET

VII)          Omission /mistake coital timing not instructed properly

VIII)       Omission /mistake timing of ovulation is not assess by LH kit/ serum Prog/ FM etc

IX)             Omission /mistake suppl of Progesterone.

* These are not universally recommended for CC cycles only. U may or may not add but the fact remains that to maximize the benefit of simple drug ,if mney is no bar than one can have about 50% P rate with CC in properly selected in wel oeastronized cases with patent tubes, N seminal parameters, no PID or endometriosos.

Sustain long term and there is a high rate of dropout. Nonetheless, the incentive of a much wanted pregnancy can be sufficient stimulus for many women with obesity-related subfertility.

Clomifene Citrate Therapy

Anti-oestrogen therapy with CC or tamoxifen has traditionally been used as first-line therapy for anovulatory PCOS. CC has been avail­able for many years, and its use has tended not to have been closely monitored. A meta-analysis has confirmed that clomifene is effective in increasing pregnancy

Pre-treatment investigations: semen analysis, assessment of tubal patency. If BMI > 10 kg/m², advise weight loss

Monitoring of therapy:-

·         serial ultrasound scans until response is confirmed_, standard would be ultrasound monitoring for each cycle   

·         luteal-phase progesterone each cycle

·         mid-follicular-phase (day 8) LH in first cycle of a new dose

Dose: start with 50 mg, increase to 100 mg if no response and drop to 25 mg if overresponse.

Use of clomifene citrate in induction of ovulation. (From kousta E el al.Hum Repord Update 3, 359-65,1997)