1) CC is a drug of considerable
pharmacologic potency. With careful selection and proper .Management of the
patient, CC has been demonstrated to be a useful therapy for the
.Anovulatory patient desiring pregnancy.
Clomiphene
citrate is capable of interacting with estrogen-receptor-containing tissues,
including the hypothalamus, pituitary, ovary, endometrium, vagina, and cervix.
It may compete with estrogen for estrogen-receptor-binding sites and may delay
replenishment of intracellular
estrogen
receptors. Clomiphene citrate initiates a series of endocrine events
culminating in a
preovulatory
gonadotropin surge and subsequent follicular rupture. The first endocrine event
in
response to
a course of clomiphene therapy is an increase in the release of pituitary
gonadotropins.
This initiates steroidogenesis and folliculogenesis, resulting in growth of the
ovarian
follicle and an increase in the circulating level of estradiol. Following
ovulation, plasma
progesterone
and estradiol rise and fall as they would in a normal ovulatory cycle.
Available
data suggest that both the estrogenic and antiestrogenic properties of
clomiphene may participate in the initiation of ovulation. The two clomiphene
isomers have been found to have mixed estrogenic and antiestrogenic effects,
which may vary from one species to another. Some
data suggest
that zuclomiphene has greater estrogenic activity than enclomiphene. Clomiphene citrate has no apparent
progestational, androgenic, or antiandrogenic effects and
does not
appear to interfere with pituitary-adrenal or pituitary-thyroid function
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