CLOMIPHENE the unknown story

:_Indications and usage of clomiphene citrate

Clomiphene citrate is indicated for the treatment of anovulation  but more probably in ovulatory dysfunction in women desiring pregnancy. Q. 1A:Can it be prescribed in males?? There are no adequate or well-controlled studies that demonstrate the effectiveness of in the Clomiphene citrate treatment of male infertility. In addition, testicular tumors and Gynaecomastia have been reported in males using clomiphene. The cause and effect relationship between reports of

testicular tumors and the administration of Clomiphene citrate is not known

Q,.2: What tests should ideally precede prior to prescribing CC ??  Ans; Other impediments to achieving pregnancy must be excluded or adequately treated before beginning CC   therapy.

Q3 . Who are most likely to respond?? Ans: Those patients most likely to achieve success with clomiphene therapy include patients with polycystic ovary syndrome like  WHO class II anovulatory disorders. It is also Oligo ovulation (patients with demonstrated ovulatory dysfunction)-

Q4: Who may not respond well but no harm in trying 1-2 cycle of CC as trial basis?? Ans: 1) who had hyperstimulation with gonadotrophins, 2) amenorrhea-galactorrhea syndrome, 3) psychogenic amenorrhea, 4) post-oral-contraceptive

amenorrhea, and 5) certain cases of secondary amenorrhea of undetermined etiology. 6) reduced estrogen levels,(Low ET on basal SCAN)  while less favorable, do not preclude successful therapy,

Q 6: What Lab tets must preceede prior to commencing CC??  Ans:-a) LFT, b) Pelvic scan to exclude myoma, Ov cyst, Ovarian cysts c) TSH. PRL ,Besides other genital tract impediments(gross PID)  or systemic diseases like (renal, hepatic, DM, Hypothyroid etc)  to achieving pregnancy must be excluded or adequately treated before beginning Clomiphene citrate therapy.

 Q.7: What may go wrong during CC ? What may be side effects??  Ans:-There are some rare risks  which are : 1)Ovarian Hyperstimulation Syndrome 2) very rarely reversible eye changes ,like  eclampsia

 Q. 8 What spl advice to offer to couple ?? Properly timed coitus in relationship to ovulation is important. An urinary LH kit may be of help so that the patient and her physician realizes that drug has responded by causing ovulation .Once ovulation has been established, each course Clomiphene citrate of should be started on or about the 2 -3rd day of the cycle so that the ill effects of CC on Endometrium is lessened by the time Et is supposed to be ready for implantation (window of implantation).

Q.9: Warning:- Ans :Long-term cyclic therapy is not recommended beyond a total of about six cycles (including three ovulatory cycles).

Q.10.  PRECAUTIONS.) Clomiphene citrate

is indicated only in patients with demonstrated ovulatory dysfunction who meet the conditions described below .Properly timed coitus in relationship to ovulation is important.

Q. 12: How many cycles of CC is permitted?? Ans. Long-term cyclic therapy is not recommended beyond a total of about six

cycles (including three ovulatory cycles).

Q. 13: Where CC is contraindicated? .   Ans 1 Pelvic examination is necessary prior to the first and each subsequent course of Clomiphene citrate treatment

2. Patients without ovarian cysts. Clomiphene citrate should not be used in patients with ovarian enlargement except those with polycystic ovary syndrome.3. Patients without abnormal vaginal bleeding. If abnormal vaginal bleeding is present, the patient should be carefully evaluated to ensure that neoplastic lesions are not present.

4. Patients with abnormal liver function.

50 Is she hypo oestrogenic?? Ans:-  Oestrogen Levels In addition, patients selected for Clomiphene citrate therapy should be evaluated in regard to the

Following: USG ET . Patients should have adequate levels of endogenous estrogen as estimated from bleeding in response to progesterone in cases of sec amenorhoea .But it is equally true that reduced estrogen levels, while less favorable, do not preclude successful therapy.

Primary Pituitary or Ovarian Failure. Clomiphene citrate therapy cannot be expected to substitute

for specific treatment of other causes of ovulatory failure.

3. Endometriosis and Endometrial Carcinoma. The incidence of endometriosis and

endometrial carcinoma increases with age as does the incidence of ovulatory disorders.

Endometrial biopsy should always be performed prior to Clomiphene citrate therapy in this population.

4. Other Impediments to Pregnancy. Impediments to pregnancy can include thyroid disorders, adrenal disorders, hyperprolactinemia, and male factor infertility.