clomiphene

1)HOW CC ACTS? CC is a drug of considerable pharmacologic potency. With careful selection and proper .Management of the patient, CLOMID 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

Why En- clomiphene is better?

En & Zu clomiphene. En is more potent as OI. Half life is short, But Zu last long in the body as many as 1 month after stimulation. In obese women higher dose –no benefit.

 Q.4. What is the prevalence of CC resistance case & how do we treat that?    About 20-25 % cases do not respond to CC. The options are further investigations & treat with followings:.

 Q.5. Is there any Carry Over Effect?

 Although there is no evidence of a “carryover effect” of CC , spontaneous ovulatory menses have been noted in some patients after CLOMID therapy.

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Q.5. what is the pregnancy rates?

CLINICAL STUDIES

During clinical investigations, 7578 patients received, CC some of whom had

impediments to ovulation other than ovulatory dysfunction (In those clinical trials, successful therapy characterized by pregnancy occurred in approximately

30% of these patients.

There were a total of 2635 pregnancies reported during the clinical trial period. Of those

pregnancies, information on outcome was only available for 2369 of the cases. Table 1

summarizes the outcome of these cases.

Of the reported pregnancies, the incidence of multiple pregnancies was 7.98%: 6.9% twin, 0.5%

triplet, 0.3% quadruplet, and 0.1% quintuplet. Of the 165 twin pregnancies for which sufficient

information was available; the ratio of monozygotic to dizygotic twins was about 1:5. Table 1

reports the survival rate of the live multiple births.

A

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