clomiphene

.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.

5. Uterine Fibroids. Caution should be exercised when using Clomiphene citrate in patients with uterine fibroids due to the potential for further enlargement of the fibroids.

.

Q, 14: can we coprescribe Gonadotrophins / Bromo / oestrogens along with CC to promote folliculogenesis?? Ans:  Although the medical literature suggests various methods, there is no universally accepted standard regimen for combined therapy (ie., Clomiphene citrate in conjunction with other ovulation-inducing drugs. Coprescription  1:-Many ART specialist do coprecribe HMG 75 IU on day 3 with the idea it will recruit more no of follicles and also another dose of HMG on day 8 with the idea that this second dose will speed up any follicles which is lagging behind (late bloomers) .This picking up of slowly growing will hopefully increase serum Oestrgen and there will be no blunting  of LH surge and avoid hopefully LUF.  Coprescription  2; Low cost IVF:- Similarly, there is no standard Clomiphene citrate regimen for ovulation induction in vitro fertilization programs to produce ova for fertilization and reintroduction.

.