Tamoxifene when AS ovulation induction

 Tamoxifen when? Scope & Indications of Tamoxifen as Ovulogens:-:- In present day the main and possibly the only indication of prescribing TMX is when there are side effects with CC particularly visual /neurological side effects . Scintillating  vision . or CC resistant PCO women but age of woman concerned is a barrier to a strong agent as strong as gonadotrophins. I  marine cases where there is societal pressure for a baby at te age of 20-22 yrs only 1 yr after marriage, Quite often and vary logically we arte Hestia to use gonadotrophin at such tender age with very  little duration of marriage, The options are after CC 3-4 cycles with document CC resistance is Gonadotrophins, having admitted that age is a bar...

 Use of TMX when ?? Ans:- Occurrence of CC resistance is common –as high as 30% PCOS women. In such situation Gonadotrophin is best after control of Ire by insulin sensitizers and decreasing serum LH, androgen by Diane 35 like agents  as pretreatment cycle.  used Tamoxifen 20 mg OD from day 2- day 6 many times with results comparable to clomiphene. 

Gonadotrophins are quite effective in CC resistant cases but costly . CC has failed after couple of cycles. Now, what are the practical options open to young women in Indian perspective? Once counseling done after several cycles of failed CC, many Indian couple (even uneducated couple) does realize that gonadotrophin is badly needed for them but repent because they are simply unable to afford for G cycle. Put in such a situation (after CC resistant cases) the option remaining to the treating physician to prescribe TMX (as an alternative to Gonadotrophin) and make some compromise. Doctor feel-“Watch- what happens”-.

Not to speak of Gonadotrophins: Many Indians cannot afford further tests so as to why r CC resistance followed:--Unfortunately, many Indian couple cannot afford for usual tests at this juncture - so as to why CC failed in their case. Such tests, if not carried out earlier are 1) AMH .2) AFC, 3) Insulin Resistance, 4) high D2 LH & testosterone 5) DHEASO4, & 6) PRL --not to speak of other costly tests. In such cases further tests so as to find the etiology of CC resistant in particular women. We, Indian doctors have to make many compromises at every step of clinical practice not only in the discipline of reproductive medicine.