Clomiphen citrate why fails

CC resistance:-

Clomiphene Resistance:  This implies that there is no ovulation wit CC-for 3-4 cycles even with increasing dosage up to 150 mg OD where due monitoring was done .The causes may be high hormonal levels of on day 3  LH, FSH, PRL, , Testosterone, DEASO4. Such hormones have to be evaluated.

By contrast CC failure implies there is documented ovulation with clomiphene but there is no conception. In such cases in fair number subfertility is due to some anatomical cause(may be tubal / uterine/ endometriosis)  and in good number failure to conceive may be due poor endometrial receptivity / thin endometrium(asynchrony).  Little can be done for this problem but one can switch over to Tamoxifene or letrozole which may not lead to iatrogenic thin ET. By and large repeated thin ET at the dose of even 100 mg CC cycles call for change of Ovulogens and added oestrogens to promote endometrial growth has little value .

Further investigations will depend on her and trying time: ,CC failure/ resistance has many causes which have been discussed . But there are other tests to be assessed before embarking on another Ovulogens-.Examples of such tests have been mentioned and rest are depending on her age AFC, AMH, , Metabolic disorders, high day 9 LH, PCOS of several phenotypes , In case of CC failure it invites possibility of host of anatomical diseases in the form of minimal endometriosis, Tubo-peritoneal causes, Uterine factors, high BMI,  koch’s, and coital factor too. Hypothalamic-PIT diseases are rare possibility. If day 3 DHEASO4 is on higher side that may be a cause of cc resistance .Such raised DHEASO4 qualifies for establishing Adrenal androgen excess and one can plan for corticosteroid Ry. Similarly review of semen other reputed Lab /PCT under your own Clinic  may be thought of.