What is Clomiphen citrate failure/ Clomipfene citrate resiatnce??

What do we mean by CC resistance??

What are the causes of CC failure?

Ans: CC failure (documented ovulation ether by LH kit or by Folliculometry) / resistance (anovulation) have many causes which should be assessed before embarking on another Ovulogens- be it oral/ parental. 

Scrutiny of all previous records is a must : What was the indication of CC therapy earlier ??  Ans: PCOS of several phenotypes is the usual indication which often lead to either anovulation or oligo ovulation or poor oocyte quality due to androgen excess (letrozole acts here to reduce intraovarian hyperandrogenism). Metformin if administerd as an adjunct hopefully will decrees hyper insulinaemiac and decrees serum IGF 2 and thereby facilitate quality oocyte by maintaing normal endocrine milieu intraovarian .However sufficient time should be offered to  scrutinized the luteal phased length (LPD) and to cheek the previous monitored cycle (any evidence of thin endometrium –cc induced) & , dose of cc employed. Any adjunct used or not??  

Etiology of persistent anovulation (CC resistance / CC failure) taken together  inspite of 150mg CC (maximum total 2-4 cycles ).  Ans: Maximum 3-4 cycles should be tried, depending on age  and not exceeding 4 cycles Causes CC failure are possibility of host of anatomical diseases in the form of 1) minimal endometriosis(Do laparoscopy) ,2)  Tubo-peritoneal causes (do laparoscopy) , uterine factors(SIS/ hysteroscopy) ,3)  raised BMI (estimate BMI weight in Kg/ Ht in cm²,  4) Endometrial koch’s(hysteroscopy )  and 5) persistent thin ET 6) Luteal phase defect 7) coital factor too. Hypothalamic-PIT diseases are rare possibility in regularly menstrual cycles.. DHEASO4 should be estimated on Day 3  for establishing Adrenal androgen excess and planning for corticosteroid Ry. WE should diligently search for clinical evidence of hyper androgenism( Acne, hair loss) and or hyperinsulinaemia ( High W/H ratio, Acanthosis )

What next tests after CC failure/ CC resistance ?? Examples of such tests are, 1)  PRL, 2 ) Metabolic disorders, 3)  . Day 3 LH,4)  FSH, 5) E2,  6) AMH    7) AFC   8) DHEASO4 and 9)    ? High day 9 LH. 10) Lapro-Hysteroscopy if thetre is palpable mass or tenderness or clinical evidence to suggest pelvic adhesive diseases,   minimal endometriosis SIS is another alternative 11) Similarly review of semen some other reputed Lab  &  12 ) PCT under your control may be thought of.     All tests   will be cost apporx Rs 20,000/- (if one does not go for lap hyst then cost will come down to Rs 7000/ approx. But in subfertility treatment time is essence. Earlier she becomes mother it will be medically easy for parents to rear up the child/ children including health supervision education. Further, every futile ovulation induction cycle  invites disappointment and frustration to the couple

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Few are of opinion that results of induction may be superior with Enclomiphene dosage schedule from day 2 to day 6 one tab od 50mg than total clomiphene but opinion varies