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Clomid,
Clomiphene Citrate
Clomid is often a first line
treatment to induce regular ovulation.
Clomid works at the level of the hypothalamus where
it competes for estrogen binding sites. When these "sites
are occupied" by Clomid, the hypothalamus responds
by producing more GnRH which then stimulates the pituitary
to produce
FSH. Remember, in a normal cycle healthy follicles
produce estrog en,
which signals the hypothalamus to reduce production
of FSH. Clomiphene is
marketed in the United States by Aventis Laboratories
as Clomid and by Serono Laboratories as Serophene.
The goal of clomiphene therapy in treating infertility is to establish normal ovulation rather than cause the
development of numerous eggs. Once ovulation
is established, there is no benefit to increasing
the dosage further . Numerous studies show that pregnancy
usually occurs during the first three months of infertility therapy
and treatment beyond six months is not recommended.
Clomiphene can cause side effects such as ovarian hyperstimulation
(rare), visual disturbances, nausea, diminished "quality"
of the cervical mucus, multiple births, and others.
Clomid is often prescribed by generalists as a "first line" ovulation induction therapy. Most patients should undergo the fertility "workup" prior to beginning any therapy. There could be many causes of infertility in addition to ovulatory disorders, including endometriosis, tubal disease, cervical factor and others. Also, Clomid therapy should not be initiated until a semen analysis has been completed.
Other Ovulation Induction Drugs
If Clomid is not effective in 3-6
cycles, the fertility specialist will usually advance
the patient to the "next level of therapy "
of infertility treatment What this "level" is depends upon each couple's
specific cause (s) of infertility. Some physicians may
try Clomid intrauterine insemination; however; many
specialists opt for FSH IUI because of its superior
success rates.
In FSH stimulated IUI cycles, the
patient self-administers subcutaneous injections of
follicle stimulating hormone. Unlike Clomid, FSH
directly stimulates the ovaries to develop multiple
follicles, each of which contains an egg.
Patients must come to our
clinic for periodic monitoring of their follicular development
via ultrasound and estradiol measurement. FSH stimulation
comes with the risk of side effects such as hyperstimulation
and multiple births. In general, FSH should only be
administered by a reproductive endocrinologist thoroughly
trained in its use.
Most fertility specialists will administer
three to six cycles of FSH stimulated IUI. If pregnancy
does not result, the patients are moved to the next
treatment option which is often in
vitro fertilization, IVF. The next treatment step
depends of the causes (s) of each couples infertility.
See our sections on FSH
and IUI
for more information.
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