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Clomid,
Clomiphene Citrate; How Should it be Used?
Clomid was one
of the first ovulation inducing agents to treat infertility introduced into
the United States and interestingly, Clomid was first
tested as a birth control agent. Once Clomid was available
on the US market, OB/GYNs began to prescribe it for
women with ovulatory problems.
Clomid, through
clinical usage, was demonstrated to produce side effects
. Clomid's adverse reactions range from ovarian enlargement,
hot flushes, abdominal discomfort, breast discomfort,
nausea, vomiting, visual symptoms, headache, abnormal
uterine bleeding, and multiple births. Clomid's side
effects of are usually transient and not severe.
Clomid
works at the level of the hypothalamus and competes
with estrogen receptors causing increased production
of FSH. As clinical information accumulated , it was
learned that Clomid
was most likely to be effective in three to six ovulatory
cycles. Geisler conclusively demonstrated this in his
landmark study of Clomid's effectiveness in the early
nineties. However, not all practicing OB/GYNS were immediately
aware of it's limitations.
Some physicians may still prescribe
long-term therapy with Clomid even though it is
highly unlikely that it will result in pregnancy. Infertility specialists usually limit it's use to three to six months. Clomid's
use is sometimes associated with side effects and hormone
imbalances such as elevated luteinizing hormone levels.
Women receiving it should have monthly examinations
by their physicians.
The fertility field is like any
other in that the amount of new information available
is often overwhelming to the non-specialist. This is
compounded by the fact that infertility comprises a
very small part of most OB/GYNs practice. An infertility specialist should be consulted after 3-6 failed cycles of Clomid.
Clomid's widespread use by non-specialists
was not always accompanied by a semen analysis. We now
know that over 47% of infertile couples will have a
male component. It male infertility is present, Clomid cannot
be effective. Infertility specialists always order
the semen analysis before beginning any therapy on the
female. Additionally, infertility doctors are much more effective
in advancing patients to the next treatment step such
as stimulated
IUI or eventually IVF.
When a physician specializes in
infertility, it is no different than the evolution of
other specialties. If you have heart disease you will
probably seek care from a cardiologist rather than a
family practitioner. Many studies show that pregnancy
is more likely to result sooner when a reproductive
endocrinologist, infertility specialist, renders treatment
.
To summarize:
- Clomid
is an effective ovulation inducing agent.
- Clomiphene
should not be used for more than 3-6 ovulatory cycles.
- Clomid
has side effects and women must be examined monthly
by their physicians.
- The
semen analysis is one of the most important fertility
tests.
- Pregnancy
is more likely to result from specialist care.
Clomid
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