Clomiphene Brand Name– Clomid | Serophene
What is Clomiphene
Clomiphene is a nonsteroidal fertility agent used to induce ovulation in infrequently ovulating or anovulatory women, including patients with polycystic ovary syndrome (PCOS).
The drug is effective at producing ovulation in patients with an intact hypothalamic-pituitary-ovarian axis and with ovaries that are capable of functioning normally.
Clomiphene is often the first-line agent for these patients due to the relative ease of use and low economic expense.
Clomiphene will induce ovulation in 80% of appropriately-chosen patients; roughly 40% will become pregnant within 6 cycles of treatment.
Clomiphene is not effective at increasing pregnancy rates in women who spontaneously ovulate on a regular cycle.
Clomiphene therapy is associated with only slightly increased rates of multiple births (3—5%) compared to the general population (1%). Multiple gestation, if it occurs, is usually twins. Less than 1% deliver triplets or more.
The rate of multiparity with clomiphene as a single-agent is much lower than that which occurs with other fertility agents (e.g., menotropins or FSH).
Clomiphene is sometimes used as a diagnostic tool to assess ovarian reserve. It is also administered to regulate the timing of ovulation in those patients receiving donor insemination.
Interestingly, clomiphene has been used to increase sperm counts in male patients with idiopathic oligospermia. The FDA first approved clomiphene in 1967.
Indications
- infertility
- oligospermia
For the treatment of infertility in women due to anovulation, irregular ovulation, or luteal phase defects, including women with polycystic ovary syndrome (PCOS)
Side Effects
- abdominal pain
- acne vulgaris
- alopecia
- anxiety
- appetite stimulation
- ascites
- blurred vision
- breakthrough bleeding
- cataracts
- cervical mucus thickening
- chest pain (unspecified)
- constipation
- depression
- diarrhea
- diplopia
- dizziness
- dyspnea
- edema
- elevated hepatic enzymes
- emotional lability
- erythema
- erythema multiforme
- erythema nodosum
- fatigue
- headache
- hepatitis
- hot flashes
- hypertension
- hypertrichosis
- hypotension
- increased urinary frequency
- insomnia
- irritability
- macular edema
- mastalgia
- menorrhagia
- menstrual irregularity
- migraine
- mittelschmerz
- nausea
- new primary malignancy
- ocular pain
- oliguria
- optic neuritis
- ovarian enlargement
- ovarian hyperstimulation syndrome (OHSS)
- palpitations
- pelvic pain
- phlebitis
- photophobia
- photopsia
- pleural effusion
- pruritus
- psychosis
- pulmonary edema
- pulmonary embolism
- rash
- restlessness
- retinal hemorrhage
- retinal thrombosis
- scotomata
- sinus tachycardia
- teratogenesis
- thromboembolism
- thrombosis
- urticaria
- visual impairment
- vomiting
- weight gain
- weight loss
Monitoring Parameters
- LFTs
- pelvic exam
- pelvic ultrasound
- serum gonadotropin concentrations
- serum progesterone concentrations
- sperm count
- weight
Contraindications
- abdominal pain
- adrenal insufficiency
- ascites
- breast cancer
- breast-feeding
- depression
- diabetes mellitus
- driving or operating machinery
- dysfunctional uterine bleeding
- endometrial cancer
- endometriosis
- hepatic disease
- obesity
- ovarian cancer
- ovarian cyst
- ovarian failure
- pituitary adenoma
- pituitary insufficiency
- polycystic ovary syndrome
- pregnancy
- psychosis
- testicular failure
- thromboembolic disease
- thrombophlebitis
- thyroid disease
- tobacco smoking
- uterine leiomyomata
- visual disturbance
- vomiting
Interactions
- Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
- Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements): (Major)
In women, androgens may antagonize the effects of some fertility treatments. Prasterone, dehydroepiandrosterone, DHEA is converted via hydrosteroid dehydrogenases and aromatase into androstenedione, testosterone, and estradiol by peripheral tissues. Increased endogenous levels of the hormone prasterone, dehydroepiandrosterone, DHEA have been associated with hyperandrogenism and infertility; it is postulated that nutritional supplementation with DHEA may reduce the response to clomiphene treatment.
Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved): (Major)
In women, androgens may antagonize the effects of some fertility treatments. Prasterone, dehydroepiandrosterone, DHEA is converted via hydrosteroid dehydrogenases and aromatase into androstenedione, testosterone, and estradiol by peripheral tissues. Increased endogenous levels of the hormone prasterone, dehydroepiandrosterone, DHEA have been associated with hyperandrogenism and infertility; it is postulated that nutritional supplementation with DHEA may reduce the response to clomiphene treatment.
