Clomiphene

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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

  1. abdominal pain
  2. acne vulgaris
  3. alopecia
  4. anxiety
  5. appetite stimulation
  6. ascites
  7. blurred vision
  8. breakthrough bleeding
  9. cataracts
  10. cervical mucus thickening
  11. chest pain (unspecified)
  12. constipation
  13. depression
  14. diarrhea
  15. diplopia
  16. dizziness
  17. dyspnea
  18. edema
  19. elevated hepatic enzymes
  20. emotional lability
  21. erythema
  22. erythema multiforme
  23. erythema nodosum
  24. fatigue
  25. headache
  26. hepatitis
  27. hot flashes
  28. hypertension
  29. hypertrichosis
  30. hypotension
  31. increased urinary frequency
  32. insomnia
  33. irritability
  34. macular edema
  35. mastalgia
  36. menorrhagia
  37. menstrual irregularity
  38. migraine
  39. mittelschmerz
  40. nausea
  41. new primary malignancy
  42. ocular pain
  43. oliguria
  44. optic neuritis
  45. ovarian enlargement
  46. ovarian hyperstimulation syndrome (OHSS)
  47. palpitations
  48. pelvic pain
  49. phlebitis
  50. photophobia
  51. photopsia
  52. pleural effusion
  53. pruritus
  54. psychosis
  55. pulmonary edema
  56. pulmonary embolism
  57. rash
  58. restlessness
  59. retinal hemorrhage
  60. retinal thrombosis
  61. scotomata
  62. sinus tachycardia
  63. teratogenesis
  64. thromboembolism
  65. thrombosis
  66. urticaria
  67. visual impairment
  68. vomiting
  69. weight gain
  70. 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. 

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