Clomid was one of the first infertility medications and is
widely employed to induce ovulation. Originally, it
was thought that it might hold potential as a birth
control agent but research revealed its ovulation inducing
properties. Letrozole is a new ovulation inducing agent used by many specialists.
Clomid works at the hypothalamus (a small organ located at
the base of the brain) to cause the release of gonadotropin
releasing hormone (GnRH) into the bloodstream. GnRH
travels to the pituitary gland where it stimulates the
release of follicle stimulating hormone (FSH). FSH stimulates
the recruitment and development of eggs within the ovarian
follicles. These hormonal processes are complex and
are discussed in detail by our authors. Dr.
Muasher submitted an excellent article on Clomid use
and alternatives.
Clomid therapy should not be administered for more than 3-
6 months dependent upon many individual patient variables.
Clomid studies have clearly demonstrated that pregnancy
is most likely to occur during the first three months
of therapy. There is little advantage to increasing
the clomiphene dosage beyond that required to regulate
ovulation.
Even
though ovulatory dysfunction is present, a male semen
analysis should be performed. Male factor is a contributor
in over 47% of infertility cases and must be ruled out
prior to treatment of the female.
Clomid
therapy is often administered by the non-specialist;
however, it is not always the best choice and can
produce unwanted side effects. Reproductive endocrinologists
are trained to diagnose the various complex conditions
that can cause ovulatory disorders, such as polycystic
ovarian syndrome.
There
are also other alternatives to Clomid, especially
in the PCOS patient where Metformin often is the drug
of first choice.
Clomid
should not be administered to women over the age of
35 without a complete fertility evaluation. Fertility
can decline rapidly in older female age groups. Once
again, Clomid should not be prescribed without a male
semen analysis.
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