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Overview of Medications

CLOMIPHENE CITRATE

GONADOTROPINS

HUMAN CHORIONIC GONADOTROPIN

GnRH

Clomiphene citrate (Siphene and Fertyl) is an oral medication that is commonly administered to induce ovulation in women who do not ovulate regularly.

Mechanism of Action

Clomiphene acts within the brain to promote the production of the hormone, GnRH. As a result, the pituitary gland makes more FSH and LH, the hormones that stimulate ovarian function.

Dosage and Monitoring

For minimal stimulation, the usual dosage of clomiphene is 100 mg daily for five days, beginning on day two of the menstrual period. Follicle development in response to clomiphene is most accurately determined by ultrasonography.

Adverse Effects

Severe adverse effects are uncommon with clomiphene citrate. First, as multiple follicles can sometimes develop, multiple pregnancies may occur. Another complication is ovarian cyst formation. While these cysts usually resolve spontaneously, they may cause bloating and abdominal discomfort. Approximately 10% of women who take clomiphene citrate experience hot flashes, which may disrupt sleep. A small percentage of patients (less than 5%) report some visual changes during clomiphene citrate therapy. Some patients describe blurred vision, while other patients describe seeing spots or flashes of light or after images.
There does not appear to be any increased risk of birth defects in offspring of women likewise, the risk of miscarriage in women taking clomiphene does not appear to be increased over that noted in the general population.
There has been recent concern about an association of the use of clomiphene with the subsequent development of ovarian cancer. At this time, information about this subject is very limited. The increased risk of ovarian cancer in patients taking clomiphene seems to occur only in women who have taken clomiphene for greater than one year (12 cycles). The risk has not been observed in women who have a successful pregnancy from clomiphene therapy.

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