Which of the following is true for patients treated with clomiphene -
Ans. is 'c' i.e., Increased risk of ovarian hyperstimulation and polycystic ovaries Clomiphene Citrate* It binds to both ERa and ER(3 and acts as a pure estrogen antagonist in all human tissues, but the racemate displays weak agonistic action in rats.* It induces Gn secretion in women by blocking estrogenic feedback inhibition of pituitary.* The amount of LH/FSH released at each secretory pulse is increased.* In response, the ovaries enlarge and ovulation occurs if the ovaries are responsive to Gn.* Antagonism of peripheral actions of estrogen results in hot flushes. Endometrium and cervical mucus may be modified.* The chief use of clomiphene is for infertility due to failure of ovulation: 50 mg once daily for 5 days starting from 5th day of cycle. Treatment is given monthly. Conception occurs in many women who previously were amenorrhoeic or had anovular cycles.* If 1-2 months treatment does not result in conception--the daily dose may be doubled for 2-3 cycles. No more than 6 treatment cycles should be tried.* The antiestrogenic effect of clomiphene on developing follicle, endometrium or cervical mucus can be counterproductive. Luteal phase dysfunction has also been blamed for therapeutic failures.* Addition of menotropins or chorionic gonadotropin on the last 2 days of the course improves the success rate.* Clomiphene is well absorbed orally, gets deposited in adipose tissue and has long t1/2 of ~6 days. It is largely metabolized and excreted in bile.* Adverse effects Polycystic ovaries (Hyperstimulation syndrome), multiple pregnancy, hot flushes, gastric upset, vertigo, allergic dermatitis. Risk of ovarian tumour may be increased.* Other uses To aid in vitro fertilization Clomiphene given with Gns causes synchronous maturation of several ova--improves their harvesting for in vitro fertilization.* Oligozoospermia : In men also clomiphene increases Gn secretion promotes spermatogenesis and testosterone secretion. For male infertility--25 mg daily given for 24 days in a month with 6 days rest for upto 6 months has been recommended. However, success rates are low.
Decreased risk of ovarian carcinoma
Causes decreased sexuality if given in males
Increased risk of ovarian hyperstimulation and polycystic ovaries
Risk of ectopic pregnancy
Endocrinology