Clomid (Clomiphene) is a drug used to call ovulation. It is a non-steroidal triarylethylene compound chemically remotely similar to stilbestrol. Clomiphene has a fertile effect due to the ability to bind to estrogen receptors. When the content of endogenous estrogens is relatively elevated, it acts as an anti-estrogen.
It is believed that clomiphene at the level of the hypothalamus and, possibly, the pituitary gland neutralizes the effect of negative feedback, realized through circulating in the bloodstream, estrogens, thereby causing an increase in the levels of FSH and LH in the blood plasma.
Daily intake of clomiphene for 5 days leads to an increase in the content of FSH to a level comparable to that observed during the early follicular phase of the normal menstrual cycle, and can cause the growth of the follicle. In the future, it is required that the estradiol produced by the maturing follicle initiates the appearance of an LH wave necessary for ovulation.
How to start treatment with Clomid?
Firms that produce clomiphene are recommended to begin treatment with a dose of 50 mg daily for 5 days, counting from the 5th day naturally occurring or caused by progesterone preparations of menstruation. If ovulation occurs, and pregnancy does not occur, then this course of treatment is repeated. If ovulation does not occur, then the dose of the drug is increased to 100 mg / day.
Despite the fact that the clomiphene manufacturer does not recommend continuing treatment after 3 ovulation cycles or taking it at doses exceeding 100 mg / day, prolonged use of clomiphene and such doses as 200 or 250 mg / day are widely used in gynecological practice, while achieving satisfactory results. In those cases where the growth of the follicle is obvious, but ovulation does not occur (lack of positive feedback), a permissible dose of hCG can be prescribed in the middle of the menstrual cycle.
Clomid (Clomiphene) and Ovulation
Using Clomid (clomiphene), ovulation is much more often achieved than pregnancy occurs. The mechanism explaining this contradiction is the persistent antiestrogenic effect of clomiphene, which is manifested at the level of the mucous membrane of the cervical canal and the endometrium. Additionally, prescribed steroid drugs are supposed to minimize this action, but prospective studies of this problem, carried out with appropriate controls, are unfortunately not available.
Pregnancy, occurring against the background of taking clomiphene, can be complicated by spontaneous abortion (19.3%) and multiplicity (7.9%). Other side effects of clomiphene are rarely serious, but nausea, depression, aggravation of hirsutism and acne, hair loss (very rare), decreased vision or scotoma, and hot flushes can occur, especially when taking large doses of the drug. Occasionally, ovarian hyperstimulation is also observed, especially in patients with polycystic ovary syndrome, and this can lead to serious consequences.
To exclude residual ovarian enlargement and a tendency to hyperstimulation, one should perform their palpation research before each subsequent treatment cycle. If clomiphene is prescribed by negligence in the early stages of pregnancy, an anomaly of development of the reproductive organs in the fetus is possible.