Mode of Action
Clomid is a very potent drug. However, with proper dose selection and short term therapy it can help infertile women. Clomiphene mimics estrogen in its actions. It has the ability to interacts with estrogen receptors in the hypothalamus and block these sites. The brain than thinks there is a low amount of estrone in the body and causes a surge in the levels of Gonadotropins which hyperstimulates the ovary to make more estrogen. This results in an increase in steroid synthesis in both the adrenal and ovaries. The surge in estrogen is important for fertilization to take place.
Indications
Clomid is only recommended for use in women with ovulatory dysfunction but also meet the following requirements:
- the female is not pregnant at the time
- Absence of ovarian cysts. An ultrasound is done on each
female to rule out ovarian enlargement prior to therapy
- There should be no vaginal bleeding. If vaginal bleeding
is present, the female should be thoroughly examined to
ensure there is no evidence of a cancer
- all patients should have normal liver function tests
While Clomid has met with some success in females with ovulatory dysfunction, it has not been well studied in male infertility. Clomid has occasionally been tried out in Europe and the USA to treat males with fertility disorders. Clomid has been shown to promote the surge of LH, FSH with resulting increase in sperm count. However, these are isolated case reports and the therapy was only for a few months.
No discernible side effects have been observed in these isolated case reports. However, there is concern that long term therapy with clomiphene in males may be associated with the development of testicular tumors and mild gynecomastia.
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