The last century is marked by significant achievements in the field of diagnostics and treatment of female sterility, and on the boundary of centuries it is possible to tell with confidence about the basic decision of this problem at an available level of our knowledge.

It became possible owing to the basic researches, which allowed to decipher the basic mechanisms of regulation and activity of reproductive system of women in the norm and at various forms of its infringements; to successes of endoscopic surgery, allowing to diagnose the condition of organs of a small pelvis authentically and correct their pathological changes; to occurrence of methods of auxiliary reproductive technologies (ART), enabling to perform in vitro fertilization.

In connection with the aforesaid it is possible to allocate the basic ways of treatment of sterility: the drug therapy, operative endoscopy and methods of ART. And in the clinical practice all the specified methods are applied, as a rule, in a combination. Medicamentous means: antibiotics, immune correctors, viricide and, certainly, hormonal preparations can be used at all forms of sterility as in a complex with an operative method (for example, at tubal-peritoneal factor, an endometriosis), and in the form of independent treatment. So, at endocrine sterility caused by functional infringements of reproductive system, medicamentous, hormonal, treatment is a pathogenically proved method of restoration of fertility.
Clomiphene (Clomid) is used mainly for stimulation of ovulation. Many women at whom ovulation does not occur, by means of reception of clomiphene can begin to ovulate. Clomiphene can be prescribed to women, ovulating in a natural way, for increase of chances for pregnancy. The antiestrogenic effect of Clomiphene can cause thickening of cervical mucus. It can complicate in turn promotion of spermatozoa to ovum. The treatment may include artificial (intravaginal) insemination and, in rare cases, external management/influence on the level of estrogens.
Clomiphene can also provoke precision of endometrium, which is the adverse factor for implantation of an embryo. If ultrasonic defines thin endometrium then treatment by other preparations stimulating ovulation may be applied. Clomiphene is usually accepted in a doze of 1 tablet daily, or 50 mg during 5 days. Treatment is usually begun from the 2nd-5th days of a cycle (the first day of a bleeding is considered as the first day of a cycle). Now the preparation is more often prescribed from the 2nd day of a cycle. Women usually start from 50 mg daily during 5 days. If ovulation happens, but pregnancy does not come from the first cycle, then treatment by Clomid can be repeated in the same dosage during 3-6 cycles. If ovulation at an initial dosage does not occur, then the doze can be increased up to 2 tablets within 5 days of the following cycle.
The use of clomiphene in the appointed dosage can be repeated only from 3 up to 6 cycles. The limiting doze of Clomiphene is considered to be 150 mg, or 3 tablets daily within 5 days. In rare cases 4 tablets, or 200 mg a day can be appointed. There are some various ways of definition of ovulation. The methods of definition by the basal temperature, jump of luteinizing hormone, biopsy of endometrial, definition of level of a progesterone or transvaginal ultrasonic research of development of follicles are used more often than others. Each of these methods has its advantages and disadvantages, and any of these methods cannot authentically define whether the ovulation had happened or not. The chances to conceive on the background of reception of Clomiphene make 10-13 % for a cycle of treatment depending on age, the reasons of sterility, reaction of an organism to the treatment and other preparations, which are used simultaneously with Clomiphene. It is comparable with 20-25 % of women with normal fertility. The opportunity of conception is increased up to 30-60 % after 6 cycles of reception of Clomiphene. About 5-10 % of pregnancies, which occurred at reception of Clomiphene, result in birth of twins, not less than 1 % with a birth of 3 and more children. It is comparable with 1,2 % of the twins born by women, not accepting Clomiphene. Clomid is used in the USA since 1967. For today there are no acknowledgements of the fact that Clomiphene increases probability of a birth of children with deviations and/or affects the development of children.
By-effect
From ovaries and endocrine status: transient increase of ovaries, accompanied by discomfort or ache in the bottom of the stomach, the raised sensitivity of mammary glands, "inflow" of blood to face. From sight: transient infringements in the form of blurriness of sight, scintillating scotoma, the functional changes of a retina, established at electroretinography.
From a liver: delay of deducing of bromsulfalein, a jaundice (in single instances).
Dermatological reactions: atonic dermatitis, reversible alopecia.
Other: nausea, vomiting, irritability, insomnia, a headache, dizziness, increased fatiguability.
Contra-indications
- uterine bleedings of unstated etiology;
- malignant tumours of a uterus or a mammary gland;
- contra-indications to pregnancy;
- pregnancy;
- primary dysfunction of ovaries;
- ovarian cyst (except for polycystic), an endometriosis;
- ovarian insufficiency on a background of hyperprolactinemia;
- diseases of a liver or its dysfunction;
- the raised sensitivity to any components of the preparation.
Special instructions
Before the prescription of a preparation it is necessary to conduct the inspection of patients with the purpose of exception of malignant tumours of a uterus or a mammary gland, cysts or increases of ovaries (Stein-Leventhal syndrome is not a contra-indication to prescription of a preparation), and also other diseases at which application of Clomid is counter-indicative. It is necessary to consider, that the preparation is more effective at a sufficient level of endogen estrogens and less effective at a low level of estrogen and is practically inefficient at a low level gonadotropic hormones of a hypophysis.
The treatment is conducted with the use of minimally effective dozes of a preparation. It is not recommended to conduct more than 6 courses. During the treatment careful supervision over a condition of the patient is conducted, the attributes of occurrence of pregnancy are carefully supervised. It is necessary to be aware, that pregnancy quite often comes during a cycle following the canceling of a preparation.
The gynecologic inspection except for abnormal increase of ovaries is also conducted before each subsequent course of treatment by a preparation. The patients should be warned of necessity urgently to inform the doctor on occurrence of pains in the bottom of a stomach, and also about increase of weight of a body. In case of occurrence of pains in the bottom of a stomach during reception of a preparation, careful inspection of the patient should be conducted and if the increase of ovaries is marked, the treatment must be stopped before normalization of the size of ovaries. A doze of a preparation and duration of its prescription during a following cycle in such cases should be reduced.
In case of development of infringements of sight the preparation should not be prescribed again.

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Common uses

This medicine is a fertility agent used to stimulate ovulation in women who want to become pregnant. It may also be used to treat other conditions as determined by your doctor.

Before using

Inform your doctor of any other medical conditions, allergies, pregnancy, or breast-feeding. Use of this medicine is not recommended if you have a history of liver conditions. Contact your doctor or pharmacist if you have any questions or concerns about taking this medicine.

Directions

Follow the directions for using this medicine provided by your doctor. Store this medicine at room temperature in a tightly-closed container, away from heat and light. If you miss a dose of this medicine, contact your doctor for instructions.

Cautions

This medicine may cause dizziness, lightheadedness, or changes in vision. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to this medicine. Using this medicine may result in multiple pregnancy (twins, etc.). Be sure you have discussed this possibility with your doctor. Do not use this medicine if you are or become pregnant. If you suspect that you could be pregnant, contact your doctor. It is unknown if this medicine is excreted in breast milk. Do not breast-feed while taking this medicine.

Possible side effects

Side effects, that may go away during treatment, include hot flashes, nausea, vomiting, breast tenderness, dizziness, lightheadedness, headache, or mood changes. If they continue or are bothersome, check with your doctor. Check with your doctor as soon as possible if you experience stomach or pelvic pain, bloating, or blurred vision. If you notice other effects not listed above, contact your doctor, nurse, or pharmacist.

If you take too much

If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include nausea, vomiting, flushing, blurred vision, and stomach pain.

Additional information

Do not share this medicine with others for whom it was not prescribed. Do not use this medicine for other health conditions. Keep this medicine out of the reach of children.

Drug interactions

Drug interactions can result in unwanted side effects or prevent a medicine from doing its job. Some medicines or medical conditions may interact with this medicine. Inform your doctor or pharmacist of all prescription and over-the-counter medicine that you are taking.