Ovulation Drug Clomiphene Citrate

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Ovulation DrugClomiphene Citrate

• Reproductive Management Inc.

Evan Sorley, Dana Tackes, Sarah Hoffmann, Camille
Darriet
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Case Study, Problem

• 25 yr old woman who cant become pregnant
• She has infrequent menstrual periods, about 4 to
  5 a year with 45-60 days between menstruation
• Her male partner has normal sperm
• The woman will be treated with Clomiphene Citrate

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Drug Treatment

• Standard dosage is 1 or 2 tablets per day for 5
  consecutive days.
• This treatment is begun early in the cycle, on
  the 2-5th day after menstruation begins.
• If ovulation does not happen, the dosage can be
  increased, the treatment can be prolonged, or
  other medications can be added in addition to
  clomiphene citrate.

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Clomiphene Citrate

• Most commonly prescribed ovulation drug
• Sold as Clomid and Serophene
• Comes in tablet form
• Some side effects
• increased incidence of multiple births,
• miscarriage
• thick, dry cervical mucus
• hot flashes, nausea, breast tenderness
• occasional headaches or blurred vision
• depression, mood swings
• ovarian cysts, pelvic discomfort

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Clomiphene Citrate

• Mechanism of Action-
• Works by binding to E2 receptors in the
  hypothalamus
• Suppresses synthesis of new E2 receptors
• Creates state of hypoestrogenicity
• Decreased negative feedback of estrogen causes
  increased FSH secretion
• Ovulation is known to occur in about 70 of cases
  while pregnancy occurs only in about 25-30 of
  the cases

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Days 2-7
Mechanism
Day 14
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Reproductive State and Effectiveness

• Eligible Patients
• Infrequent periods and long cycles
• Prevents the estrogen mediated negative feedback
• Ineffective in cases of
• Women with hypothalamic disorders that cause
  irregular or absent ovulation
• Women with very low levels of estrogen

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Methods of Ovulation Detection

• Typical Methods
• Menstrual Cycle Length Shortened menstrual
  cycle
• not the most reliable method - random uterine
  bleeding, or more regular cycles, can occur
  without ovulation
• Ovulation Prediction Kits
• Basal Body Temperature Low during follicular
  phase, there will be an increase of at least 0.5
  degrees Fahrenheit when progesterone production
  begins
• Blood Hormone Levels elevated levels of
  progesterone

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Is Clomiphene Working?

• Other Methods to Detect Ovulation
• Cervical Mucus Test increase in cervical mucus
  discharge due to increased estrogen production
  from large follicular growth
• Abdominal Pain pain on one side of abdomen due
  to follicular maturation, followed by another
  pain due to ovulation
• Ultrasound
• Endometrial Biopsy

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Alternative Solutions

• If ovulation does not occur
• Increase Clomiphene dose
• Increase duration of treatment
• Add other medications
• Switch to another drug