Steph, Amy, Ashley, Sam

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Human Infertility

• Steph, Amy, Ashley, Sam

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Case Study

• Woman wants to get pregnant
• 25 yrs old
• Irregular menstrual cycles 4-5 cycles/yr
• Infertility problem is not male in origin
• Fertility drugs
• Allow ovulation to occur more regularly in women
  with ovulatory problems
• control time of ovulation, stimulate eggs to
  mature and be released.

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Treatment Clomiphene citrate

• Brand Names Clomid, Serophene
• stimulate ovulation in women who have infrequent
  periods and long cycles.
• Tablets 1-2 tablets (50-100 mg)/day taken orally
  for 5 consecutive days.
• Begins on 2nd,3rd,4th,5th day of cycle
• Used simultaneously with other drugs

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Common 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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Functions of Clomiphene Citrate

• Acts as anti-estrogen
• Blocks target estrogen receptors in the
  hypothalamus, which causes pseudo estrogen
  deficiency
• Hypothalamus reacts to estrogen deficiency
• Pituitary releases LH and FSH. FSH increase
  causes follicular growth. Follicle produces
  estrogen
• Hypothalamus senses estrogen
• LH surge from pituitary which causes ovulation

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Drug Treatment Regime

• Clomiphene Citrate refresher
• Oral medicine given in tablet form
• Standard dosage is one to two tablets
• (50-100 mg) per day
• Take for 5 consecutive days

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Clomiphene Citrate Regime

• Begin taking drug early in the cycle
• 2nd, 3rd, 4th, or 5th day after menstruation
• If necessary induce menstrual period with
  progestin tablets or progesterone injections
• Pregnancy test administered before progestin
  given
• Will not work any later in menstrual cycle
  because of the balance of hormones

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Clomiphene Citrate Regie (contd.)

• Ovulation occurs about one week after last
  Clomiphene tablet given
• Cycle may be as long as 35 days
• Menstrual pattern, the basal body temperature
  (BBT) chart, ovulation prediction kits,
  ultrasound monitoring, and/or serum progesterone
  levels are used to indicate response to treatment

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Treatment Follow-up

• If ovulation does not occur, increase dose for
  next few cycles
• If this does not work, doctor may prolong
  duration of treatment or add other drugs
• Given for no more than 6 cycles
• 40-45 success rate
• Women with hypothalamic disorders or low estrogen
  levels do not respond well to Clomiphene Citrate

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Treatment Follow-up

• Problems due to thick cervical mucus
• Postcoital test is done 4-12 hours after
  intercourse
• A sample of cervical mucus is taken to make sure
  sperm are present and mobile
• Unsatisfactory results lead to intrauterine
  insemination or a change in medication
• Problems due to thin endometrial lining
• Additional medication

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References

• "Ovulation Drugs A Guide for Patients." American
  Scoiety for Reproductive Medicine (2000) 1-22.