Which of the following is true for patients treated with clomiphene -
Ans. is 'c' i.e., Increased risk of ovarian hyperstimulation and polycystic ovaries Clomiphene Citrate* It binds to both ERa and ER(3 and acts as a pure estrogen antagonist in all human tissues, but the racemate displays weak agonistic action in rats.* It induces Gn secretion in women by blocking estrogenic feedback inhibition of pituitary.* The amount of LH/FSH released at each secretory pulse is increased.* In response, the ovaries enlarge and ovulation occurs if the ovaries are responsive to Gn.* Antagonism of peripheral actions of estrogen results in hot flushes. Endometrium and cervical mucus may be modified.* The chief use of clomiphene is for infertility due to failure of ovulation: 50 mg once daily for 5 days starting from 5th day of cycle. Treatment is given monthly. Conception occurs in many women who previously were amenorrhoeic or had anovular cycles.* If 1-2 months treatment does not result in conception--the daily dose may be doubled for 2-3 cycles. No more than 6 treatment cycles should be tried.* The antiestrogenic effect of clomiphene on developing follicle, endometrium or cervical mucus can be counterproductive. Luteal phase dysfunction has also been blamed for therapeutic failures.* Addition of menotropins or chorionic gonadotropin on the last 2 days of the course improves the success rate.* Clomiphene is well absorbed orally, gets deposited in adipose tissue and has long t1/2 of ~6 days. It is largely metabolized and excreted in bile.* Adverse effects Polycystic ovaries (Hyperstimulation syndrome), multiple pregnancy, hot flushes, gastric upset, vertigo, allergic dermatitis. Risk of ovarian tumour may be increased.* Other uses To aid in vitro fertilization Clomiphene given with Gns causes synchronous maturation of several ova--improves their harvesting for in vitro fertilization.* Oligozoospermia : In men also clomiphene increases Gn secretion promotes spermatogenesis and testosterone secretion. For male infertility--25 mg daily given for 24 days in a month with 6 days rest for upto 6 months has been recommended. However, success rates are low.