نقش كلوميفن سيترات در درمان نازايي

The role of Clomiphene citrate in the treatment of infertility

Ovulation induction with clomiphene is the most commonly used treatment for infertility. It represents an inexpensive, convenient and relatively safe first choice medication in normogonadotrophic oligo/amenorrhoeic infertility (WHO group 2), essentially associated with polycystic ovaries. Anovulatory women who are responsive to clomiphene citrate should be treated for at least six cycles and the treatment should probably be limited to a maximum of 12 cycles. It is necessary to monitor at least the first with ultrasonography because of the risk of multiple pregnancy and the variable response of patients to different doses of clomiphene. In addition, the risk of ovarian hyperstimulation syndrom should not be underestimated. More triplet and higher order pregnancies result from ovulation induction, in vitro fertilization, and multiple pregnancy has many risks for both mother and babies. The role of empirical clomiphene in the treatment of unexplained infertility is debatable and the present data are inconclusive. Obesity, hyperandronaemia and insulin resistance are important factors in clomiphene-resistant patients. Failure to ovulate in response to clomiphene has been approached by either medical or surgical methods. An effective alternative medical treatment is gonadotrophin injections. Metformine and troglitazone are the best studied insulin sinsitizers used for ovulation induction. The most widely used surgical treatment is laparoscopic ovarian diathermy which appears to be as effective as gonadotrophin therapy. Also this surgical treatment has been linked to a decrease in the elevated rates of spontaneous abortions documented in patients with polycystic ovaries.