Clomiphene is a drug that is mainly taken by women who are unable to conceive. The active ingredient is a so-called estrogen receptor antagonist, which triggers ovulation. Clomiphene can be taken simply in the form of a tablet and for this reason it is prescribed as the drug of choice for infertility.
Clomiphene is a drug from the group of so-called selective estrogen receptor modulators (SERM). The active substance contained in the tablets is clomiphene dihyrocitrate. It is a hormone preparation that acts as an estrogen receptor antagonist (also called anti-estrogens). The effect of clomiphene is based on the fact that it prevents the hormone estradiol from binding to the corresponding estrogen receptors in the hypothalamus and in the pituitary gland (Pituitary gland), both of which are in the brain. Due to a complex feedback mechanism, the hypothalamus produces an increased amount of the hormone GnRH (Gonadotropin-Releasing Hormone), which in turn leads to a massive distribution of LH (luteinizing hormone) and FSH (Follicle-stimulating hormone) from the pituitary gland. The increased release of LH and FSH promotes the maturation of the egg cells in the ovary and ultimately leads to ovulation. In this way, clomiphene induces ovulation. The entry in turn is the prerequisite for the mature egg cell to be fertilized and an embryo to develop.
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Clomiphene triggers ovulation after ingestion (ovulation) and is therefore used in women who are infertile due to a malfunction of the fallopian tubes (sterile) are. The indication for taking clomiphene is therefore a desire to have children in women whose fallopian tubes are not functioning properly.
The prerequisite for clomiphene to be successful in treatment is that the sterility is caused by hormones. This means that the women to be treated are sterile because they produce too few sex hormones or pituitary hormones. Ovulation is usually controlled by hormones. During the cycle, a woman's body produces various hormones (GnRH, LH, FSH, estrogen and progesterone) that stimulate the ovaries, lead to follicular maturation and ultimately ovulation. The mature egg is expelled from the ovary and taken up by the fallopian tube. In the fallopian tube, fertilization can then take place by a sperm. Due to a reduced concentration of these hormones, ovulation either remains or occurs only rarely, which is why these women cannot conceive children. Egg maturation disorders can also be treated with clomiphene.
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Clomiphene should be taken exactly as instructed by the attending physician. Clomiphene is primarily characterized by its ease of use. In contrast to other hormone preparations, which often have to be administered in the form of injections, clomiphene can simply be taken orally as a tablet. Treatment with the hormone preparation begins in the first week of the cycle. The beginning of menstrual bleeding also marks the beginning of a new cycle in a woman. The intake of clomiphene begins either on the 2nd or 5th day of the cycle and is then continued for a period of five days (i.e. up to the 7th or 9th day of the cycle). If a normal ovulation cycle does not occur after an initial dose of clomiphene, the intake can be continued for several cycles (i.e. months). In such cases, the dose can be increased to 100-150 mg (i.e. two to three tablets per day) after consulting your doctor.
However, a maximum intake duration of six months and a total dose of 750 mg clomiphene (equivalent to 15 tablets) per intake cycle should not be exceeded. After three consecutive cycles with clomiphene at the latest, a break in intake of at least two months must be observed. If pregnancy occurs, the tablets must no longer be taken and must be discontinued immediately, otherwise the embryo may be damaged or a spontaneous abortion may occur.
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Clomiphene is administered orally on the 2nd or 5th day of the cycle (i.e. two or five days after the onset of menstrual bleeding). The dosage is 25 mg or 50 mg per tablet. The drug is taken in a cycle for five days in a row. If after an initial cycle the desired effect (i.e. a normal cycle with ovulation) does not occur, the doctor may consider increasing the dosage to 100-150 mg daily (equivalent to an amount of 2-3 tablets). The exact dosage of clomiphene is determined in advance by the attending gynecologist.
As with all medications, side effects can also occur when taking clomiphene. The undesirable effects are mainly dependent on the dosage and the duration of use of the drug. The hormonal stimulation can lead to multiple pregnancies and ovarian enlargement. Ovarian cysts with fluid retention in the abdomen can also develop when taking clomiphene. Common side effects also include sudden flushing of the face (vasomotor flush) and hot flashes.
Clomiphene prevents the effects of estrogen by blocking estrogen receptors. As a result, the use of clomiphene can cause symptoms that are otherwise characteristic of menopause. These include hot flashes, night sweats, headaches, visual disturbances and a feeling of tension in the breasts.
In rare cases, women after taking clomiphene suffer from nervousness, insomnia and fatigue, depression, sensitivity to light and allergic skin symptoms. Liver disorders and vision problems (flickering eyes, blurred vision or flashes of light) can also occur. Frequent use of clomiphene (for more than three months) also increases the risk that patients will develop ovarian cancer as a result of hormonal overstimulation.
Get detailed information about the Side effects of clomiphene
Taking clomiphene can cause weight gain. Gaining a few pounds is normal and is one of the side effects of the drug. However, women who take other infertility drugs in addition to clomiphene (for example hMG, the human menopausal gonadotropin) can develop what is known as ovarian hyperstimulation syndrome (OHSS). This is a potentially life-threatening condition that causes enlarged ovaries and fluid retention in the abdomen. As a result of the edema (accumulation of water), the affected women seem to gain weight significantly. To avoid such complications, any fertility treatment should only be carried out under close medical supervision and regular check-ups.
An unpleasant side effect that many women suffer from after taking clomiphene is hair loss. Usually the hair loss disappears after stopping the drug. However, it can take a few months for the hair cycle to normalize and hair to grow back. If after several months there is still no improvement in the hair loss, there may be another cause behind it (for example a dysfunction of the thyroid gland).
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Occasionally menopause-like symptoms occur when taking clomiphene due to the blockage of the estrogen receptors. In addition to headaches and a feeling of tension in the breasts, this also includes hot flashes. The women feel a spontaneous sensation of heat that occurs mainly in the head area. In addition, there is an increase in heart rate and profuse sweating. The hot flashes usually go away after you stop taking the drug.
Clomiphene should not always be given to every woman. In the event of an intolerance or allergy to the active ingredient clomifene dihydrocitrate, the drug must not be taken. To the contraindications (Contraindications) Treatment with the hormone preparation also includes certain pre-existing conditions of the ovaries, such as ovarian tumors or ovarian cysts. Clomiphene must also not be administered to tumors of the pituitary gland. During treatment with clomiphene, the tumors or cysts can become enlarged.
Further contraindications are liver diseases, liver dysfunction and blood clotting disorders. In the event of a pregnancy, clomiphene must be discontinued immediately and must never be continued. The drug must also not be taken during breastfeeding.
There are currently no known interactions between clomiphene and other medicinal products. Nevertheless, before starting therapy, it should be clarified with the attending physician whether the woman is taking any other medication.
Alternatives to clomiphene
Treatment with clomiphene does not lead to the desired success for every woman. In addition to clomiphene, there are also alternative drugs that can stimulate ovulation in infertile women. These include hormones such as FSH (Follicle-stimulating hormone) or LH (Luteinizing hormone), which are administered in the form of syringes. The hormone choriogonadotropin alpha (Ovitrelle, Predalon) can also be administered by injection to support follicle maturation.
The price for clomiphene depends not only on the manufacturer but also on the package size and the active ingredient content. The price fluctuates between 20 and 35 euros. The company Ratiopharm offers a pack of clomiphene at a price of around 20 euros. This contains 10 tablets with an active ingredient content of 50 mg each.
When does the health insurance company pay?
Clomiphene is a prescription drug. If the doctor considers clomiphene fertility treatment appropriate for a patient, he or she will prescribe a prescription. Usually the women in the pharmacy only have to pay the prescription fee of 5 euros and the rest of the costs are covered by the health insurance.
Is clomiphene also available without a prescription?
Clomiphene is a prescription drug. Clomiphene can, however, be bought without a prescription in various Internet pharmacies. However, it is a drug that interferes with the hormonal balance of women. For this reason, clomiphene should only be taken under medical supervision. The gynecologist discusses with the patient whether clomiphene can lead to the desire to have children in her case and the side effects associated with taking it. The doctor also determines the exact dosage and duration of intake individually for each patient. Then the doctor will write a prescription that can be used to buy the drug in any pharmacy.
When does ovulation occur
When exactly a woman will ovulate while being treated with clomiphene cannot be precisely predicted. Every body reacts differently and some women respond very well to the drug while others are less effective.
Typically, a woman's cycle lasts an average of 28 days. Ovulation occurs on the 14th day after the last menstrual bleeding (ovulation). During this time, the woman is fertile and pregnancy can occur if sex is unprotected. When clomiphene is taken, the time of ovulation depends on which day of the cycle it was started. If you start taking clomiphene on day 2 of your cycle, ovulation will occur around day 16. When treatment begins on day 5 of the cycle, ovulation is postponed by five days and is then around day 21. However, these are only very imprecise calculations.
There are a few symptoms, such as a slight rise in temperature and changes in cervical mucus, that occur when you ovulate. Since many women have very different times of ovulation, an ovulation test is recommended to accurately determine the fertile days. It is also possible for the gynecologist to use ultrasound to determine whether ovulation has occurred every two days from the 12th day of the cycle.
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What is the success rate?
Treatment with clomiphene is said to stimulate ovulation, thereby increasing the chances of conceiving. Clomiphene is a relatively effective drug with a high success rate. Statistics show that 70 percent of patients ovulate within the first few months of starting treatment and are therefore potentially fertile. About 25 percent of treated women do not ovulate due to clomiphene resistance and the treatment is not successful. Many women of these women also become pregnant. The exact percentage varies quite a bit and is between 10 and 50 percent.
This is because successful fertilization of the mature egg depends on many factors, such as the age of the woman, the sperm quality of the partner or the time of sexual intercourse (i.e. on which day of the cycle). For this reason, the exact rate of success and the likelihood of becoming pregnant after treatment with clomiphene cannot be accurately predicted.
Most pregnancies that occur after clomiphene treatment are normal and the children show no abnormalities. However, taking clomiphene increases the risk of miscarriage. There is also a likelihood of having multiple pregnancies.
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Does Clomiphene Increase Chances of Having Twins?
Clomiphene increases the likelihood of multiple pregnancy occurring. By blocking the estrogen receptors, clomiphene leads to ovarian overstimulation, which means that several follicles in the woman's ovary mature at the same time. As a result, not just one, but several egg cells are released.After the egg cells have reached the ovary, they can be fertilized by sperm there and a multiple pregnancy occurs. The children who are born are fraternal twins or triplets. This occurs in five to 15 percent of pregnancies caused by clomiphene. The probability of a twin pregnancy is then estimated at 10 percent, the probability of triplets at one percent.
Through the use of clomiphene, the number of twin births in Germany has almost doubled in the last few decades. However, multiple pregnancies are not entirely safe. Often children are born prematurely and are born with too little weight. As a result, they often have to be ventilated after birth and have an increased risk of later suffering from respiratory or cardiovascular disease.
What happens when a man takes clomiphene?
Clomiphene can also be prescribed to men in rare cases. This is the case when the man has poor sperm quality, low sperm count, or poor sperm motility. Treatment with clomiphene in infertile men only makes sense if the sterility is due to a hormonal imbalance. Clomiphene blocks the estrogen receptors present in men and thereby stimulates the man's own testosterone production. Testosterone acts as a male sex hormone and improves the quality of the sperm.
Clomiphene is also used by men as a doping agent to stimulate testosterone production. Especially after taking anabolic steroids, the body's own testosterone is only produced less. The intake of estrogen blockers such as clomiphene then supports the body's own testosterone production again and maintains it. The men can maintain the muscle mass that was previously built up by the anabolic steroids. As with women, however, clomiphene can also lead to undesirable side effects such as allergic reactions, depression and visual disturbances in men.
How does clomiphene work for polycystic ovaries?
Polycystic ovaries lead to the clinical picture of polycystic ovarian syndrome (PCO). This is a hormonal disorder in women that leads to an increased concentration of male sex hormones in the blood. This delays the maturation of the follicles and makes it harder for women to get pregnant. Ovarian stimulation therapy with clomiphene causes follicles to mature in the ovaries and increases the fertility of the affected women.
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