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DRCPG MCQs for Circuit A Answers
Published in Una F. Coales, DRCOG: Practice MCQs and OSCEs: How to Pass First Time three Complete MCQ Practice Exams (180 MCQs) Three Complete OSCE Practice Papers (60 Questions) Detailed Answers and Tips, 2020
According to the British National Formulary (BNF), the side-effects of clomiphene include visual disturbances, ovarian hyperstimulation, hot flushes, abdominal discomfort, depression, insomnia, breast tenderness, headache, intermenstrual spotting, menorrhagia, endometriosis, convulsions, weight gain, rash and dizziness.
Reproductive Endocrine Disorders
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Clomiphene acts as an estrogen antagonist to increase gonadotropin secretion and induce ovulatory cycles in estrogen-secreting anovulatory women who do not have primary pituitary or ovarian failure (36). Normalization of reproductive endocrine functions and menstrual cycles among women who have both partial seizures and menstrual disorders with documented inadequate luteal phase has been demonstrated to significantly and sometimes dramatically lessen seizure frequency (37,38). In one investigation of 12 women, 10 improved, and seizure frequency declined by 87% (37). Clomiphene, however, is a drug with considerable pharmacologic potency and potentially disturbing adverse effects. Therefore, it should be used only after potential risks and benefits are weighed carefully and treatment with antiseizure medications and progesterone prove inadequate to control seizures. Clomiphene should not be administered in cases of suspected pregnancy or in the absence of adequate birth control measures unless it is used in conjunction with a gynecologist as part of a fertility program. Endometrial carcinoma should be ruled out prior to institution of therapy if abnormal uterine bleeding is present, and normal liver function should be assured since clomiphene is excreted in the feces via the enterohepatic circulation.
What to do if nothing wrong can be found and how to answer when a couple asks ‘what can we do to improve our fertility?’
Published in David J Cahill, Practical Patient Management in Reproductive Medicine, 2019
Ovulation induction agents (clomifene – orally – or gonadotrophins – by injection) improve the chances of pregnancy by stimulating the release of more than one egg each month. Clomifene on its own is generally recognised not to improve the chance of pregnancy in women with unexplained infertility (33). Intrauterine insemination in combination with ovulation induction using clomifene or gonadotrophins gives a higher chance of pregnancy (15%–20%/cycle). IUI is only suitable if the woman has healthy fallopian tubes and if sperm numbers and sperm function tests are normal. Data from elsewhere are even more encouraging about the use of IUI, a relatively simple technique; with women who were treated with IUI, 35% delivered after this – with reported multiple pregnancy rates of 12% (34).
Ultrasound monitoring during first-cycle treatment with clomifene citrate: a national survey of compliance with NICE
Published in Human Fertility, 2020
Heather Garthwaite, Jane Stewart, Kathryn King, Ken McGarry, Scott Wilkes
In this study, over half of the clinicians surveyed were not always using TVUS to monitor clomifene-associated multiple pregnancy risk, and their practice is therefore contrary to NICE Clinical Guideline 156. The main reasons cited for this were resource limitations, personal experience of low multiple pregnancy rates and the lack of an evidence base. The survey also suggested that clinicians and patients are often willing to accept a risk of multiple pregnancy with clomifene. The relevance of scanning the first cycle only was brought into question. Interestingly, 22.9% of respondents indicated that they use clomifene for unexplained infertility, despite evidence that it is no more effective than expectant management (Bhattacharya et al., 2008; Hughes, Brown, Collins, & Vanderkerchove, 2010). Further analysis regarding this is beyond the scope of this paper.
Clomiphene- induced pulmonary embolism
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Clomiphene is a selective estrogen receptor modulator that has been used in the treatment of hypogonadism, especially in men of reproductive age, as it does not affect the intra-testicular production of testosterone and hence preserves spermatogenesis. Clomiphene causes an increase in pituitary gonadotropins release, increases the estradiol levels, and cause thrombotic effects. Common side effects of clomiphene include headaches, visual disturbance, hot flushes, and fluid retention. There are a few case reports of clomiphene being associated with central retinal vein occlusion, deep vein thrombosis, and a case report of intracranial venous thrombosis [2]. The duration of therapy leading to thrombosis varies.
Current and emerging medical therapeutic agents for idiopathic male infertility
Published in Expert Opinion on Pharmacotherapy, 2019
Ylenia Duca, Aldo E. Calogero, Rossella Cannarella, Rosita A. Condorelli, Sandro La Vignera
The most studied and mainly used compounds of this pharmacological class are clomiphene and tamoxifen. According to an American survey, clomiphene is also the most used drug in empirical medical management of idiopathic male infertility, at least in the United States [57]. Estrogen antagonists are relatively safe drugs although, compared to AIs, they have the disadvantage of increasing estrogen production in addition to testosterone [58]. The potential side effects of clomiphene and tamoxifen include nausea, hot flushes, headache, visual disturbances and cardiovascular disorders, but they have a low incidence and are usually transient [59].