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Multiple pregnancy and infertility
Published in Janetta Bensouilah, Pregnancy Loss, 2021
Polycystic ovarian syndrome (PCOS) accounts for around 75% of anovulatory cases of infertility. Women with PCOS are at increased risk of spontaneous miscarriage. Although the exact pathophysiological mechanism is unclear, the elevated luteinising hormone (LH) level that characterises the syndrome has in the past been thought to be responsible, although recent research suggests this is unlikely. Instead, hyperandrogenaemia, obesity and hyper-insulinaemia have been identified as more probable contributory factors.8 Clomifene citrate has traditionally been the first-line treatment for women with anovulatory PCOS who wish to conceive. In cases that are resistant to clomifene, and in women who fail to conceive, gonadotrophins may be given. Women with PCOS who are treated with gonadotrophins have a multiple pregnancy rate of 36%. In recent years the use of metformin in PCOS has become increasingly widespread, and there is some evidence to suggest that this may have a number of protective effects in pregnancy by reducing complications such as gestational diabetes and early pregnancy loss.9
DRCOG MCQs for Circuit A Questions
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
Side-effects of clomiphene citrate include: Visual disturbances.Hot flushes.Intermenstrual spotting.Weight gain.Hair loss.
SBA Questions
Published in Justin C. Konje, Complete Revision Guide for MRCOG Part 2, 2019
A woman on clomifene citrate (CC) for induction of ovulation has been undergoing follicular tracking. Ovulation has been confirmed. What proportion of women who are on CC that ovulate will become pregnant by the sixth ovulatory cycle?40%–50%50%–60%60%–70%70%–80%80%–90%
Histomorphometric and immunohistochemical changes in interstitial cells and ovarian follicles of rats with polycystic ovaries treated with clomiphene citrate
Published in Gynecological Endocrinology, 2021
Leonardo Augusto Lombardi, Leandro Sabará Mattos, Ricardo Santos Simões, Rinaldo Florencio-Silva, Manuel de Jesus Simões, Paulo Celso Franco, Adriana Aparecida Ferraz Carbonell, Gisela Rodrigues da Silva Sasso, Edmund Chada Baracat, José Maria Soares-Jr
Several animal models have been developed to mimic PCOS, among them stands out PCOS induction by means of continuous illumination exposure. It induces the animal to an estrous-permanent condition associated with anovulation, presence of multiple cysts, and increase in androgens and estrogens serum levels, along with a reduction in melatonin synthesis [1]. Clomiphene citrate and insulin sensitizers can be used alone or combined to induce ovulation [2]. Treatment with clomiphene citrate promotes an increased sensitivity of the pituitary to GnRH while decreasing the efficiency of GnRH antagonists [3]. Primarily acting on the hypothalamus, clomiphene citrate has an antagonistic effect to estrogen thereby generating a feedback mechanism. Its efficiency in ovulation is attributed to stimulation of follicular proliferation due to increased FSH release, which is accompanied by a proportional increase in LH. Clomiphene citrate has been used to induce ovulation since 1962 and is recommended by several guidelines as the first-line drug for PCOS treatment [4]. However, the effects of this drug on interstitial cells and ovarian follicles have not been fully elucidated under PCOS condition.
Effect of serum vitamin D level on endometrial thickness and parameters of follicle growth in infertile women undergoing induction of ovulation
Published in Journal of Obstetrics and Gynaecology, 2018
An ultrasound was performed to determine endometrial thickness and antral follicle size in the day of hCG injection. Clinical pregnancy was defined by the presence of a heartbeat of an intra-uterine gestational sac. The treatment used in this study has been clomiphene citrate. Typically, one clomiphene citrate 50 mg tablet was taken orally for 5 days, from cycle day 3 to cycle day 7. On day 11 or 12 of the menstrual cycle, ultrasound monitoring was conducted to determine if an ovarian follicle or follicles have developed and to measure the endometrial lining. In order for ovulation induction to be successful, when 2–3 follicles with 18–30 mm diameter were visible, an injection of hCG was performed and a form of the progesterone was given via vaginal tablets. If ovulation occurred, a timed intercourse or IUI was performed.
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
Clomifene citrate has been the first-line medical treatment for polycystic ovarian syndrome-related (WHO class II) infertility for over 30 years. It acts by up-regulating follicle stimulating hormone, which encourages follicular development (Wallach & Adashi, 1984). However, more than one follicle may result, thus increasing the risk of multiple pregnancy from the background rate of 1.6% to approximately 5–8% (Legro, 2016; Office for National Statistics, 2017). The majority are dichorionic twins, with the risk of triplets reported as 0.3–0.5%, quadruplets 0.3% and quintuplets 0.13% (McDowell, Kroon, & Yazdani, 2013).