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Clomid for the treatment of female infertility - causes and how to deal with them

fertility treatment

About 20-30% of all cases of female infertility are associated with anovulatory cycles. In this case, most often, this pathology is amenable to medical correction. In this case, antiestrogens(progestins) are used. One of them is Clomid.

In a healthy female body, the ovulation period is characterized by the release of the Mature germ cell into the abdominal cavity. Then the egg makes slow progress through the fallopian tubes in the direction of the uterus. In the case of anovulatory (endocrine) factor of infertility, this process does not occur, as a result of which the sex cells of the partners can not meet.

Ovulation is the exit of a Mature egg from the ovarian follicle into the abdominal cavity. Normally, this process occurs in a woman's body every month. If it is constantly violated, infertility occurs.


Clomid, what is this drug?

Clomid (or Clomiphene) is a drug that is used to treat functional disorders and treat infertility in women. The essence of the action is that the active components of the drug activate the growth of follicles and egg maturation.

Important! You can't prescribe the drug yourself! You can harm your health.

In which cases is the use of clomid justified?

The decision to prescribe the drug can only be made by a doctor after collecting all the tests and conducting the necessary examinations. Clomid is used to treat infertility only if the cause is the lack of ovulation in a woman.

What tests and examinations are needed:

  1. Semen analysis for your spouse
  2. Examination for the patency of the fallopian tubes
  3. Checking partner compatibility
  4. Examination of the uterine mucosa
  5. Tests for sexual infections

Reasons for the lack of ovulation, in which stimulation with the drug will not give results:

  1. Disorders of the thyroid gland
  2. Increased prolactin levels

The drug can also be prescribed for natural ovulation if a woman is diagnosed with Chiari-Frommel or Stein-Leventhal syndrome.


Contraindications for taking Clomid

Clomid is not prescribed to women with renal and hepatic insufficiency, visual impairment, metrorrhagia of unknown origin, genital tumors, galactose intolerance, lactase deficiency, and glucose absorption disorders. Also, the drug is contraindicated in endocrine diseases: thyroid disorders, hypofunction or pituitary tumors, ovarian insufficiency in hyperprolactinemia.

Of gynecological pathologies, endometriosis and ovarian cysts can be an obstacle to treatment, with the exception of polycystic syndrome. More information about the effect of endometriosis on women's reproductive function→ Clomid and pregnancy (already occurred earlier), as well as lactation-are incompatible. In this case, and if hypersensitivity to the components of the drug is detected, it is contraindicated.


Possible negative effects of the drug

When taking Clomid, it can lead to undesirable consequences. Some of them are related to the General state of the body, while others are related to the functioning of the reproductive system. Common adverse reactions may include:

  • headache
  • drowsiness
  • nighttime sleep disorders
  • depression
  • increased excitability
  • mental and physical disability
  • dyspeptic disorders
  • abdominal pain
  • weight gain
  • frequent urination
  • allergic skin rashes
  • reduced vision

When palpation is observed tenderness of the mammary glands. On the part of the reproductive system, the following disorders are possible: dysmenorrhea – severe pain during menstruation; menorrhagia – prolonged and profuse menstrual bleeding; ovarian enlargement, including due to cysts; pain in the lower abdomen. With long-term use of clomid, there is a risk of ovarian hyperstimulation with the formation of cysts and ruptures. It is sometimes possible premature exhaustion of the ovaries, causing early menopause occurs.


Types and causes of infertility

Determining the cause of a woman's lack of ovulation is considered a crucial factor for overcoming endocrine infertility.

A woman's reproductive health is regulated by the endocrine interaction between the pituitary gland, hypothalamus, and ovaries. The key hormonal factors in this regard are luteinizing (LH) and follicle-stimulating (FSH) hormones, as well as estradiol. Anovulatory infertility can be caused by any disorder in this chain:

  1. Deficiency of gonadotropins
  2. Polycystic ovary syndrome
  3. Premature depletion of the ovulatory reserve

More rare factors that provoke anovulation include hypothyroidism and hyperprolactinemia. Diagnosis and therapy for each type of disease has its own characteristics.


Gonadotropic insufficiency

This form of pathology is characterized by a decrease in the secretion of gonadotropins (hormones that stimulate the growth of follicles with eggs), this may be caused by a complicated course of chronic diseases, sudden weight loss, stress, and hereditary predisposition. There are two types of normogonadotropic anovulatory infertility:

  1. Hypothalamic
  2. Pituitary

On the basis of a hormonal study, experts distinguish the mild, medium and severe degree of the disease. The conclusion is based on the quantitative content of LH, FSH, and estradiol.

Symptoms of gonadotropic insufficiency can be:

  • phenotypic features such as high height, male-type physique
  • elongated arms and legs
  • reducing the amount of pubic and armpit hair

Often, women suffering from this form of endocrine disorder have amenorrhea-the primary or secondary absence of menstruation. Using ultrasound, specialists can observe a decrease in the size of the uterus and ovaries.

Determination of normogonadotropic anovulatory infertility involves the following diagnostic measures:

  • Blood test for hormones
  • Ultrasound of the pelvic organs
  • Lipidogram
  • Determination of bone mineral density

Treatment of this form of childlessness consists of two stages. The goal of the first stage is to prepare the body for ovulation by prescribing replacement therapy. Thus, it is possible to achieve an increase in the size of the ovaries and uterus, the appearance of signs of the female phenotype, as well as the readiness of the endometrium for implantation of a fertilized egg.

The second stage of therapy involves drug stimulation of ovulation by prescribing special drugs-menotropins. If ovulation occurs, it is recommended to provide support for the second, subsequent phase of the cycle, by oral administration of progesterone.


How to treat gonadotropin insufficiency?

Before starting treatment, the main scheme is selected, which can be modified depending on the characteristics of the menstrual cycle or the patient's reactions.

If the patient in the absence of ovulation does not have thyroid disorders, there is sufficient estrogenic stimulation and there is a normal content of prolactin in the blood serum, clomiphene citrate is usually prescribed.

All patients are instructed how to measure basal body temperature, which makes it easier to evaluate the results of treatment.

If ovulation has occurred, as can be seen from ultrasound, the two-phase nature of the basal body temperature curve, changes in cervical mucus (it becomes opaque, viscous and does not form crystals) and (or) a unilateral increase in the ovary, which was absent during the initial examination of the patient, then when menstruation occurs, the same dose of clomiphene citrate is prescribed.

If a woman has a stable anovulation, the attempt to cause progestin-conditioned bleeding is repeated, and the dose is increased. This is repeated until ovulation occurs or the maximum dose of the drug is reached (without ovulation).


Determining the effectiveness of Clomid therapy?

The effectiveness of treatment will primarily depend on the severity of anovulatory infertility associated with gonadotropin deficiency. The age of the patient is also important. Statistics confirm the onset of pregnancy in 80% of women treated with this scheme.


If the body does not respond to Clomid therapy?

If a woman has a stable anovulation, the attempt to cause progestin-conditioned bleeding is repeated, and the dose is increased. This is repeated until ovulation occurs or the maximum dose of the drug is reached (without ovulation).

Treatment is carried out for at least 3 ovulatory menstrual cycles before a conclusion is made that there are no positive results.

In cases where the signs of ovulation are doubtful, the progesterone content in the blood serum is determined before prescribing progestins. If the onset of menstruation has deviations from the norm, then before the beginning of the next cycle of treatment with clomiphene, an objective examination is repeated and pregnancy tests are performed.


Polycystic ovary syndrome

If the ultrasound shows signs of polycystic ovaries, they say that anovulatory infertility of type II. This form of pathology is often associated with hypoandrogenism and insulin resistance. Polycystic ovary syndrome is difficult to correct with medication. However, with the right hormone therapy and duration of treatment, it is possible to expect a positive result of pregnancy.

Treatment of this form of childlessness also involves a surgical operation-laparoscopic thermocauterization. In the case of a successful outcome of surgery, the probability of pregnancy increases significantly.


Premature ovarian depletion

This condition is characterized by the absence of oocytes, due to early depletion of the ovulatory stock. This form of anovulatory infertility is considered the most difficult in therapeutic terms, since it is impossible to provoke and predict spontaneous ovulation.

All forms of endocrine infertility can be successfully adjusted to the normal hormonal level, when all the necessary hormones are " tuned”, and the woman's body can produce normal eggs, and when they are fertilized, they can be successfully preserved.

All forms of endocrine infertility can be successfully adjusted to the normal hormonal level, when all the necessary hormones are " tuned”, and the woman's body can produce normal eggs, and when they are fertilized, they can be successfully preserved.

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