Clomiphene Citrate


Clomiphene Citrate (Clomid)

Clomid citrate is commonly the first medication that is pre­scribed for patients who are unable to ovulate on their own with unspecified infertility in combination with insemina­tion. Women who have normal fallopian tubes, regular 28 day cycles, and partners with a normal sperm count, but are still experiencing infertility, are termed as having ‘unspecified’ infertility. The pituitary gland regulates the amount of FSH (follicle stimulating hormone) and LH (leutenizing hormone) in the system. These two hormones play a key role in ovulation. The levels of these hormones determine when and how many eggs are developed and re­leased. LH is responsible for the further maturation and re­lease of the egg(s).

Clomid citrate is an anti-estrogen medication. This means that it tricks the pituitary gland into thinking that the levels of estrogen in the body are low, causing the pituitary gland to secrete additional FSH and LH. This increase of FSH and LH stimulates the development of the follicles which contain the egg(s). Clomid citrate is taken as a pill, and is generally pre­scribed as one (50mg) pill each day for 5 days in the beginning of the menstrual cycle (days 3-7). A mature follicle is usually found around day 12 of the cycle. If ovulation does not occur, the medication can be changed to reflect the patient’s needs. Ultrasound is the best way to determine the number and maturity of the follicles. Ovulation predictor kits can be used to measure if there has been a surge of LH mid-cycle, indicating ovulation has occurred. Ovula­tion occurs about 24-28 hours after the detection of the LH surge in the urine. Once ovulation has occurred, natural or artificial insemination is performed in an attempt to fertilize the egg(s) that have been produced.


Male Factor Infertility


One of the contributing factors to a couple’s fertility difficulties can be problems with sperm number or function. Approximately 15-20% of infertility can be ascribed to male factor infertility. When sperm are evaluated, they are assessed for quantity, motility, and how normal they look. Results can appear normal, borderline, or severely abnormal. Severely abnormal semen analyses will often require in vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI) to achieve pregnancy. Normal or borderline sperm may be able to generate a pregnancy, but at a reduced chance of success.
An important item to remember is that a semen analysis does not measure male fertility; it measures sperm production. From those numbers, we try to draw connections between analyses and chances of pregnancy, but the correlation is not always exact. If problems with sperm production are identified, urological evaluation may be suggested. A urologist can perform a focused history, physical exam, and laboratory assessment, that might identify a reason behind the male’s difficulties. Many times, a hormonal or anatomic reason can be identified, which might be treated with medication or surgery.
Treatment for male factor generally involves increasing the number of normal, motile sperm having access to the eggs. This can be done with timed intercourse around the time of ovulation, intrauterine insemination, or IVF-ICSI. With intrauterine insemination, the seminal fluid is exchanged with neutral, hypoallergenic media, and the best-swimming sperm are collected after treatment in a centrifuge. Misshapen, immotile sperm are discarded, and the fraction of strong-swimming sperm is placed with a thin catheter into the woman’s uterus. Conception will still rely on the sperm’s ability to reach the egg, bind to its shell, and fertilize. If an insemination does not work, there is no way to tell where the process failed.IVF with ICSI minimizes failure by leaving the least to chance. Individual normal, motile sperm are carefully placed into oocytes, giving the highest chance for fertilization. The fertilized eggs are placed directly into the uterine cavity, minimizing the chance for ectopic pregnancy.
Other recommendations for maximizing male fertility include eating a regular diet, and avoiding tobacco, alcohol, and illegal drugs. One multivitamin per day may also help. The elements most likely to impair sperm number or quality include chemotherapy, radiation therapy, and anabolic (muscle-building) steroids. Many times, male infertility can not be “fixed”, but its effects can be minimized with intrauterine insemination or in vitro fertilization.