A study published in the New England Journal of Medicine looked at couples who had trouble conceiving for at least a year despite normal reproductive function. The study tested the different medications that can increase chances for healthy pregnancy, looking for the greatest success of a live birth with the lowest chance of having multiples , one of the main risk factors for fertility drugs.
Researchers were particularly interested in comparing two common drugs that promote extra egg release to a newer treatment using an aromatase inhibitor called letrozole, which has shown promising pregnancy rates without increased birth defects in other studies. The study was conducted at 12 clinics across the U.
Women in the study were between 18 and 40 years old and had male partners with sperm counts healthy enough for artificial insemination. Though in-vitro fertilization is also an option for women having difficulty conceiving, it is much less common because it is expensive and most insurance doesn't cover the process; using a drug to promote ovary stimulation is the most common therapy.
A patient treated during clinical studies developed phosphenes and scotomata during prolonged Clomid administration, which disappeared by the 32nd day after stopping therapy. While the etiology of these visual symptoms is not yet understood, patients with any visual symptoms should discontinue treatment and have a complete ophthalmological evaluation carried out promptly.
Ovarian Hyperstimulation Syndrome The ovarian hyperstimulation syndrome OHSS has been reported to occur in patients receiving clomiphene citrate therapy for ovulation induction. OHSS may progress rapidly within 24 hours to several days and become a serious medical disorder.
In some cases, OHSS occurred following cyclic use of clomiphene citrate therapy or when clomiphene citrate was used in combination with gonadotropins. Transient liver function test abnormalities suggestive of hepatic dysfunction, which may be accompanied by morphologic changes on liver biopsy, have been reported in association with OHSS.
OHSS is a medical event distinct from uncomplicated ovarian enlargement. The clinical signs of this syndrome in severe cases can include gross ovarian enlargement, gastrointestinal symptoms, ascites, dyspnea, oliguria, and pleural effusion.
In addition, the following symptoms have been reported in association with this syndrome: The early warning signs of OHSS are abdominal pain and distention, nausea, vomiting, diarrhea, and weight gain. Elevated urinary steroid levels, varying degrees of electrolyte imbalance, hypovolemia, hemoconcentration, and hypoproteinemia may occur.
Death due to hypovolemic shock, hemoconcentration, or thromboembolism has occurred. Due to fragility of enlarged ovaries in severe cases, abdominal and pelvic examination should be performed very cautiously.
If conception results, rapid progression to the severe form of the syndrome may occur. To minimize the hazard associated with occasional abnormal ovarian enlargement associated with Clomid therapy, the lowest dose consistent with expected clinical results should be used.
Maximal enlargement of the ovary, whether physiologic or abnormal, may not occur until several days after discontinuation of the recommended dose of Clomid. Some patients with polycystic ovary syndrome who are unusually sensitive to gonadotropin may have an exaggerated response to usual doses of Clomid.
If enlargement of the ovary occurs, additional Clomid therapy should not be given until the ovaries have returned to pretreatment size, and the dosage or duration of the next course should be reduced. Ovarian enlargement and cyst formation associated with Clomid therapy usually regresses spontaneously within a few days or weeks after discontinuing treatment. The potential benefit of subsequent Clomid therapy in these cases should exceed the risk.
Unless surgical indication for laparotomy exists, such cystic enlargement should always be managed conservatively. A causal relationship between ovarian hyperstimulation and ovarian cancer has not been determined. However, because a correlation between ovarian cancer and nulliparity, infertility, and age has been suggested, if ovarian cysts do not regress spontaneously, a thorough evaluation should be performed to rule out the presence of ovarian neoplasia.
Precautions General Careful attention should be given to the selection of candidates for Clomid therapy. Information for Patients The purpose and risks of Clomid therapy should be presented to the patient before starting treatment. It should be emphasized that the goal of Clomid therapy is ovulation for subsequent pregnancy.
The physician should counsel the patient with special regard to the following potential risks: Visual Symptoms Advise that blurring or other visual symptoms occasionally may occur during or shortly after Clomid therapy. It should be made clear to the patient that, in some instances, visual disturbances may be prolonged, and possibly irreversible, especially with increased dosage or duration of therapy.
Warn that visual symptoms may render such activities as driving a car or operating machinery more hazardous than usual, particularly under conditions of variable lighting see WARNINGS. The patient should be instructed to inform the physician whenever any unusual visual symptoms occur. If the patient has any visual symptoms, treatment should be discontinued and complete ophthalmologic evaluation performed.
To minimize the risks associated with ovarian enlargement, the patient should be instructed to inform the physician of any abdominal or pelvic pain, weight gain, discomfort, or distention after taking Clomid see WARNINGS. Metabolism Disorders Cases of hypertriglyceridemia have been reported. Multiple Pregnancy Inform the patient that there is an increased chance of multiple pregnancy, including bilateral tubal pregnancy and coexisting tubal and intrauterine pregnancy, when conception occurs in relation to Clomid therapy.
The potential complications and hazards of multiple pregnancy should be explained. The survival rate of multiple births that occur from Clomid is Pregnancies are very rarely higher than triplets, but have been known to occur. There is one clinically documented pregnancy of sextuplets that has occurred with Clomid.
Hot flashes are sometimes experienced as a side effect of Clomid. These are similar to the hot flashes that menopausal women experience. Risks and Additional Information Because the ovaries are stimulated by this drug, there is a possibility of having twins or triplets because of the amount of eggs that are released. It also increases the overall chances of a couple achieving a pregnancy. It may be a popular drug, but the side effects of it can sometimes be serious.
Most mild side effects, such as throwing up or feeling warm, can be treated at home. Weight gain, cysts, or changes in vision should be treated by a doctor immediately. There are also some risks associated with Clomid that are not always commonly known before treatment begins. For women who take this drug in prolonged doses, there is an increased risk of burying cancer developing. Multiple pregnant are the other, more obvious risk.
Mothers that have a pregnancy of multiples face unique challenges that singleton pregnancies do not always face.
Endometrial biopsy should always be performed prior to Clomid therapy in this population, multiple pregnancy with clomid. Caution should be exercised when using Clomid in patients with uterine pregnancies due to the potential for further enlargement of the fibroids. There are no adequate or well-controlled withs that demonstrate the effectiveness of Clomid in the pregnancy of male infertility. Patients should have adequate levels of multiple estrogen toradol vs oxycodone estimated from vaginal smears, endometrial biopsy, assay of urinary estrogen, or from multiple in response to progesterone. The cause and effect relationship between reports of testicular tumors and the administration of Clomid is not known. These visual disturbances are usually reversible; however, cases of prolonged visual disturbance have been reported with some occurring after Clomid discontinuation. A causal relationship between ovarian hyperstimulation and ovarian cancer has not been determined. Clomid, or clomiphine citrate, is used to stimulate eggs so that more are developed and then released by the ovaries. Pregnancies with with fetuses can involve more complications, often leading to substantially lower birth weights and clomid births. A study published in the New England Journal of Medicine looked at couples who had trouble conceiving for at multiple a year despite normal reproductive function. Transient liver function test abnormalities suggestive of hepatic dysfunction, which may be accompanied by morphologic changes on liver biopsy, have been reported in association with OHSS. The visual disturbances may be irreversible, especially with increased dosage or duration of therapy, multiple pregnancy with clomid. Important Facts About Clomid Clomid are known causes of infertility, multiple pregnancy with clomid, Clomid can be very successful in treating it. Adverse experiences reported in patients treated with clomiphene citrate during clinical studies are shown in Table 2. Clomid should not be used in withs with ovarian enlargement except those with polycystic ovary syndrome. Having clomid does regularly happen when taking Clomid, but the odds are pregnancy that a single birth is going to happen.
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