Clomid can also provoke precision of endometrium, which is the adverse factor for implantation of an embryo. If ultrasonic defines thin endometrium then treatment by other preparations stimulating ovulation may be applied. Clomid is usually accepted in a doze of 1 tablet daily, or 50 mg during 5 days. Treatment is usually begun from the 2nd-5th days of a cycle (the first day of a bleeding is considered as the first day of a cycle). Now the preparation is more often prescribed from the 2nd day of a cycle. Women usually start from 50 mg daily during 5 days. If ovulation happens, but pregnancy does not come from the first cycle, then treatment by Clomid can be repeated in the same dosage during 3-6 cycles. If ovulation at an initial dosage does not occur, then the doze can be increased up to 2 tablets within 5 days of the following cycle.
The use of Clomid in the appointed dosage can be repeated only from 3 up to 6 cycles. The limiting doze of Clomid is considered to be 150 mg, or 3 tablets daily within 5 days. In rare cases 4 tablets, or 200 mg a day can be appointed. There are some various ways of definition of ovulation. The methods of definition by the basal temperature, jump of luteinizing hormone, biopsy of endometrial, definition of level of a progesterone or transvaginal ultrasonic research of development of follicles are used more often than others. Each of these methods has its advantages and disadvantages, and any of these methods cannot authentically define whether the ovulation had happened or not. The chances to conceive on the background of reception of Clomid make 10-13 % for a cycle of treatment depending on age, the reasons of sterility, reaction of an organism to the treatment and other preparations, which are used simultaneously with Clomid. It is comparable with 20-25 % of women with normal fertility. The opportunity of conception is increased up to 30-60 % after 6 cycles of reception of Clomid. About 5-10 % of pregnancies, which occurred at reception of Clomid, result in birth of twins, not less than 1 % with a birth of 3 and more children. It is comparable with 1,2 % of the twins born by women, not accepting Clomid. Clomid is used in the USA since 1967. For today there are no acknowledgments of the fact that Clomid increases probability of a birth of children with deviations and/or affects the development of children.
By-effect
From ovaries and endocrine status: transient increase of ovaries, accompanied by discomfort or ache in the bottom of the stomach, the raised sensitivity of mammary glands, “inflow” of blood to face. From sight: transient infringements in the form of blurriness of sight, scintillating scotoma, the functional changes of a retina, established at electro retinography.
From a liver: delay of deducing of bromsulfalein, a jaundice (in single instances).
Dermatological reactions: atopic dermatitis, reversible alopecia.
Other: nausea, vomiting, irritability, insomnia, a headache, dizziness, increased fatiguability.
Contra-indications
- uterine bleedings of unstated etiology;
- malignant tumours of a uterus or a mammary gland;
- contra-indications to pregnancy;
- pregnancy;
- primary dysfunction of ovaries;
- ovarian cyst (except for polycystic), an endometriosis;
- ovarian insufficiency on a background of hyperprolactinemia;
- diseases of a liver or its dysfunction;
- the raised sensitivity to any components of the preparation.
Special instructions
Before the prescription of a preparation it is necessary to conduct the inspection of patients with the purpose of exception of malignant tumours of a uterus or a mammary gland, cysts or increases of ovaries (Stein-Leventhal syndrome is not a contra-indication to prescription of a preparation), and also other diseases at which application of Clomid is counter-indicative. It is necessary to consider, that the preparation is more effective at a sufficient level of endogen estrogens and less effective at a low level of estrogen and is practically inefficient at a low level gonadotropic hormones of a hypophysis.
The treatment is conducted with the use of minimally effective dozes of a preparation. It is not recommended to conduct more than 6 courses. During the treatment careful supervision over a condition of the patient is conducted, the attributes of occurrence of pregnancy are carefully supervised. It is necessary to be aware, that pregnancy quite often comes during a cycle following the canceling of a preparation.
The gynecologic inspection except for abnormal increase of ovaries is also conducted before each subsequent course of treatment by a preparation. The patients should be warned of necessity urgently to inform the doctor on occurrence of pains in the bottom of a stomach, and also about increase of weight of a body. In case of occurrence of pains in the bottom of a stomach during reception of a preparation, careful inspection of the patient should be conducted and if the increase of ovaries is marked, the treatment must be stopped before normalization of the size of ovaries. A doze of a preparation and duration of its prescription during a following cycle in such cases should be reduced.
In case of development of infringements of sight the preparation should not be prescribed again.