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Clomifene citrate (Clomid is a common brand name) is the medication which is most commonly used to treat anovulation. It is a selective estrogen-receptor modulator, affecting the hypothalamic–pituitary–gonadal axis to respond as if there was an estrogen deficit in the body, in effect increasing the production of follicle-stimulating hormone.
Ovulatory disorders result in infrequent ovulation (Oligoovulation) or absent ovulation (anovulation) which causes infertility. The World Health Organisation (WHO) has classified anovulation into three main classes, which are hypogonadotropic hypogonadal anovulation (Class 1), normogonadotropic normoestrogenic anovulation (Class 2), and hypergonadotropic hypoestrogenic anovulation (Class 3).
When used in conjunction with in vitro fertilization (IVF), controlled ovarian hyperstimulation confers a need to avoid spontaneous ovulation, since oocyte retrieval of the mature egg from the fallopian tube or uterus is much harder than from the ovarian follicle. The main regimens to achieve ovulation suppression are:
Other medications in this class include tamoxifen and raloxifene, although both are not as effective as clomiphene and are thus less widely used for fertility purposes. [7] They are used in ovulation induction by inhibiting the negative feedback of estrogen at the hypothalamus. As the negative feedback of estrogen is inhibited, the hypothalamus ...
The main medications used for induction of final maturation are human chorionic gonadotropin (hCG) and GnRH agonist. In fresh (rather than frozen ) autologous cycles of in vitro fertilization , final oocyte maturation triggering with GnRH agonist instead of hCG decreases the risk of ovarian hyperstimulation syndrome but decreases live birth rate .
Clomifene has been used almost exclusively for ovulation induction in premenopausal women, and has been studied very limitedly in postmenopausal women. [ 64 ] Clomifene was studied for treatment and prevention of breast cancer , but issues with toxicity led to abandonment of this indication, as did the discovery of tamoxifen . [ 65 ]
It is in fact possible to restore ovulation using appropriate medication, and ovulation is successfully restored in approximately 90% of cases. The first step is the diagnosis of anovulation. The identification of anovulation is not easy; contrary to what is commonly believed, women undergoing anovulation still have (more or less) regular periods.
Not all women with PCOS have difficulty becoming pregnant. For those who do, anovulation is a common cause. The mechanism of this anovulation is uncertain, but there is evidence of arrested antral follicle development, which, in turn, may be caused by abnormal interaction of insulin and luteinizing hormone (LH) on granulosa cells.