Antiestrogenic drug of non-steroidal structure. Stimulates ovulation. It is assumed that clomiphene blocks estrogen receptors in the hypothalamus and ovaries and increases the secretion of gonadotropic hormones, in particular luteinizing hormone, by means of feedback. This, in turn, stimulates the maturation and endocrine activity of the follicle in the ovary, increases the concentration of estradiol in the blood. At low levels of estrogen hormones in the body shows a moderate estrogenic effect. At high levels of estrogen shows antiestrogenic action, inhibits the secretion of gonadotropins in high doses. Does not exhibit progestagenic and androgenic activity.
Ovulation stimulation in women with infertility due to secondary ovarian pituitary function, mainly due to functional hypothalamic-pituitary disorders. Ovulation induction in women with anovulatory cycle. Anovulatory disorders of central hypothalamic origin cycles, secondary amenorrhoea of various etiologies, oligomenorrhoea. Amenorrhoea after application of contraceptives. Galactorrhea (non-tumor genesis). Stein-Leventhal syndrome. Hyari-Frommel syndrome. Oligospermia.
To stimulate ovulation, the dose of the drug is 50 mg once a day before bedtime, starting on the 5th day of the menstrual cycle for 5 days (from the 5th to the 9th day of the menstrual cycle). Patients without menstruation can be prescribed therapy at any time. Ovarian reaction should be controlled by clinical and laboratory tests. Ovulation usually occurs between the 11th and 15th day of the cycle. The development of ovulation is determined by the presence of a two-phase basal temperature, an average cyclic increase in the production of luteinizing hormone, the growth of serum progesterone during the probable medium phase of luteinization or in menstrual bleeding in patients with amenorrhoea. In the absence of effect (ovulation did not occur within 30 days) prescribe a second course of treatment. In this case, the dose is 100 mg once a day before bedtime, starting from the 5th day of the menstrual cycle for 5 days. If the second course does not lead to ovulation, it is repeated. If there is no effect after a three-month break, you can repeat the three-month course in the same dosage. The total dose of the drug during one cycle should not exceed 750 mg. In amenorrhea caused by the use of contraceptives, the first course is usually effective (50 mg per day for 5 days). In case of oligospermia, 25 mg is prescribed once a day for 25 days with a subsequent break for 5 days. The course of treatment is 3 months.
Before prescribing the drug, patients are examined to exclude malignant tumors of the uterus or breast, cysts or ovarian enlargement (Stein-Leventhal syndrome is not contraindication to the prescription of the drug), as well as other diseases in which the use of clomiphene is contraindicated. In case of disorders of oocyte maturation it is necessary to exclude other causes of infertility or to carry out their preliminary therapy prior to clomiphene prescription. It is recommended to conduct a study of liver and kidney function before treatment. It is advisable to prescribe the drug in cases where the total content of gonadotropins in urine is slightly lower than normal or within normal limits, ovaries palpatorno without changes, the functions of the thyroid gland and adrenal glands are normal. It should be taken into account that the drug is more effective at a sufficient level of endogenous estrogens, less effective at a low level of estrogens and almost ineffective at a low level of gonadotropic hormones of the pituitary gland. Before prescribing the drug it is always necessary to conduct a thorough gynecological examination. Fertomide is used only with constant gynecological control! In the course of treatment it is necessary to regularly monitor the condition of the ovaries. Gynecological examination to exclude abnormal ovarian enlargement is carried out before each next course of treatment with the drug. Patients should be warned about the need to immediately inform the doctor about the occurrence of abdominal pains, as well as increasing body weight. In case of abdominal pain during the drug administration, a thorough examination of the patient is carried out. If during therapy the increase in ovaries and their cystic degeneration is determined, the use of the drug should be discontinued until the normalization of ovarian size. After that, the total dose or duration of therapy should be reduced. During Fertomidomide treatment, the basal temperature should be regularly monitored and in case of its biphasis the use of the drug should be stopped. Treatment is carried out with the use of minimum effective doses of the drug. It is not recommended to conduct more than 6 courses. In the course of treatment, careful monitoring of the patient's condition is carried out, closely monitoring the signs of pregnancy. It should be taken into account that pregnancy often occurs during the cycle, which begins after the withdrawal of the drug. After clomiphene therapy to determine the timing of ovulation is difficult, there is often a lack of yellow body, so after conception is recommended to prescribe progesterone prophylactically. Due to the fact that clomiphene may cause drowsiness and reversible visual impairment, during treatment, it is necessary to refrain from working with vehicles and mechanisms. After successful treatment with the drug the frequency of multiple pregnancies increases. During the use of the drug for the treatment of men it is necessary to regularly monitor the spermogram. Interaction with other drugs. Rational is considered to be a comprehensive therapy, carried out on the basis of indications, with the use of Fertomidoo and drugs of gonadotropic hormones.