Active Ingredient: Clomiphene
The vagus nerve is the major nerve of the parasympathetic division of the autonomic nervous system purchase 100 mg clomid amex, which regulates several vital body functions discount clomid 100 mg fast delivery, including heart rate cheap 100 mg clomid amex, gut motility, and bronchial constriction.
Microbiota can elicit signals via the vagal nerve to the brain and vice versa Fig.
Transvaginal ultrasound examination and measurement of endometrial thickness is a useful screening tool for identifying those having an abnormally thickened endometrium. In the absence of any data to define the thickness that should be regarded as an indication for biopsy in the asymptomatic individual, thickness greater than 10 mm e.
Although successful ovulation induction and cyclic endogenous progesterone production will normalize the hyperplastic endometrium within one to three cycles, preliminary treatment with progestational agents is generally recommended before attempts at ovulation induction with CC begin in earnest.
Before CC treatment begins, other important causes of infertility should be excluded. Ovulation induction will achieve little purpose if significant male, uterine, or tubal factors are also present.
Preliminary semen analysis is always wise.
The test is relatively inexpensive, poses no risk, and when clearly abnormal, often will signal the need for a change in treatment strategy.
Evaluation of uterine and tubal factors, typically accomplished by performing a hysterosalpingogram HSG, should also be considered.
A preliminary HSG is clearly indicated in women with past history of pelvic infection, inflammatory bowel disease, or previous pelvic surgery e. It is also prudent in older women e.
It is reasonable to begin CC treatment without preliminary HSG in young asymptomatic anovulatory women with an entirely normal past gynecologic history, but if conception is not achieved within 3 to 6 ovulatory treatment cycles, further evaluation is clearly necessary.
In anovulatory women, ovulation rates, conception rates, and pregnancy outcome are similar regardless whether treatment begins on cycle day 2, 4, or 5. Standard incremental clomiphene treatment regimen.
Treatment typically begins with a single 50-mg tablet daily for 5 consecutive days e. Lower doses e. Once the effective dose of CC is established, there is no indication for further increments unless the ovulatory response is lost.
Higher doses will not improve the probability of conception, only the risk of hyperstimulation and multiple pregnancy. Cumulative pregnancy rate during clomiphene treatment.
Adapted with permission from the American Society for Reproductive Medicine.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. This article has been cited by other articles in PMC.