Clomiphene citrate in the management of anovulation: a review of mechanisms, outcomes, and clinical challenges - PubMed
3 hours ago
- #anovulation
- #Clomiphene citrate
- #polycystic ovary syndrome
- Clomiphene citrate (CC) is the first-line oral ovulation induction agent for WHO Group II anovulation, commonly polycystic ovary syndrome.
- CC acts at the hypothalamus, depleting estrogen receptors to increase gonadotropin-releasing hormone pulsatility and stimulate gonadotropin release.
- CC restores ovulation in ~73% of treated women but pregnancy rates remain lower (~36%), highlighting an ovulation-pregnancy gap.
- The ovulation-pregnancy gap is attributed to CC's peripheral anti-estrogenic effects, which can impair implantation via endometrial suppression and hostile cervical mucus.
- Treatment success is influenced by obesity, insulin resistance, and hyperandrogenism, which predict CC resistance.
- Side effects include hot flashes, mood swings, headaches, visual disturbances, and a risk of multiple pregnancies (8%-10%).
- CC remains a cornerstone for ovulation induction but requires adjunctive strategies, careful patient selection, and transition to advanced therapies when needed.