1. An ovarian factor is suggested by irregular cycles, abnormal BBT charts, midluteal phase serum progesterone levels less than 3 ng/mL, or luteal phase defect documented by endometrial biopsy. Ovulatory dysfunction may be intrinsic to the ovaries or caused by thyroid, adrenal, prolactin, or central nervous system disorders. Emotional stress, changes in weight, or excessive exercise should be sought because these disorders can result in ovulatory dysfunction. Luteal phase deficiency is most often the result of inadequate ovarian progesterone secretion.
2. Clomiphene citrate (Clomid, CC) is the most cost-effective treatment tor the treatment of infertility related to anovulation or oligo ovulation, . The usual starting dose of CC is 50 mg/day for 5 days, beginning on the second to sixth day after induced or spontaneous bleeding. Ovulation is expected between 7 and 10 days after the last dose of CC.
3. Ovulation on a specified dosage of CC should be confirmed with a midluteal phase serum progesterone assay, BBT rise, pelvic ultrasonog raphy, or urinary ovulation-predictor kits. In the event ovulation does not occur with a specified dose of CC, the dose can be increased by 50 mg/day in a subsequent cycle. The maximum dose of CC should not exceed 250 mg/day. The addition of dexamethasone is advocated for women with elevated dehydroepiandrosterone sulfate levels who remain anovulatory despite high doses of CC. The incidence of multiple gestations with
CC is 5% to 10%. Approximately 33% of patients will become pregnant within five cycles of treatment. Treatment with CC for more than six ovulatory cycles is not recommended because of low success rates.
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