Development, pharmacology and clinical experience with clomiphene citrate

被引:148
作者
Dickey, RP
Holtkamp, DE
机构
[1] Fertility Institute of New Orleans, New Orleans, LA
[2] Div. of Reproductive Endocrinology, Dept. of Obstetrics and Gynecology, Louisiana State Univ. Sch. of Med., New Orleans, LA
[3] Lebanon, OH 45036, 130, S. Liberty-Keuter Rd.
[4] Fertility Institute of New Orleans, New Orleans, LA 70128
关键词
clomiphene; ectopic pregnancy; follicles; multiple pregnancy; preclinical abortion;
D O I
10.1093/humupd/2.6.483
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
This review describes the development and pharmacology of clomiphene and those specific characteristics of both drug and patients which determine its clinical efficacy. The studies reviewed describe clinical observation of patient characteristics (age, additional infertility diagnosis, semen quality), vaginal ultrasound observations of ovaries (number and size of pre-ovulatory follicles) and endometrial lining (thickness, pattern) in 2841 clomiphene cycles in patients who required intrauterine insemination (IUI) because of poor sperm quality or an unsatisfactory postcoital test. They show that (i) conception in clomiphene cycles is related to the number and size of pre-ovulatory follicles, endometrial thickness, patient age, pelvic adhesions, type of anovulatory disorder and semen quality; (ii) pregnancy rates per clomiphene-IUI cycle are constant through at least six cycles; (iii) multiple births cannot be prevented by withholding human chorionic gonadotrophin or advising against coitus when multiple pre-ovulation follicles are present unless all follicles down to 10-12 mm diameter are counted. We also reviewed pregnancy outcome (number of gestational sacs, babies, preclinical and clinical abortion, ectopic pregnancy and birth sex) in 1744 clomiphene pregnancies from our clinic. We found that (i) preclinical and clinical abortions are increased only slightly by clomiphene use, compared to spontaneous pregnancy; (ii) clinical abortions are decreased in patients with polycystic ovaries and luteal insufficiency who use clomiphene; (iii) conception and preclinical abortions are related to endometrial thickness prior to ovulation; (iv) ectopic pregnancies are not increased by clomiphene and (v) the ratio of male births is not altered by clomiphene, except possibly in timed insemination cycles. These studies repudiate many misconceptions regarding clomiphene. They also show that clinical outcome may be improved by pre-ovulation ultrasound monitoring of ovarian and endometrial response.
引用
收藏
页码:483 / 506
页数:24
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