Want Babies

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Want Babies - November 2

What are the risks of taking Clomid? What are the chances of having more than 1? and what is the rate(%) of it working for the first month?


seeadocdonotselfmedicate - November 2

CLOMID Clomid is an estrogen receptor agonist/antagonist. Treatment with clomid involves oral doses of 50-100 mg per day for a five-day period in 40-day cycles until pregnancy is achieved or the regimen is discontinued. Rosa (1990) estimated that approximately 1% of women of reproductive age undergo ovulation induction. Successful induction of ovulation can be achieved in 70-90% of patients with conception rates ranging between 30-40% (Scialli, 1986). These success rates fail to mention the number of treatment cycles required. However, this number may be of significance in determining the teratogenicity of clomid. With a half-life of 5-7 days, it is possible that clomid, after inducing a successfully fertilized ovulation, remains in the mother's system well into the initial weeks of pregnancy. Mikkelson et al. (1986) suggested that with repeated treatment cycles, clomid and its metabolites might build up, resulting in considerable exposure for the fetus. However, the estrogen receptors necessary for interaction with clomid are not present until the fetal stage of pregnancy (56 days post-conception) (Cunha et al., 1987). Furthermore, multiple gestations occur in 8-13% of pregnancies after use of clomid (Adashi et al., 1979; MacGregor et al., 1968; Harlap, 1976; Hack et al., 1972; Karrow et al., 1968). These studies also do not consider deformations due to multiple gestations. ANIMAL STUDIES Clark and McCormack (1980) studied the effects of clomid on the reproductive tract of fetal and neonatal mice. They found that a wide number of abnormalities occurred due to the intense and sustained estrogenic stimulation of the tract's epithelial lining during its development. The number of abnormalities was related to the dosage and animal's age, as the number of estrogen receptor increases as mice age. Laufer et al, (1982 and 1983) found that high doses of clomid in vitro might lead to degeneration of rat oocytes. In looking at this effect in vivo, they found that clomid exposure in preovulatory mice was a__sociated with a decrease in the number of ova and a diminished fertilization potential. Dziadek (1993) found that preovulatory administration of clomid to mice was a__sociated with lower implantation rates and IUGR in surviving fetuses. A higher incidence of exencephaly was also noted in these offspring. The degree of effect was dependent on dosage and timing in relation to ovulation. Implant rate was lowest and IUGR highest with injection before ovulation. Administration in the pre-implantation period led to complete inhibition of implantation, while post-implantation exposures led to small decreases in fetal weight. Finally, transfer of exposed blastocysts to unexposed foster mother mice showed that effects were mediated by clomid on the mother's reproductive system and not directly on the embryo. HUMAN STUDIES Effects on the Reproductive Tract Dlugi et al. (1985), in an in vivo a___lysis of oocytes released via clomid treatment, demonstrated no impairment in terms of quality and number of oocytes that occurred subsequently implanted. Clomid may alter the development of the human reproductive tract (Cunha et al., 1987). Tissue culture exposure of fetal tissues to clomid demonstrated the occurrence of estrogenic proliferation. This only developed in tissues of 16 weeks gestation or greater. Again, this is likely due to the absence of estrogen receptors until the 11th week of gestation. The authors suggested that earlier exposures do not have a comparable effect. Spontaneous Abortion (SAB) and Other Pregnancy Loss Several reports suggest a possible a__sociation between pre-ovulatory clomid use and increased frequency of pregnancy loss. Toshinobu et al. (1979) found a 24% SAB rate post-clomid use compared to a control group rate of 8.9%. Garcia et al. (1977) found a 25% SAB rate for pregnancies conceived after previous clomid use but which had been discontinued before conception. In a study of subclinical loss, Bateman et al. (1992) presented information suggesting that such loss is more common in clomid-treated pregnancies. Subclinical loss is defined as hCG > 0.5 IU/L in the luteal phase with luteal phase of normal length (14 days + 2). A review of the literature on clomid and SAB by Shoham et al. (1991) indicated that 16-22% of clomid-a__sisted pregnancies were lost as SABs. A review by Venn et al. (1994) cited this range to be between 8.7 and 27%. While the percentages of loss varied, the a__sociation between clomid and SAB was apparent. Scialli (1986) and numerous other authors pointed out, however, that all studies of such nature were biased by the scrutiny under which pregnancies achieved via fertility treatment were placed. These pregnancies were detected earlier than pregnancies from the general population, and reports of their higher susceptibility to SAB were likely to be biased by surveillance. Scialli did point out, however, that there might be an a__sociation between miscarriage rates and cycle timing and duration of clomid treatment. The author stated that one-half of all SABs occurring in clomid-treated patients had undergone treatment for greater than 6 months. Perhaps Mikkelson's acc_mulation theory (1986) is applicable to understanding these findings. Venn (1984) also reviewed other forms of pregnancy loss and their a__sociations with clomid use, suggesting a 0.7-7% perinatal mortality rate and a 0.5-4% ectopic pregnancy rate (general population ectopic pregnancy rates estimated at 0.7-0.8% (Weiss et al., 1975) and 0.3-1.3% (Martinez et al., 1986)). Venn does state that in much of the literature reviewed, report rates may be biased by levels of surveillance, inadequate comparison groups and small population sizes. Neural Tube Defects (NTD) Perhaps the most controversial issue is the possible a__sociation between NTDs and clomid use. Between 1972 and 1990, 368 birth defects arising after clomid use by the mother were reported to the FDA. This number included 35 reports of NTDs (Rosa, 1990). Researchers began looking at this question, because of conflicting and ambiguous results. Czeizel (1989) asked the mothers of 825 children born with NTDs and 18,904 controls about pre-conceptional clomid use. 0.4% of the case mothers reported usage compared to 0.1% of control mothers. The author stated that significance of this finding was unclear. A similar study by Cuckle and Wald (1989) cited 3.7% of case mothers used clomid compared to 2.3% of control mothers. Vollset (1990) combined studies and found an odds ratio of 2.94% (95% CI 1.32-6.5), indicating that a__sociation between clomid use and NTDs was real. Robert (1991) reported a similar odds ratio: 2.36 (95% CI 1.25-4.46). Mills (1990) questioned this a__sociation, citing the limited size of the populations studied, biases because of utilization of maternal recall methods, and publication of only positive results and lack of submission of negative results. Mills found that exposure to clomid during pregnancy was rare and questioned how a pre-ovulatory agent could affect an event occurring 3-4 weeks after conception. In perhaps the most powerful study undertaken, Mills proceeded to compare 571 women with a diagnosis of NTD in her fetus or child, 546 women with the diagnosis of another abnormality and 573 control mothers without diagnosis of an abnormality. Fertility drug use around the time of conception was not common for case mothers compared to mothers of children with other abnormalities or in the case of mothers of children without abnormalities (odds ratio, 1.28 [95% CI 0.39-4.51] and 0.8 [95% CI 0.27-2.27]). Fertility drug use at times other than around conception gave an odds ratio of 1.37 (95% CI 0.70-2.74) for case mothers compared to mothers of children with other abnormalities and 1.05 (95% CI 0.56-1.98) for case mothers in contrast to mothers of children without abnormalities. Other researchers corroborated the results of this study (Lammer, 1995; Shaw, 1995; Milunsky, 1990). In a meta-a___lysis undertaken by Schechtman and Pergament at Northwestern University (1996), the conflicting reports of an a__sociation between clomid and ONTD were pooled. Meta-a___lysis of 11 studies (5 showing increased risk, 5 showing no increased risk and one uninterpretable) gave an odds ratio of 1.45 (95% CI 1.10-1.92) (p=0.01). There is a need for a large case-control study which considers the following possible confounding factors: the decrease in NTD prevalence rates over time, the termination of affected pregnancies following MSAFP screening, the variance of NTD rates by geography, and the use of different ovulation induction agents in these studies. Other Abnormalities The possible a__sociation between clomid use and NTDs may be most debated, but it has not been the only a__sociation evaluated. Other abnormalities have been studied for their occurrences in births linked to exposure to the ovulation induction agent, clomid. Haring et al. (1992) and Sceusa et al. (1990) reported cases of acardius acephalus, a rare defect seen in twin pregnancies (1/34,600 deliveries), a__sociated in pregnancies enabled by clomid. There have been reports of neuroectodermal tumors in children whose mothers utilized fertility treatments including clomid. Kurachi et al. (1983) cited previous reports of a 1.1-10.8% incidence of malformations following clomid use. They studied 935 livebirths after clomid treatment and found 21, or 2.3% with visible malformations. This was not increased over the general population frequency or the frequency they found in their control population (1.7%). The types of malformations were similar between groups, and there was no dosage or age correlation. The authors surmised that there were not teratogenic effects linked to clomid. Scialli (1986) found no affect of clomid on fetal growth in terms of length and weight. A comprehensive study detailed the defects that have been found in clomid-treated pregnancies found odds ratios for the following occurrences: microcephaly, 8.4; anorectal atresia, 4.6; hydrocephaly, 3.4; NTDs, 1.2; and, anophthalmia/ microphthalmia, 6.4. Overall, the odds ratio for defects was 0.97 (95% CI 0.55-1.71), indicating no risk for birth defects with clomid use. However, special attention should be paid to the specific defects listed above. Ovarian Cancer Risk in Women Using Clomid Although this is a teratogen newsletter, the risk of ovarian cancer in users of clomid should be mentioned. The lifetime risk for ovarian cancer in the general population is 1.8%. Whittemore (1994) cites a 4-5% risk for women treated with clomid. Rossing (1994) evaluated this risk and the lengths of time women were on clomid and found that the relative risk for less than 1 year of treatment was 2.3. However, this risk increased to 11.1 for women treated for 1 year or longer (12 cycles). SUMMARY The controversy over clomid use and its teratogenicity is still unresolved. At the present time, the largest studies suggest either no risk or a minimal risk for NTDs and other malformations. Risks for pregnancy loss are clouded by increased surveillance of clomid-induced pregnancies. NTDs can often be identified by ultrasound and MSAFP screening, suggesting that the non-invasive tests can be offered to any woman with concerns about previous clomid use. Commonly, pregnancies enabled with reproductive technologies are followed closely. Perhaps this offers rea__surance and early detection to patients with concerns about past or current clomid use. Further studies are needed to definitively decide if clomid is truly a teratogenic agent and, if so, to what extent in the case of specific congenital malformations. if you are trying to have multiples please also research the risk on the children when you do this, what could happen and go wrong with a twin, triplet or more pregnancy. Bedrest, premature delivery, death of babies


http://www.fetal-exposure.org/ - November 2



moreinfo - November 2

Clomid - What, Why and How Contributed by Angie Boss, Staff Writer Clomid - the very name is enough to strike fear in the hearts of husbands of infertile women everywhere. After a few days of it, my husband will wistfully ask, "Why aren't there hormone-free safe houses for men to go to?" Often the first line of defense when it comes to infertility medication, it is often among the worst offenders when it comes to emotional side effects. On the other hand, Clomid is a good fertility medication and doesn't require injections, which is always a plus. What is it? Clomiphene citrate is frequently referred to by its brand names, Clomid and Serophene. Clomiphene is used to induce ovulation, to correct irregular ovulation, to help increase egg production and to correct luteal phase deficiency. It is one of the selective estrogen receptor modulators that acts as an anti-estrogen and tricks the pituitary gland into producing more FSH and LH, which, in turn, stimulates the ovary into producing more eggs and follicles. Generally, Clomid follicles are larger than injectible follicles right before ovulation What should I know before taking it? If there is a male factor involved in your inability to get pregnant, Clomid will not fix the problem. In fact, that's why most physicians suggest a thorough exam and adequate laboratory testing before beginning Clomid. One would not want to arbitrarily begin taking Clomid if there are other problems that need to be addressed, as it would not necessarily be of any value in the face of other unrelated factors. Especially if you're paying out of pocket, unproductive overuse of the drug can get expensive. What const_tutes a thorough exam and adequate laboratory testing? Preliminary fertility testing should consist of a cycle day 3 ultrasound, a hysterosalpingogram (HSG - to check the condition of the fallopian tubes and to make sure there are no uterine anomalies), cycle day 3 bloodwork (to check FSH and LH levels), and a progesterone/prolactin check (bloodwork) seven to nine days after ovulation. A s____n a___lysis for the partner is just as important. Ideally, doctors would try to find out why a couple is not achieving a pregnancy. "I walked in to my doctor's office, told him I had been trying to get pregnant for a year and wanted to try Clomid," remembers Dawn, a 34-year-old woman. "He said 'ok' and wrote me a prescription with six refills. I wasted six months before anyone realized I had blocked fallopian tubes." Just as women's bodies are so different from one another, their reactions to Clomid vary tremendously. Some women have virtually no side effects. Others do, but they are more frequently related to emotions. As Lana describes her three months on Clomid before moving on to other medications: "Hormone hell is probably the best way to describe it. By the third or fourth day of taking it, I would become hysterical for absolutely no reason. I felt as if I had no control over my body. I began to wonder if this was worth it. But, it only lasted a few days, and we all got through it. But it wasn't fun." Other side effects may include mood swings, hot flashes, b___st tenderness, and thinning of the uterine lining. Multiple gestation pregnancies may occur (about an 8-10 percent occurrence in those who get pregnant). Ironically, Clomid can cause hostile fertile mucous and thins the uterine lining in over 30 percent of the women who use it. The hostile mucus kills sperm, and the thin uterine can prevent implantation or cause an early miscarriage. Can I afford it? On a more positive note, Clomid is one of the more affordable fertility drugs, and it has a generic equivalent. A five-day supply of 50-mg tablets can run from $15 to $35. Obviously, it gets more expensive when you triple or even quadruple the dosage. Generally, research shows that if the drug doesn't work in four to six cycles, it isn't likely to work. However, if you take a break and start over, perhaps with the addition of HCG or an insulin sensitizer for women with PCOS, then you may elect to start the four to six cycles over again. What are the risks? As with most ovulation-inducing drugs, there is a risk of ovarian hyperstimulation. Cysts can erupt and ovaries can be enlarged. This is rarely serious and is more common with other fertility medications. However, if you are taking this medication and have unexplained pain, call your doctor. A quick ultrasound can determine if there are any problems. This drug should not be taken if you are pregnant or have a history of liver disease. Several years ago, there research findings were reported stating that Clomid increased a woman's chance of getting cervical cancer. The data a__sociated with that study have since been found to be flawed, and many physicians discredit the researchers' conclusions. However, if you have concerns, talk to your physician about them. How will I be monitored? Many physicians will not perform routine ultrasounds on a Clomid cycle unless an HCG is added. However, on or around cycle day 21, a progesterone check (blood draw) is often done. Ideally, clomiphene would trigger higher progesterone production, which can improve the quality of the uterine lining and/or lengthen the luteal phase of the cycle. In addition, an ovulation predictor kit can be used to test for an LH surge. Each kit is different and you may need to test on a different day when on this drug - do read the instructions carefully. Clomid can create hostile cervical mucus or dry up the mucus, in which case a postcoital test may be done. However, this would not be necessary when undergoing intra-uterine insemination (IUI). Once on Clomid, the only way to determine if it is "doing it's job" is proper monitoring. A cd 3 scan may reveal any cysts, another scan around cd 11 or 12 may be conducted to check follicular development and the lining, and a progesterone check six or seven days past ovulation may be performed to see if progesterone levels are high enough to support a pregnancy (p4 levels should be "15" or better). Also, a post coital test (PCT) should be done when either blood work or ovulation predictor kits detect an LH surge. If hostile mucous presents a threat to the sperm, then an IUI should be done. When follicle(s) are big enough, an HCG shot followed within 36 hours by an IUI procedure may provide optimal results.


Want baies - November 2

In Canada what is the cost ($) of a month worth of this stuff


want babies - November 3

Thanks for the info, but it was information over load



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