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Clomiphene Citrate (Clomid--The Fertility Drug)
Clomiphene citrate (CC, Clomid, Serophene) is often the first fertility drug that couples come in contact with. It is (relatively) inexpensive as fertility drugs go, it is easily taken (orally rather than by injection) and it is the first line drug used for ovulation induction in patients with PCOS and other ovulatory disorders. It has been used for patients with luteal phase defect. It can also be used to assess ovarian reserve or, in other words, the likelihood that a woman's ovaries can still produce viable eggs. Clomid is not useful for women whose ovaries have reached the end of their working life.
How does it work?
Clomid is actually quite a potent and somewhat complicated medication. It is capable of reacting with all of the tissues in the body that have estrogen receptors. These tissues include hypothalamus, pituitary, ovary, endometrium, vagina, and cervix. Clomid influences the way that the four hormones required for ovulation, GnRH, FSH, LH and
Estradiol, relate and interrelate. While we do not completely understand the mechanisms by which this drug works, in essence it appears that Clomid fools the body into believing that the estrogen level is low. This altered feedback information causes the hypothalamus (an area of the brain) to make and release more gonadotropin releasing hormone (GnRH) which in turn causes the pituitary to make and release more FSH and LH. More follicle stimulating hormone and more
Luteinizing hormone should result in the release of one or more mature eggs - ovulation.
How is it taken?
When used for ovulation induction, Clomid is taken orally for approximately five days early in the menstrual cycle. Depending upon your clinic protocol this may start as early as day 3 or as late as day 5. It is important to remember that the first day of the menstrual cycle is the first day of normal bleeding, not spotting. Most women begin with an initial dose of one tablet (50 mg.) per day. This dose may be increased by your physician in subsequent cycles if pregnancy does not occur. Once ovulating, most pregnancies occur in the first 6 cycles of treatment. Clomid is said to be able to induce ovulation in as much as 85% of the women who use it, though only half of those will actually become pregnant. Most authorities agree that continuing for more than 6 ovulatory cycles in not likely to increase the chances of success.
At many clinics a pelvic examination or ultrasound is done each cycle shortly before starting on CC in order to determine if there are any ovarian or uterine abnormalities. Approximately 5% of women using Clomid will develop an ovarian cyst at some time during their treatment period. These cysts are benign and will usually resolve spontaneously without any treatment, but may cause discomfort. If you are using Clomid and do not have a menstrual period by cycle day 35, you may have failed to ovulate or you may be pregnant! In either event you need to schedule a visit to your doctor to ascertain what is happening. If you are not pregnant, your doctor may prescribe other medications to help bring on your period. Extended luteal phases (late periods, long cycles) are not uncommon on Clomid.
What are the side effects of Clomiphene?
Twin pregnancies may occur in as many as 5% of the women who use Clomid. Triplet pregnancies are far more rare. Other reported adverse effects include ovarian enlargement 13.6%,Vasomotor Flushes 10.4%, abdominal or pelvic discomfort, distention or bloating 5.5%, nausea and vomiting 2.2%, breast discomfort 2.1%, visual symptoms (blurred vision, lights, floaters, waves, unspecified visual complaints, photophobia, diplopia, scotoma, etc.) 1.5%, headache 1.3% and abnormal uterine bleeding (intermenstrual spotting,
menorrhagia) 1.3%. Although there has been much talk about the relationship of clomiphene (and other fertility drugs) to ovarian cancer the vast majority of the evidence now seems to point at infertility itself, rather than the use of fertility drugs as being the primary explanation for the slightly increased incidence of reproductive cancers in the infertility population. (See recent discussion on our boards.)
Clomid has been used to induce ovulation for more that thirty years. There is not any evidence that it causes an increase in congenital abnormalities or birth defects in children. It is not associated with an increase in premature labor or in other complications of pregnancy.
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Coping With Infertility
By Garrett Coan
Infertility is a medical problem that results in the inability to conceive a child or carry a pregnancy to full term. A couple is usually diagnosed as infertile after one year of frequent, unprotected, sexual intercourse.
It is estimated that 10 to 15% of couples are infertile. About 35% of infertility cases can be traced to physical problems of the woman and 35% have causes in the man. In the remaining 30% of cases, infertility is either unexplained or is caused by problems in both partners.
Why Infertility Can Be Devastating
The inability to have children can be one of the greatest challenges that a person or couple will ever face. It affects people emotionally, physically, and financially. It can place tremendous stress on a couple’s relationship and on their relationships with family and friends.
On a physical level, the experience of being examined and tested monthly, weekly, or even daily is embarrassing, exhausting, and very expensive. Medications often have side effects, and daily injections may be required. Surgery is often necessary, and sometimes several procedures are needed.
As the process continues over months and years, the couple’s privacy is invaded time and again, physically and emotionally. One or both of the partners learn to put aside their feelings as they lie on the examining table, have fluids taken, or give sperm for the tenth, twentieth, or fiftieth time.
At the same time, family, friends and coworkers are waiting to see if this month will bring good news. The couple becomes used to hearing, “Anything new?” with an expectant smile. They also hear comments like, “Maybe you should take a month off and just relax,” or “A vacation would do you good” or “This sounds like a good problem. At least you can have fun trying.” To make it even worse, throughout this experience, the couple regularly hears of others who have become pregnant. In fact, it sometimes seems as if the whole world is pregnant.
These experiences often make the infertile person feel like a failure. The feelings come up each time there is a treatment failure or when yet another friend or acquaintance announces a pregnancy.
After each expensive procedure or round of treatment, when no pregnancy results, the disappointment turns to devastation. Many infertile people become depressed and anxious. The strain in the marriage and among family members sometimes becomes unbearable. The self-esteem of one or both partners plummets. They often feel lonely, sad, and angry. The long series of disappointments that many experience can cause a numbing effect, and depression can result. If one partner has the medical problem that is causing the infertility, he or she often feels guilty and may even offer the other a divorce. At the same time, the infertile person may fear that the other partner will leave the relationship. All of these changes can make people feel emotionally distant and needing to avoid intimacy.
Some people cut themselves off from friends and family. They look for ways to avoid attending social gatherings and family events, fearing that they will be subjected to discussions about pregnancy, children, or infertility. Socializing with friends and family who have children or who are pregnant is a special challenge. Sometimes these feelings are intensified, especially for women, when they are taking large doses of drugs that can affect their emotions.
Emotional Self-Care during Infertility
Almost no one expects to be infertile. Most people think they will grow up, get married, and have children, just like everyone else around them. So when a couple learns that they are infertile, they are often surprised at how devastated they feel. After all, they reason, they don’t have cancer or a deadly disease (in most cases); it’s just infertility. So why do they feel so badly? Most couples gradually come to realize that it is a distressing experience. Many eventually seek the help of a team of professionals, realizing that it is a good idea to create a support network and take advantage of the help that is available.
When one or both partners start to feel the impact of infertility, it can be a good idea to seek the services of a mental health professional, especially one who has experience working with the issues of infertility. Since these issues are so complex, it is important to find a counselor who has experience and training in dealing with the impact on individuals, couples, and families. Many couples also find relief in support groups where they can meet regularly with other infertile couples, share experiences, and support each other. Such groups are offered through organizations like RESOLVE, a national infertility support organization. RESOLVE also provides referrals to medical practitioners who specialize in infertility. Visit www.resolve.org for information.
Infertility is primarily a medical problem, but during treatment it is important to address the emotional implications of infertility. Joining a support group or seeing a qualified counselor is especially important at any of the following points:
• When you begin a new phase of your treatment
• After a course of treatment has failed
• When you are faced with difficult decisions about treatment
• When you are thinking about options such as surrogacy, egg or sperm donation
• When you are considering stopping medical treatment
• When you are thinking about adopting
• When one or both of you have troubling feelings that won’t go away
• When you experience strained relationships with your partner, friends, or family
• When you avoid being with others because of the infertility
Although a mental health professional cannot influence the outcome of the medical treatment, he or she can help the couple get through the process by helping them communicate better with each other and gain support from family and friends.
Garrett Coan is a professional therapist,coach and psychotherapist. His two Northern New Jersey office locations are accessible to individuals who reside in Bergen County, Essex County, Passaic County, Rockland County, and Manhattan. He offers online and telephone coaching and counseling services for those who live at a distance.
He can be accessed
through http://www.creativecounselors.com
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Article Source:
http://EzineArticles.com/ |
Male Infertility and Glutathione
By Priya Shah
Are You Half The Man Your Father Was?
It is a well-known fact that sperm counts have dropped by half in the last 50 years, and that modern men have 20 percent less semen volume than their fathers (BMJ, 1992, volume 305).
A recent report from researchers in Aberdeen presented preliminary data that suggests the sperm concentration of the men seen in their clinic had declined by 29% over the past 14 years. (British Fertility Society; 5 January 2004)
Persistent organic pollutants (POPs) and endocrine-disrupting chemicals from normal, everyday plastics are known to cause reproductive damage, as documented in Theo Colborn's book "Our Stolen Future."
Damage to sperm caused by exposure to common chemicals like alcohol, pesticides in food, has been linked to lowered intelligence and behavioral disorders in children.
Lifestyle risk factors known to decrease sperm quality include
> Cigarette smoking
> Alcohol consumption
> Chronic stress
> Nutritional deficiencies.
Other reasons for infertility include congenital factors, and health conditions like prostatitis and diabetes that can affect sperm production.
Pollution is stealing our future, and there's little anyone can do to avoid it. There may not be a lot you can do to reduce your exposure to persistent environmental toxins.
But there are definite measures you can take to reduce the impact of the environmental pollutants and toxins on your body.
You can prevent and, to a certain extent, repair the damage they cause to your body, through a better lifestyle and nutrition.
Some nutritional therapies and antioxidants that have proven beneficial in treating male infertility and improving sperm counts, sperm morphology and motility include:
>L-Carnitine
>L-Arginine
>Zinc
>Selenium
>Vitamin B-12
>Vitamin C
>Vitamin E
>L-Glutathione
>Coenzyme Q10
Studies show that anti-oxidant supplementation - glutathione in particular - can improve sperm quality, and possibly increase your chances of conceiving.
If you smoke, drink, are exposed to stress, chemicals, radiation, pesticides or take medication or drugs (like sulfasalazine, ketoconazole, azulfidine, anabolic steroids, marijuana) that affect fertility, you should consider taking an antioxidant supplement to reverse some of the damage.
Why are Antioxidants Important for Sperm Quality?
Mammalian spermatozoa are coated by a membrane rich in polyunsaturated fatty acids. These fatty acids are extremely susceptible to oxidative damage by free radicals or Reactive Oxygen Species (ROS) by a process called lipid peroxidation (LPO).
Lipid peroxidation damages the sperm cell membrane. It is considered to be the key mechanism of ROS-induced sperm damage and leads to
> Loss of sperm motility
> Abnormal sperm morphology
> Reduced capacity for oocyte penetration
> Infertility
To protect sperm from damage, the body depends on powerful antioxidant enzymes in the body such as superoxide dismutase (SOD), catalase, and glutathione peroxidase/reductase (GPX/GRD).
Seminal plasma and spermatozoa have several antioxidant enzymes - glutathione peroxidase, glutathione reductase, superoxide dismutase.
Some amount of all the antioxidant enzymes, which may protect spermatozoa from oxidative attack, are also made by the epididymis during storage.
The glutathione peroxidase/reductase enzymes play a central role in the defense against oxidative damage in human sperm.
Why is Glutathione important for Sperm Quality and Fertility?
A decrease in levels of reduced glutathione (GSH) during sperm production is known to disrupt the membrane integrity of spermatozoa due to increased oxidative stress.
Intracellular glutathione levels of spermatozoa are known to be decreased in certain populations of infertile men. Compared with a control group, the infertile men in all groups had significantly higher levels of ROS and lower levels of total antioxidants.
There is strong clinical evidence to show that men diagnosed with infertility have high levels of oxidative stress that may impair the quality of their sperm.
In some groups, higher levels of ROS were associated with lower sperm counts and defective sperm structure, while lower antioxidant levels correlated with reduced sperm movement.
Previous evidence has also shown that oxidative stress can decrease a sperm's life span, its motility, and its ability to penetrate the oocyst, or egg cell.
Up to 40% of men with unexplained male infertility have higher levels of free radical activity in their bodies.
Because men with high levels of ROS have a seven-fold lower likelihood of inducing a pregnancy than men with lower levels, researchers recommend that treatment for infertile men should include strategies to reduce oxidative stress and improve sperm quality.
How can Glutathione help in the Treatment of Infertility?
Glutathione is not only vital to sperm antioxidant defenses, but selenium and glutathione are essential to the formation of "phospholipid hydroperoxide glutathione peroxidase" - an enzyme present in spermatids - which becomes a structural protein in the mid-piece of mature spermatozoa.
When either substance is deficient, it can lead to instability of the mid-piece of the spermatozoa, resulting in defective motility.
Free radical scavengers - such as glutathione - that restore the structure and function of poly-unsaturated fatty acids (PUFA) in the cell membrane, can be used to treat these cases.
In a double-blind cross-over study of twenty infertile men, treatment with glutathione led to a statistically significant improvement of the sperm quality.
The study concerned men in whom the sperm quality was poor due to unilateral varicocele or germ-free genital tract inflammation - two conditions in which ROS or other toxic compounds are indicated as causative factors.
Treatment with glutathione was also found to have a statistically significantly positive effect on sperm motility (in particular forward motility) and on sperm morphology.
The findings of these studies indicate that glutathione therapy could represent a possible therapeutical tool in cases where ROS or exposure to toxins is the probable cause of infertility.
Read the complete
report with references on Male
Infertility and Glutathione
Copyright © 2004
Priya Shah
About the author:
Priya Shah is the Editor of The
Glutathione Report, a newsletter featuring regular
updates on the health benefits of glutathione. Get a Free
report on Glutathione in Health and Disease
Article Source: http://EzineArticles.com/
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