Month: March 2022

Clomiphene: mechanism of action

Clomiphene belongs to the group of nonsteroidal antiestrogenic drugs that stimulate ovulation. The mechanism of action of this drug is based on the activation of the synthesis of gonadotropins in the pituitary gland: FSH (follicle-stimulating), LH (luteinizing) and prolactin.

The effect of clomiphene directly depends on its dosage: the larger it is, the more gonadotropin production is suppressed, and vice versa, small doses of the drug enhance the formation of tropic hormones and promote ovulation. In addition, it is worth noting that the mechanism of action of clomiphene is affected by the concentration of estrogens in the blood: with small estrogen levels, it causes moderate estrogenic effect, and with elevated values leads to an antiestrogenic effect. At the same time, it does not affect the gestagenic and androgenic activity in any way.

Nowadays, the drug is widely used in gynecology as part of infertility therapy, because after its absorption, the processes of follicle maturation are activated and accelerated. Clomiphene is available in the form of flat tablets of grayish-white color. Its active ingredient is clomiphene citrate (Klostylbegit), in an amount of 50 mg per tablet. It is absorbed very quickly in the digestive tract after ingestion. The processes of disintegration of the drug occur in the liver, and the metabolites are completely excreted together with bile within 10-14 days.

Klostylbegit is often prescribed for IVF (in vitro fertilization) to stimulate the formation of eggs. There are cases when specialists do not wait for the rupture of the follicle, but immediately punctuate mature female germ cells for the next stage of IVF.

Indications and contraindications

The main purpose of taking klostilbegit (Clomiphene) is to stimulate ovulation, which is carried out in the following situations:

• Anovulatory cycles;
• Amenorrhea of various genesis or oligomenorrhea;
• Polycystic Ovary syndrome (PCOS);
• Pituitary tumors that cause galactorrhea;
• Prolonged postpartum amenorrhea and galactorrhea caused by various pathological processes, for example, Chiari-Frommel syndrome;
• Androgen deficiency.

Klostylbegit is prescribed not only for women, but also for men, since this drug has a positive effect on the quality of sperm, especially with oligospermia (a decrease in the number of sperm in the ejaculate).

But this drug can cause adverse reactions from other organs and systems, so it is contraindicated in renal and hepatic insufficiency, neoplasms of the reproductive system and pituitary gland, ovarian cysts, renal and hepatic insufficiency. It should not be used with changes in the functionality of the adrenal glands and thyroid gland, hypofunction of the pituitary gland, uterine bleeding of unclear etiology, visual and metabolic disorders. It is also not recommended to use klostylbegit during pregnancy and lactation, with hypersensitivity to the components of the drug.

There is still more scientific data on the impact of dangerous microflora on the ability to reproduce offspring relative to men. Cases of testicular inflammation of viral genesis have been recorded. Also, SARS-CoV-2 was detected in male seminal fluid. The ACE 2 protein, which promotes the penetration of the virus to the human cell, is found in large quantities in the testes.

Among women, the age category from 37 years old is the most negatively affected by microorganisms. Factors contributing to damage to the reproductive organs are the severity of the disease and excess body weight. Overweight patients after a severe form of Covid have a 5-fold increased risk of a decrease in the supply of eggs, compared with young girls who have been ill easily or asymptomatically.

Read also: Coronavirus and pregnancy.

The growth of gynecological diseases during the pandemic has not yet been observed. Their structure remains stable. In the leading positions — inflammation of the pelvic organs (per 100,000 – 3,000 cases). Menstrual cycle failures are in second place (per 100,000 – 1300). There are 225 women with infertility per 100 thousand. These are approximate figures, since many girls take birth control pills, others do not live a sexual life, and others are not going to become mothers in the near future. These categories (in the majority) do not know the state of their own fertility. For sure, many of them have a violation of reproductive function.

IVF and coronavirus

During the pandemic period, infertile patients were much less likely to seek medical help due to sanitary and epidemiological restrictions and self-isolation. In 2020, outpatient services were not fully available. From February 2020 to July, assisted reproductive programs were suspended. According to statistics, about 50 thousand infertile couples did not use ART during this six-month period. At the moment there are no restrictions, the procedures are carried out as planned and the indicators have leveled off.

Vaccination during pregnancy

In the USA, 14 thousand women were vaccinated during gestation. Information on 827 vaccinated pregnant women has been published. The following conclusions are made: the complications are the same and occur with the same frequency as in the unvaccinated. The number of spontaneous abortions, premature births, fetal development disorders and other complications are not increased, and do not differ with the general population frequency of pathological changes.