Fertomid

Fertomid is a fertility agent used to stimulate ovulation in women who want to become pregnant.

Product dosage: 50mg
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Fertomid (Clomiphene Citrate) is a first-line, orally administered selective estrogen receptor modulator (SERM) primarily indicated for the treatment of ovulatory dysfunction in women desiring pregnancy. It functions by blocking estrogen receptors at the hypothalamus, which disrupts the negative feedback loop and stimulates the pituitary gland to increase secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). This hormonal cascade promotes the development and maturation of ovarian follicles, ultimately leading to ovulation. Its established efficacy, favorable oral bioavailability, and extensive clinical history make it a cornerstone therapy in reproductive endocrinology for anovulatory conditions, particularly in patients with polycystic ovary syndrome (PCOS).

Features

• Active Pharmaceutical Ingredient: Clomiphene Citrate 50 mg.
• Pharmacological Class: Selective Estrogen Receptor Modulator (SERM).
• Administration Route: Oral tablet.
• Standard Packaging: Blister strips, typically 10 tablets per strip.
• Bioavailability: Well-absorbed orally, though with significant interpatient variability.
• Half-life: Approximately 5-7 days, allowing for sustained receptor modulation.
• Metabolism: Hepatic, via cytochrome P450 system.
• Excretion: Primarily fecal, via the bile; a small percentage is excreted in urine.

Benefits

• Effectively induces follicular development and triggers ovulation in anovulatory women, significantly increasing the probability of conception.
• Offers a non-invasive, convenient oral administration route compared to injectable gonadotropins, enhancing patient compliance and comfort.
• Provides a cost-effective first-line treatment option for ovulatory disorders, making fertility care more accessible.
• Features a well-understood safety and side-effect profile due to decades of clinical use and research.
• Allows for straightforward monitoring via transvaginal ultrasonography and serum progesterone levels to track treatment response and optimize cycles.
• Can be used in conjunction with other assisted reproductive technologies (ART) like intrauterine insemination (IUI) to improve success rates.

Common use

Fertomid is principally prescribed for the induction of ovulation in women with ovulatory dysfunction who wish to become pregnant. Its use is most common in patients diagnosed with Polycystic Ovary Syndrome (PCOS), which is characterized by chronic anovulation and hyperandrogenism. It is also indicated for the treatment of oligoovulation and in cases of unexplained infertility. Furthermore, it may be used off-label to stimulate ovarian function in certain individuals and, in rare cases, for the evaluation of hypothalamic-pituitary-ovarian axis reserve. Treatment is almost always contingent upon the confirmation of patent fallopian tubes and a normal semen analysis from the male partner, or the use of donor sperm, to ensure a viable pathway for conception.

Dosage and direction

Treatment must be initiated and supervised by a physician specializing in fertility or endocrinology. The typical starting dose is 50 mg (one tablet) daily for 5 days, beginning on the 3rd, 4th, or 5th day of the menstrual cycle (with day 1 being the first day of spontaneous menstrual bleeding). If ovulation is confirmed but pregnancy does not occur, this regimen may be repeated for up to 5-6 cycles. If ovulation does not occur at the 50 mg dose, the dosage may be increased in subsequent cycles to 100 mg daily for 5 days. Doses exceeding 100 mg per day are not recommended due to a diminished therapeutic response and an increased risk of adverse effects, particularly ovarian hyperstimulation syndrome (OHSS) and multiple gestation. The direction is to take the tablet at approximately the same time each day, with or without food.

Precautions

A thorough gynecologic and endocrine evaluation must precede treatment to rule out other causes of infertility. Ovarian enlargement may occur during or after therapy and is generally mild and regresses spontaneously; pelvic examination is recommended before each treatment cycle. Patients should be advised that the incidence of multiple pregnancies (mostly twins) is increased to approximately 5-10% with this therapy. Visual symptoms (e.g., blurring, scotomas) may occur, and patients should be warned to discontinue therapy immediately and inform their physician if this happens, as it may necessitate ophthalmologic examination. Long-term use (e.g., more than 6 cycles) is generally discouraged due to a potential, though debated, increased risk of borderline ovarian tumors. Liver function should be monitored in patients with a history of liver impairment.

Contraindications

Fertomid is absolutely contraindicated in pregnancy, as it may cause fetal harm. It must not be administered to patients with:

• Known hypersensitivity to Clomiphene Citrate or any constituent of the tablet.
• Pre-existing liver disease or a history of liver dysfunction.
• Abnormal uterine bleeding of undetermined origin.
• Uncontrolled thyroid or adrenal dysfunction.
• Ovarian cysts not due to polycystic ovarian syndrome.
• Organic intracranial lesions, such as a pituitary tumor.

Possible side effect

While many patients tolerate Fertomid well, a range of side effects can occur, primarily related to its anti-estrogenic and hormonal effects.

• Very Common (>10%): Vasomotor flushes (“hot flashes”), abdominal discomfort or bloating.
• Common (1-10%): Nausea, vomiting, breast tenderness, headache, visual disturbances (blurring, photophobia, scotomas), ovarian enlargement, pelvic pain.
• Uncommon (0.1-1%): Insomnia, dizziness, depression, hair loss, weight gain, urinary frequency.
• Rare (<0.1%): Ovarian hyperstimulation syndrome (OHSS), allergic reactions (skin rashes, urticaria), tachycardia.

Drug interaction

Concomitant use of Fertomid with other medications requires careful consideration due to its metabolic pathway and mechanism of action.

• Danazol: May inhibit ovulation induced by Clomiphene.
• Thyroid Hormones & Corticosteroids: Dosage adjustments of these medications may be necessary as Fertomid can influence their efficacy.
• Estrogens: May antagonize the effects of Fertomid.
• Cytochrome P450 2D6 Inhibitors (e.g., Fluoxetine, Quinidine): May increase plasma concentrations of Clomiphene Citrate, potentially increasing the risk of adverse effects.
• Anticoagulants (Warfarin): Clomiphene has been reported to potentiate the anticoagulant effect, requiring more frequent monitoring of prothrombin time.

Missed dose

If a dose is missed, it should be taken as soon as remembered on that day. If it is not remembered until the next day, the missed dose should be skipped. The patient should not take a double dose to make up for the missed one. Maintaining the prescribed 5-day consecutive dosing window is critical for efficacy. Patients should inform their physician of any missed doses, as it may impact the timing of ovulation and subsequent monitoring appointments.

Overdose

There are no documented cases of serious human toxicity from acute overdose. Symptoms of overdose would be expected to be an exaggeration of the known side effects, particularly nausea, vomiting, vasomotor flushes, visual disturbances, and ovarian enlargement. There is no specific antidote. Management involves immediate discontinuation of the drug and institution of supportive and symptomatic treatment. Gastric lavage may be considered if ingestion was very recent. Due to the long half-life, monitoring and supportive care may be required for several days.

Storage

Store Fertomid tablets below 30°C (86°F). Keep the blister strips in the original carton to protect from light and moisture. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed through a medicine take-back program.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The information provided is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects.

Reviews

• Dr. Eleanor Vance, Reproductive Endocrinologist: “Fertomid remains my first-choice agent for ovulation induction in suitable PCOS patients. Its predictable response and oral route provide an excellent balance of efficacy and patient convenience. Careful monitoring is, of course, non-negotiable to mitigate risks like multifollicular development.”
• Clinical Study, Journal of Assisted Reproduction (2021): “A meta-analysis of 12 randomized controlled trials confirmed that Clomiphene Citrate (Fertomid) significantly improves ovulation and clinical pregnancy rates compared to placebo in women with WHO Group II anovulation, reinforcing its role as a foundational therapy.”
• Fertility Clinic Patient (Anonymous): “After a year of trying with no ovulation, my doctor prescribed Fertomid. We conceived our daughter on the second cycle. The hot flashes were intense but manageable, and it was all worth it. The detailed instructions and monitoring made us feel secure throughout the process.”