Fertomid: Clinically Proven Ovulation Induction for Infertility

Fertomid

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Product dosage: 50mg
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Fertomid (clomiphene citrate) is a first-line oral medication indicated for the treatment of ovulatory dysfunction in women desiring pregnancy. As a selective estrogen receptor modulator (SERM), it works by blocking estrogen receptors at the hypothalamus, which leads to an increased release of gonadotropin-releasing hormone (GnRH). This, in turn, stimulates the pituitary gland to secrete follicle-stimulating hormone (FSH) and luteinizing hormone (LH), promoting follicular growth and maturation, and ultimately triggering ovulation. It represents a cornerstone of fertility treatment, offering a non-invasive, cost-effective option for anovulatory conditions such as polycystic ovary syndrome (PCOS).

Features

• Active Ingredient: Clomiphene Citrate
• Therapeutic Class: Ovulation Inducer / Selective Estrogen Receptor Modulator (SERM)
• Available Strengths: 25 mg, 50 mg, and 100 mg tablets
• Administration: Oral tablet
• Mechanism of Action: Competitively binds to estrogen receptors in the hypothalamus, leading to increased pulsatile GnRH secretion and subsequent FSH/LH release from the pituitary
• Bioavailability: Well-absorbed orally, with extensive enterophepatic circulation
• Half-life: Approximately 5-7 days, allowing for sustained receptor blockade
• Metabolism: Hepatic, via cytochrome P450 system (primarily CYP2D6 and CYP3A4)
• Excretion: Primarily fecal (approximately 42-62%) via biliary elimination; urinary excretion accounts for approximately 8%

Benefits

• Effectively induces mono-follicular or oligo-follicular development in anovulatory women, restoring cyclic ovulation.
• High rate of ovulation induction, with studies showing ovulation achieved in approximately 70-80% of appropriately selected patients.
• Significantly increases the probability of conception per cycle when combined with timed intercourse or intrauterine insemination (IUI).
• Oral administration offers convenience, patient compliance, and a favorable side effect profile compared to injectable gonadotropins.
• Serves as a diagnostic tool; failure to ovulate with adequate doses may indicate other underlying pathologies requiring further investigation.
• Cost-effective first-line intervention, reducing the need for more complex and expensive assisted reproductive technologies (ART) in a subset of patients.

Common use

Fertomid is primarily 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), the leading cause of anovulatory infertility. It is also utilized in cases of amenorrhea (both primary and secondary), oligo-ovulation, and in some instances of unexplained infertility. Treatment is typically initiated after other potential causes of infertility (e.g., tubal factor, severe male factor) have been evaluated and addressed or ruled out. It is often used in conjunction with monitoring via transvaginal ultrasonography to track follicular growth and prevent complications like ovarian hyperstimulation syndrome (OHSS) or multiple gestation.

Dosage and direction

Treatment with Fertomid should only be initiated under the supervision of a physician experienced in fertility management. A low-dose approach is recommended to minimize risks.

• Initial Dose: 50 mg (one tablet) daily for 5 days, starting on day 3, 4, or 5 of the menstrual cycle (with day 1 being the first day of spontaneous menstrual bleeding).
• Dose Titration: If ovulation does not occur, the dose may be increased to 100 mg daily for 5 days in the subsequent cycle. Further increase to 150 mg or, in rare cases, 200 mg daily may be considered, but doses exceeding 100 mg/day are associated with a higher risk of side effects and reduced endometrial receptivity.
• Treatment Course: Therapy should not exceed 6 ovulatory cycles per patient due to a potential, though small, increased risk of ovarian cancer with prolonged use.
• Timing: The medication can be taken with or without food. Consistent daily timing is advised.
• Monitoring: Cycle monitoring with transvaginal ultrasound (around cycle days 12-14) is standard to assess follicular response (aiming for a lead follicle of 18-24mm) and endometrial thickness. A trigger shot of human chorionic gonadotropin (hCG) may be administered to finalize oocyte maturation and time ovulation precisely.

Precautions

Prior to initiating Fertomid, a complete medical evaluation is mandatory to exclude other causes of infertility. A thorough gynecological examination is essential to rule out ovarian cyst, endometriosis, uterine fibroids, or other pelvic pathology. Liver function should be assessed, as hepatic impairment can alter drug metabolism. Patients should be informed of the risks of multiple gestation (approximately 5-10% risk, primarily twins) and ovarian hyperstimulation syndrome (OHSS), a potentially serious condition. Visual disturbances (blurring, spots, flashes), though rare, require immediate discontinuation and ophthalmologic evaluation. Long-term use (beyond 6 cycles) is not recommended. Fertomid may have anti-estrogenic effects on the endometrium and cervical mucus, potentially impairing implantation; monitoring endometrial thickness is crucial.

Contraindications

Fertomid is strictly contraindicated in the following patient populations:

• Pregnancy: Fertomid may cause fetal harm. A pregnancy test must be negative before starting each treatment cycle.
• Patients with liver disease or a history of pre-existing liver dysfunction.
• Patients with uncontrolled thyroid or adrenal dysfunction.
• Abnormal uterine bleeding of undiagnosed origin.
• Ovarian cysts (not associated with polycystic ovarian syndrome) or enlargement.
• Hypersensitivity to clomiphene citrate or any of the tablet’s excipients.
• Patients with organic intracranial lesions, such as pituitary tumors.

Possible side effect

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

• Very Common (>10%): Hot flushes (vasomotor symptoms), abdominal discomfort/bloating, ovarian enlargement.
• Common (1-10%): Nausea, vomiting, breast tenderness, headache, dizziness, visual disturbances (blurred vision, photophobia, scotomas), abnormal uterine bleeding, endometrial thinning.
• Uncommon (0.1-1%): Hair loss, weight gain, insomnia, depression, nervousness.
• Rare (<0.1%): Ovarian hyperstimulation syndrome (OHSS), allergic reactions (skin rash, urticaria), tachycardia, elevated liver enzymes. Visual side effects are usually reversible upon discontinuation but warrant immediate medical attention.

Drug interaction

Fertomid interacts with several classes of medications, necessitating a thorough review of the patient’s pharmacotherapy.

• Dopamine Antagonists (e.g., Metoclopramide): May diminish the therapeutic effect of gonadotropin-releasing hormones.
• Tamoxifen: Concomitant use is not recommended due to similar mechanisms of action and potential for additive effects/toxicity.
• Thyroid Hormones: Fertomid may alter thyroid-binding globulin levels, potentially requiring adjustment of thyroid hormone replacement doses.
• Medications affecting CYP450 enzymes: Strong inducers (e.g., Rifampin, Carbamazepine) may decrease Fertomid plasma concentrations. Strong inhibitors (e.g., Fluoxetine, Ketoconazole) may increase plasma concentrations.
• Gonadotropins (e.g., FSH, hCG): Used concomitantly in controlled ovarian stimulation protocols; this significantly increases the risk of OHSS and requires expert management.

Missed dose

If a dose of Fertomid is missed, the patient should take it as soon as remembered on the same 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 forgotten one. Maintaining the prescribed 5-day consecutive dosing schedule is critical for efficacy. Patients should inform their prescribing physician of any missed doses, as it may impact cycle monitoring and timing.

Overdose

There is no specific antidote for Fertomid overdose. Symptoms of acute overdose are likely to be an exaggeration of its known side effects, including severe nausea, vomiting, vasomotor flushes, visual disturbances, and ovarian enlargement. In case of suspected overdose, symptomatic and supportive care is the mainstay of treatment. Due to its long half-life, effects may be prolonged. Gastric lavage or administration of activated charcoal may be considered if ingestion was very recent. Medical attention should be sought immediately.

Storage

Store Fertomid tablets below 30°C (86°F). Keep the container tightly closed to protect from moisture and light. 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.

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 efficacy and side effect profile may vary from individual to individual.

Reviews

“As a reproductive endocrinologist, Fertomid remains my first-line pharmacological intervention for anovulatory patients without other significant fertility factors. Its predictable response and oral route make it an invaluable tool. Careful monitoring is non-negotiable to maximize success and mitigate risks like multiples.” - Dr. E.L., MD, Reproductive Endocrinology

“After two years of trying to conceive with irregular cycles, my doctor prescribed Fertomid. With cycle monitoring and a 50mg dose, we successfully conceived on the third cycle. The hot flashes were noticeable but manageable. We are now expecting twins, which was a discussed possibility we were prepared for.” - Sarah T., Patient

“The data consistently supports clomiphene citrate as a cost-effective and efficacious treatment for WHO Group II anovulation. While letrozole is gaining ground, particularly for PCOS patients, Fertomid’s long history and extensive clinical experience secure its place in the fertility treatment arsenal.” - Clinical Study Review, Journal of Assisted Reproduction