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Clomiphene And Letrozole

Clomiphene And Letrozole

Clomid or Femara: Which One Is Better?

Clomiphene citrate (Clomid, Serophene) is an oral medication that has been used for induction of ovulation for almost 40 years. Over the last 20 – 25 years it also has been used for superovulation to increase the chance of conceiving in women who are ovulatory. Commonly, intrauterine insemination (IUI) is combined with this medication.

Clomiphene is a very weak estrogen that attaches to the estrogen receptor in the hypothalamic-pituitary area. The medication acts like an “anti-estrogen”. The brain interprets this as the quantity of estrogen circulating in the body is low and, therefore, sends a signal to the pituitary to stimulate the ovary to work harder. For most women who do not ovulate, this medication commonly will make them ovulate. For women who are already ovulating, the medication will stimulate the ovary to increase the production of the female hormones and stimulate ovulation. Occasionally, a woman will become pregnant with twins. Unfortunately, this anti-estrogen action can affect the cervical mucus and the endometrium. The result is that there is less cervical mucus produced and the sperm may have a harder time penetrating the mucous. Also, the endometrial liming may not develop as well and this could interfere with an embryo implanting. In general, the positive effects of clomiphene outweigh the negative effects.

Letrozole (Femara) was developed to be used primarily to treat certain kinds of breast cancer in postmenopausal women. Letrozole is an aromatase inhibitor. Aromatase is an enzyme that converts estrogen precursors (androgens) into estrogen. The medication works by reducing the production of the total amount of estrogen in the body. It is very helpful for treating patients who have breast cancers that are fed by estrogen. Letrozole helps to starve those cancer cells by depriving them of estrogen. Letrozole was found to induce ovulation in the same manner as clomiphene. When letrozole inhibits the conversion of androgens to estrogens, the estrogen level in the body drops and the hypothalamus sends a signal to the pituitary to stimulate the ovary to work harder. Commonly, intrauterine insemination (IUI) is combined with this medication. In contrast to clomiphene, this medication does not have the anti-estrogen effect and has been found to be associated with better endometrial development. Theoretically, letrozole would be better for patients who have used clomiphene and experienced poor endometrial development. Experience with this medication reveals the pregnancy rates are very comparable to clomiphene. Also, the multiple birth rate with letrozole is lower.

How long was he suspended for?

Jones has been suspended for a year, starting retroactively on the day USADA was informed of his test failure, which was July 6th 2016. His ban will be up on July 7th 2017 and the UFC will be free to book him in fights after that date.

Problems and solutions

There aren’t any tests to predict the right dose of clomiphene or letrozole for a particular woman, so common problems are:

The initial dose isn’t high enough to be effective. This can be picked up by blood tests or an ultrasound scan. The solution is to increase the dose the next month.

The initial dose causes too many follicles to grow, increasing the risk of multiple pregnancy such as twins or triplets. This can be picked up by blood tests or an ultrasound scan. The solution is to reduce the dose the next month.

Clomiphene partially blocks the action of estradiol in all types of tissue, including the cervix. This means it may reduce the quality of cervical mucus around the time of ovulation which may make it harder for sperm to swim through the mucus on their way to the egg. It is hard to measure this, although some women are good at detecting their mucus around ovulation. Letrozole does not affect cervical mucus.

Letrozole side effects

Letrozole works based on its ability reduce estrogen levels. Low estrogen levels of any cause can cause a woman to have symptoms. The data on side effects comes from women who have been using letrozole for an extended period of time in order to treat breast cancer. The treatment duration for letrozole is only five days. In our experience, we have seen side effects that are similar to those seen with clomiphene citrate:

  • Hot flashes
  • Headaches
  • Breast tenderness

Congenital malformations and ovulation induction

The administration of clomiphene or letrozole to pregnant rats has adverse fetal effects.5,6 For example, in pregnant rats a low dose of letrozole (0.003 mg/kg) has been reported to increase intrauterine mortality, fetal resorption, and postimplantation loss; decrease live births; and result in fetal anomalies, including dilation of the ureter and shortening of renal papillae.

However, in the setting of ovulation induction, letrozole is not administered while the patient is pregnant and is discontinued many days before ovulation and conception. Consequently, the results observed in animal studies (with the medications administered to pregnant animals) may not be particularly relevant to the clinical situation where the fertility medication is discontinued before ovulation and conception.

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