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    Clinical Instructor and Fellow, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina Ovulatory dysfunction is one of the most common causes of reproductive failure in subfertile and infertile couples. Although the therapeutic armamentarium has expanded significantly in recent years, clomiphene citrate(CC) remains the most commonly prescribed ovulation-inducing medication and is the most appropriate initial choice in the largest majority of anovulatory infertile women. This chapter provides a brief historical perspective, describes the pharmacology, mode of action, and indications for use of CC, outlines pretreatment evaluation and alternative treatment strategies for the CC-resistant anovulatory woman, discusses methods for monitoring therapy, and reviews the results, side effects, and risks of CC treatment. Initial studies of the therapeutic potential of CC, conducted more than 40 years ago, focused on its adverse effects on fertility in animal models. In 1960, Kistner and Smith performed the first clinical trials for ovulation induction in women. Since that time, results of CC treatment have not changed appreciably, despite the advent of modern immunoassays for steroid hormones, advances in ultrasound technology for cycle monitoring, and the introduction of commercial ovulation predictor kits (OPK) that allow accurate identification of the midcycle luteinizing hormone (LH) surge. Chemically, CC is a nonsteroidal triphenylethylene derivative and, like other such compounds (e.g., tamoxifen), exhibits both estrogen agonist and antagonist properties, depending on the prevailing levels of endogenous estrogen (Fig. Clomiphene is cleared through the liver and excreted in stool; approximately 85% of an administered dose is eliminated after approximately 6 days, although traces may remain in the circulation for much longer. How Clomid Works in Men Male Health - Clomid Uses, Dosage & Side Effects - Clomifen – Wikipedia
     
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