Klomifen

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6 godina 1 nedelju pre - 6 godina 1 nedelju pre #54861 od c.sonja
c.sonja je napravio novu temu: Klomifen
Generičko ime- Klomifen




Tržišna imena- Klomifen citrat
Clomid, Milophene, Serophene

Kako deluje

Klomifen stimuliše oslobađanje hormona neophodnih za izazivanje ovulacije.

Terapija klomifenom se uobičajeno primenjuje u toku pet uzastopnih dana u ranom periodu menstrualnog ciklusa, u toku tri do šest mesečnih ciklusa. Može biti potrebno nekoliko ciklusa kako bi se pronašla prava doza koja stimuliše ovulaciju. Nakon što je ta doza određena, žena će nastaviti da uzima ovaj lek u toku još najmanje tri ciklusa. Ukoliko ne zatrudni nakon šest ciklusa, verovatno je da dalja terapija klomifenom neće biti uspešna.

Zašto se koristi?

Za žene. Klomifen može biti prepisan kako bi se: stimulisala ovulacija kod žena koja ne ovuliraju ili ovuliraju nepravilno. Nivo estrogena i rad hipofize kod ovih žena moraju biti normalni, i mora biti utvrđeno da su njihovi muški partneri plodni.

- obavio test poznat kao „klomifenski izazov“, koji se ponekad koristi kako bi se kod žene procenila ovulacija i kvalitet jajnih ćelija (rezerve jajnika). Ukoliko se klomifen daje rano u toku menstrualnog ciklusa, u trajanju od pet dana, on podiže nivo folikulostimulirajućeg hormona (FSH). Ako se sledećeg dana nivo FSH padne na normalnu vrednost, to je znak normalnih rezervi jajnika i ovulacije. Povišen nivo FSH je znak niskih rezervi jajnika. Žene sa umanjenim rezervama jajnika mogu koristiti donorske jajne ćelije, što značajno uvećava njihove šanse za rađanjem zdravog deteta.

- stimulisao razvoj većeg broja jajnih ćelija za upotrebu pri pomoćnim reproduktivnim metodama, poput in vitro oplodnje (eng. in itro fertilization, ili IVF), ili transfera gameta unutar jajovoda (eng. gamete intrafallopian transfer, ili GIFT)

- regulisala ovulacija kod žena koje nepravilno ovuliraju i/ili će biti podvrgnute unutarmateričnoj oplodnji ili veštačkoj oplodnji.

Klomifen se ponekad koristi zajedno sa drugim lekovima i terapijama protiv neplodnosti.

Pre nego što probaju klomifen, ženama koje pate od sindroma policističnih jajnika, a imaju prekomernu telesnu težinu, savetuje se da smanje svoj indeks telesne mase (eng. body mass index, ili BMI) uz pomoć dijeta i vežbi. Postizanje zdrave telesne težine može iznova pokrenuti ovulaciju. Ukoliko to ne bude uspešno, upotreba lekova koji regulišu insulinski metabolizam može pokrenuti ovulaciju. Ako ni ovo ne urodi plodom, kombinacija lekova može stimulisati ovulaciju.

Za muškarce
. Klomifen se može koristiti kao terapija u lečenju oligospermije (nizak broj spermatozoida).
Koliko je uspešan?

Neobjašnjena neplodnost. Postoje ograničeni dokazi da klomifen povećava verovatnoću za začećem kod parova koji pate od neobjašnjene neplodnosti. Klomifen može biti od najveće koristi kada se koristi kako bi se proizvo veći broj jajnih ćelija pre podvrgavanja postupku oplodnje.

Neredovna ovulacija ili izostanak ovulacije. Od ukupnog broja žena čiju neplodnost uzrokuje isključivo neredovna ovulacija ili njen potpuni izostanak, njih oko 80% će ovulirati uz terapiju klomifenom.U toku devet ciklusa primene, 70% do 75% će zatrudneti. Stručnjaci su ranije smatrali da je stopa pobačaja nešto viša kod žena koje su zatrudnele uz pomoć klomifena, ali su skorašnja istraživanja pokazala da ta tvrdnja nije tačna.

Sindrom policističnih jajnika. Sam po sebi, klomifen nije efikasna terapija za većinu žena koje pate od sindroma policističnih jajnika i teške insulinske neosetljivosti, što se usko vezuje sa gojaznošću. Žene sa sindromom policističnih jajnika i prekomernom telesnom težinom često počnu da ovuliraju nakon što smanje svoj indeks tellesne mase (BMI) uz pomoć dijeta i vežbi.

Propratne pojave


Propratne pojave upotrebe klomifena uključuju:

- hiperstimulaciju jajnika, u rasponu od blage, sa uvećanim jajnicima i nelagodnostima u regionu stomaka, preko umerene, koja dodatno uzrokuje i mučninu, povraćanje i kratak dah, pa do teške i po život opasne;
- valunge;
- iritabilnost;
- mučninu, stomačne bolove;
- glavobolje;
- gustu cervikalnu sluz, kroz koju sperma ne može da prolazi. Ovaj problem se može otkloniti lekovima, ili izbeći pribegavanjem unutarmateričnoj inseminaciji;
- osetljivost dojki;
- zamućen vid;
- gubitak kose (vrlo retko);

Žene koje su ostale trudne nakon terapije klomifenom imaju oko 5% do 8% verovatnoće za višestrukom trudnoćom, u poređenju sa 1% do 2% verovatnoće u ukupnoj populaciji Severne Amerike i Evrope. Višestruke trudnoće kao rezultat terapije klomifenom su skoro isključivo blizanci. Trojke su retke.

Rizik od pobačaja?


U nekom studijama, učestalost pobačaja je nešto veća kod žena koje su ostale u drugom stanju pomoću klomifena. Nije jasno da li je ovo u vezi sa ranim hormonalnim uticajem na jajnu ćeliju, ili sa prethodno postojećim stanjima poput starosnog doba ili sindroma policističnih jajnika, koji su češće prisutni kod žena koje uzimaju klomifen. Druge studije nisu pokazale povećanu učestalost pobačaja.

Nije primećeno da klomifen ima štetno dejstvo na fetus.

O čemu treba razmišljati

Mnoge žene isprobaju terapiju klomifenom pre nego što počnu seriju analiza koje se odnose na neplodnost. Međutim, većina lekara, pre prepisivanja terapije klomifenom, preporučuje pažljivo proučavanje medicinske istorije, sistematski pregled, te analizu sperme. Ukoliko je proveren rad vaše hipofize, štitne, kao i nadbubrežne žlezde, te ne pokazujete znakove endometrioze, a plodnost vašeg partnera je utvrđena, klomifen se smatra sigurnom i jednostavnom mogućnošću.

Većini žena koje su ostale trudne upotrebljavajući klomifen se to desilo u toku prva tri ciklusa, a većina ostaje trudna u toku šest cikulusa upotrebe klomifena. Produžena terapija klomifenom obično nije od pomoći. Nakon tri do šest ciklusa preporučuje se ponovna procena stanja ili promena plana terapije.

Budite sigurni da je, pre nego što vam prepiše klomifen, vaš lekar upoznat sa bilo kakvim nenormalnim vaginalnim krvarenjem ili istorijatom problema sa cistama na jajnicima.

Izvor: bracnaneplodnost.rs
Poslednja izmena: 6 godina 1 nedelju pre od c.sonja.
Zahvalnice:: Miljana

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