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In ovarian hyperstimulation combined with IUI, women aged 38–39 years appear to have reasonable success during the first two cycles, with an overall live birth rate of 6.1% per cycle. [12] However, for women aged ≥40 years, the overall live birth rate is 2.0% per cycle, and there appears to be no benefit after a single cycle of COH/IUI. [12]
Clomifene citrate (Clomid is a common brand name) is the medication which is most commonly used to treat anovulation. It is a selective estrogen-receptor modulator, affecting the hypothalamic–pituitary–gonadal axis to respond as if there was an estrogen deficit in the body, in effect increasing the production of follicle-stimulating hormone.
Clomifene has been used almost exclusively for ovulation induction in premenopausal women, and has been studied very limitedly in postmenopausal women. [ 64 ] Clomifene was studied for treatment and prevention of breast cancer , but issues with toxicity led to abandonment of this indication, as did the discovery of tamoxifen . [ 65 ]
Clomid does help infertility in some men, though the outcomes can vary in their timeline. The most obvious sign that Clomid for fertility is working is that your partner is expecting a child.
The human ovary contains a population of primordial follicles. At 18–22 weeks post-conception, the female ovary contains its peak number of follicles (about 300,000 in the average case, but individual peak populations range from 35,000 to 2.5 million [3]). The size of the initial ovarian reserve is strongly influenced by genetics. [4]
Follicles that have fewer FSH-receptors will not be able to develop further; they will show retardation of their growth rate and become atretic. Eventually, only one follicle will be viable. This remaining follicle, called the dominant follicle, will grow quickly and dramatically—up to 20 mm in diameter—to become the preovulatory follicle.
Early follicles produce more androgens due to 5α-reductase activity, but dominant follicles, with high aromatase levels, shift to an estrogen-rich environment, crucial for their selection. [ 15 ] The LH surge, as previewed earlier, is triggered by rising estradiol levels and occurs about 34-36 hours before ovulation.
Healthy women are fertile from puberty until menopause, although fertility is typically much reduced towards the extremes of this period. The onset of puberty is typically identified by menarche and the presence of secondary sexual characteristics such as breast development, the appearance of pubic hair and changes to body fat distribution.