This article describes the unique features of this inexpensive drug which is easy to administer as it is orally active. CC is known to stimulate E 2 synthesis in the ovaries which in turn stimulate formation of FSH and LH receptors in the granulosa cells of other small follicles which would not develop under normal circumstances and thus lead to development of additional follicles during the CC therapy. Thus CC may also act directly on the follicular apparatus to recruit additional follicles. The low pregnancy rate is due to the anti-estrogenic effects of CC on the cervix, which would make it hostile to sperm penetration and on the Endometrial growth which would therefore be animical to embryo implantation. Other reasons are premature Luteinization, due to the advancement of the LH suge in some instances and the occurrance of un-ruptured follicles in others due to defective ovulatory mechanisms.
CC can impair development of the granulosa cells and thus cause Luteal phase defect.
The first treatment cycle is usually started with a daily dose of 50 mg and the dose is increased in subsequent cycles to 100 or 150 mg, if the lower dose is ineffective. Overweight patients may benefit from larger than the usual doses. At least 2 or 3 cycles need to be tried with CC before abandoning the drug. E 2 has been used in combination with CC to improve cervical mucus quality and to induce LH surge. CC in combination with dexamethasone has been found to be beneficial to women having hyperandrogenism of ovarian adrenal or mixed origin.