<prompt> Which of the following is true about clomiphenc citrate?Enclomiphene is anti-estrogenicIncreases pregnancy rate 3 times as compared to placeboIncidence of twin pregnancy is 5-6It has been shown to increase fertility in oligospermic males in randomized controlled trials  <response>: Ans. a. Enclomipheneis anti-estrogenic Eticlomiphene is more potent isomer and antiestrogenic whereas zuclomiphene is weak antiestrogenic AIIMS May 2010, May 2009 Repeat.Clomiphene Citrate: It is usual first choice for ovulation induction in most patients because of relative safety, efficacy, route of administration and relatively low cost. Novak s 14e p1064Clomiphene Citrate: Multiple ovulation and multiple pregnancy in IOdegk - Shaw 15e p3l4Pregnancy occurs in 40-50 of women following treatment and even though the dosage is carefully monitored. 5-10 of the conceptions are multiple. -Jeffcoates 7e p105A randomized clinical trial conducted by WHO involving nearly 200 men and over 1300 couple months of observation found no differences among men treated with clomiphene or placebo.Moreover a meta analysis including 10 randomized trials involving over 700 men concluded that evidence is inefficient to indicate anti-estrogen treatment improves semen quality or male infertility. Leon speroff 8e p1281Clomiphene Citrate It is non-steroidal triphenylethylene compound related to diethylstilbestrol DES. It is an isomer of cis and trans form. Enciomiphene is more potent isomer and antiestrogenic whereas zuclomiphene is weakantiestrogenic.Mechanism of Action: It hinds to estrogen receptors in the hypothalamus, so the negative feedback of estrogen on FSH is prevented resulting in pulsatile GnRH frequency and rise in FSH and LH. The antiestrogenic effects of clomiphene are seen on cervix and endometrium.Clomiphene CitrateIndicationsContraindications Anovulation, PCOS Anovulatory DUB with infertilityAmenorrhea and anovulation following the use of OCPs Postpill amenorrhea IVF, GIFT technique and assisted reproduction technique Cystic ovaries Chronic liver disease Scotoma Hypogonadotrphic and hypoestrogenic statesResult: 60-80 ovulate but 30-40 conceive because of antiestrogenic effect of clomiphene in cervical mucus leading to thick cervical mucus. Multiple pregnancy chances with clomiphene are 10. 