How does Clomiphene work in your body:

Clomiphene citrate acts by inhibiting the estrogen receptor in the hypothalamus by pausing the nagative action of estrogen on releasing the gonadotropin.This inturn, increases the regulation of hypothalamic pituitary gonadal axis. The Hypothalamic pituitary gonadal axis refers to the effects of hypothalamus, pituitary gland and gonads, that are responsible for reproduction.
Clomiphene citrate stimulates the pre-ovalutary action and follicular rupture in women's uterus. This causes in increased pituitary gonadotropins which influence steroidogenesis and folliculogenesis.The steroidogenesis is the process involved in the formation of steroids and the folliculogenesis refers to the maturation of overian follicles.These are the two important facts that are very important for egg formation.So this whole process will results in the growth of the overian follicles. This will again result in increased circulating estradiol. This helps in maintaining the plasma progesterone and estradiol lebel which is required for the normal ovalutory circle.
So in short, Clomiphene pause the influence of estrogen hormone, which further cause the increase production of two important hormones that are responsible for ovulation.These two hormones are, follicle stimulating hormone(FSH) and luteinising hormone. These two hormones are responsible for the egg formation and maturation, respectively.

Indications of Clomiphene:

• Clomiphene can only be used in the patients , such as:
• The patient, who are not pregnant.
• The patient, who has no ovarian cysts.
• The patient, who has no abnormal menstrual or vaginal bleeding.
• The patient, who has no liver problem.
• Ovarian failure (related to pituitary gland).
• The patient, who has adequate lebel of estrogen.
• The patient who has pregnancy issue because of thyroid problem, adrenal gland problem or male factor infertility.
• The patient who has uterine fibroids.

Clomiphene should be used with cautious to avoid any complication. Always take the advice from your heath care provider before taking the medicine. There is no well-controlled evidence and data found for using clomifene citrate for men's infertility treatment. But it is found effective in the off-lebel treatment for secondary male hypogonadism. However, more study are required to make strong eviodences for its use.

Known Contraindications of Clomiphene:

• Clomiphene citrate is contra-indicated in the following conditions such as:
• This medicine is not used in the patiens who are allergic to clomifene or any components of the product.
• It should not be used in pregnancy.
• It should not be used if the patient have a hormone related tumour.
• It is contra-indicated if the patient has abnormal vaginal bleeding.
• It is not used in patient who has any fibroid tumour.
• It is contraindicated if the patient has overian tumour.
• Clomiphene citrate is contraindicated if you have any liver disease.

What are the Dosage and method of administration of Clomiphene ?

• Clomiphene citrate is available at the dose of 50mg. Maximum, you can increase the dose upto 100mg. 
• Clomifene is taken by oral administration.
• You should always start the dose at 50mg, once in a day, for five days.
• Dose should start at the 5th day of the menstrual cycle.

If three ovulatory responses are observed and pregnancy not occur after taking the drug, then it is advised to discontinue the drug.
It is advised to increase the strength upto 100mg for five days, if ovulation does not occur after taking the drug at the strength of 50mg, which should be start after 30 days of the previous therapy.

What are the Side effects of Clomiphene while treating Infertility in Women?

The side effects of clomifene are very rare. But sometime you may develop the following side effects that are discussed below:
Body as a whole:
You may developed some general side effects that goes off once you discontinue the drug, but you should always inform your doctor if you notice any of these symptoms, such as,

• Stomach upset
• Abdominal fullness or pain
• Flushing
• Headach 
• dizziness

Effect on your eye:
There are possibilities to catch some eye problems while you are taking clomifene citrate, although such problem goes off when you stop using the medicine. The possible problems are:

• Blurred vision
• Seeing spots or flashes
• Vision changes
• Eye pain

Effects on cardiovascular system:
You can catch some cardiovascular problem during using Clomiphene, like,

• Chest pain
• Shortness of breath
• Edema
• Hypertension
• Palpitation
• Phlebitis(infection of artery)
• Palpitation
• Arrhythmias
• Tachycardia or increased heart rate

Effect on central nervous system:
Possible symptoms of central nervous system are:

• Migrain
• Seizure
• Parasthesia
• Stroke
• Headach
• Syncope

Effect on your skin:
You can develop some dermatological or skin problem while take Clomifene citrate:

• Allergic reaction
• Erythmia
• Pruritis 
• Urticaria
• Erythema multiforma

Effect on the unborn baby in pregnancy:
Clomifene citrate has some side effects on the fetus that are discussed below:

• Clomiphene can impact on bone during the development period of a fetus and cause bone malformations like on the skull, face, nasal passage, foot, bone joints and spine.
• Ear abnormalities like deafness.
• Cardiac anomalies like septal defects, cardiac muscle problem, tetralogy of Fallot(involve any four problem of heart),problem with the aorta of heart etc.
• Some chromosomal diseases like downs syndrom.
• GIT or gastrointestinal defect like cleft palate,cleft lips, hernia of diaphragm, imperforate anus etc.
• Malformation of lung.
• Anomalies of the ear and eye.
• Various neoplasmic tumour like thyroid tumour, leukocytic leukemia.
• Defect in renal system.

Effect on genital and urinary system:
Effects of genito-urinary systems are not severe, but if you develop any symptoms, you should consult with your physician as early as possible. Some of the problems associated to genito-urinary system are:

• Uterine hemorrhage.
• Tubal pregnancy.
• Ovarian hemorrhage.
• Ovarian cyst.
• Ovarian enlargement.

Effect on muscles and bone:
You may catch some problems on your muscular system as well on your bone, such as:

• Bone pain
• Muscle pain
• Back pain
• Difficulty in maintaining postural tone due to pain.

Neoplasmic effect:

• Clomiphene may cause the development of some tumors like,
• Liver tumor such as liver cell adenoma, hepato cellular cancer etc.
• Fibrocystic diseases of breast, carcinoma of breast.
• Tumor in the nervous system like pituitary tumour, prolactinoma, neurofibromatosis etc.
• Ovarian cyst like dermoid cyst, carcinoma of the ovary.
• Renal cell carcinoma
• Bladder carcinoma.
• Tongue carcinoma
• Perianal cyst.

Pshychotic effect:

• Mood swing
• Anxiety
• Irritability
• Depression

Other problem:

• Leukocytosis
• Thyroid problem.

Storage of Clomiphene:

• It should be kept in a tight container which has resistant to light, between the temperatures of 10-30 degree.
• Should always be kept out of reach of children.
• Always throw the unused and expired medicines.

Precautions and warnings of using Clomiphene:

The health care provider should always take precautions in choosing the patients for applying the therapy of Clomiphene. They must do the pelvic examination before starting the treatment with clomifene with different courses.
Always avoid using Clomifene in pregnant women because it may cause teratogenity or other complications to the fetus.
Always consult with your doctor if you catch any visual problems like pain in the eyes, blurred vision, sensitivity to light etc.
Always discontinue Clomifene and consult with your physician if you have pain in the pelvic region because it may be the indication of some problems like ovarian cyst or enlargement.
You should inform to your physician if you experience any abdominal pain, nausea, vomiting, dizziness, oligourea or pleural effusion, because such problems are always seen in ovarian hyperstimulation syndrom. The ovarian stimulation syndrome is a condition which occurs in women taking infertility drugs which stimulates the production of egg. 
Increased accumulation of sulfobromophthalien is stimulated by Clomifene, which may cause increased secretion of bile juice that further may lead to jaundice.
You should always be careful and follow the instructions of your healthcare provider if you are suffering from uterine fibroids.
Caution should always be taken in pregnancy and lactation period in applying Clomifene.