Assessment

• Perform a pelvic examination to determine ovarian size and presence of ovarian cysts prior to therapy and before subsequent courses of therapy

• An endometrial biopsy is recommended in older patients prior to clomiphene therapy to rule out the presence of endometrial carcinoma

• Assess patient for abdominal pain throughout therapy. Occurrence requires immediate pelvic examination to determine ovarian enlargement or cyst formation. If these occur, discontinue therapy until ovaries have returned to pretreatment size, usually within a few days to weeks. Dose and duration of next course should be decreased

• If 3 ovulatory responses occur without achievement of pregnancy, further treatment with clomiphene is not recommended

• Estrogen excretion determinations, histologic studies of the luteal phase endometrium, serum progesterone, and urinary excretion of pregnanediol may be used to determine whether ovulation has occurred following a course of clomiphene

» Liver function tests should be performed prior to course of therapy

» Immunologic assay for human chorionic gonadotropin (HCG) should be used to determine pregnancy if menses do not occur prior each course of treatment with clomiphene

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