NBME 13 Reproductive Q

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Jul 14, 2012
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32 year old woman has not been able to conceive for the past 5 years. Husband's fertility exams are normal. Menses occur at 28 day intervals. Her BP is 110/70 mmHg. Physical and pelvic exams are normal. Hysterosalpingography is normal. Hormone levels are normal. Which of the following is appropriate pharmacotherapy?

A- Bromocriptine
B- Clomiphene
C- Diethylstilbestrol
D- Ethinyl estradiol
E- Medroxyprogesterone

Why is this lady having completely normal hormone levels yet have problem conceiving? People say the answer is Clomiphene but I am really not sure what the mech behind this problem is.... Thank you!

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When there is no readily apparent reason for a woman not being able to conceive clomiphene is the drug of choice. It inhibits estrogen receptors in the thalamus. This decreases negative feedback on the gonadotropins. My understanding is that this allows the ovarian cycle to restart with a bit more strength.
clomiphene is a selective estrogen receptor modulator
estrogen acts on its receptors in the HYPOTHALAMUS to inhibit GnRH release (feedback inhibition).Clomifene blocks these receptors.So there is an increased frequency of Gnrh released which leads to more FSH and LH released which in turn leads to ovulation.
clomifene causes more follicles to mature and ovulate which would increase the chances of getting pregnant-if there are no anatomic and hormonal causes of infertility
Thanks everyone, I guess I just don't see the reason why clomiphen should be used when the question stem specifically says that her hormone levels are normal. If that part was left out, clomiphen would definitely be the answer.