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Improvements in semen parameters in men treated with clomiphene citrate—A retrospective analysis
Devang Sharma | Jacqueline Zillioux | Iyad Khourdaji | Katy Reines | Karen Wheeler | Raymond Costabile | Parviz Kavoussi | Ryan Smith
Abstract
Clomiphene citrate (CC) is commonly used off‐label for the treatment of male infertility, yet there is limited data to guide patient selection. To identify a subset of patients more likely to benefit from CC, we aimed to define predictors of improvement in semen parameters among men receiving CC. We retrospectively analyzed 151 men treated with at least 25 mg CC daily for male infertility and/or hypogonadism at two institutions between 2004 and 2014. Men previously on testosterone were excluded. The primary outcome was a change in semen parameters. Variables included baseline patient characteristics, pre‐treatment hormone profiles, and pre‐treatment semen analyses. A total of 77 men met the inclusion criteria. The median length of therapy was 2.8 months. There was a significant improvement in sperm concentration (14–21 million/ml; p = 0.002) and total motile count (TMC; 13–28 million; p = 0.04). One-third of patients who began with fewer than 5 million motile spermatozoa improved to a TMC > 5 million, increasing reproductive options to include intrauterine insemination. Patient characteristics, pre‐treatment hormone profile, and degree of oligozoospermia did not predict treatment response. While no predictors of improvement were identified, clinically useful response rates are described for use in shared decision‐making.
5 | CONCLUSIONS
Clomiphene citrate is a reasonable treatment for men with abnormal semen parameters and/or hypogonadism, with the potential of improving sperm concentration, total motile count, and serum testosterone. Patient characteristics, pre‐treatment hormone profile, and degree of oligozoospermia do not predict treatment response. Patients with a range of abnormalities on baseline hormonal assessment and semen analysis may benefit from therapy. Treatment response is variable based on the definition and modest for clinically meaningful changes in semen parameters. Providers should use these findings to help guide patient selection and in shared decision‐making.
Devang Sharma | Jacqueline Zillioux | Iyad Khourdaji | Katy Reines | Karen Wheeler | Raymond Costabile | Parviz Kavoussi | Ryan Smith
Abstract
Clomiphene citrate (CC) is commonly used off‐label for the treatment of male infertility, yet there is limited data to guide patient selection. To identify a subset of patients more likely to benefit from CC, we aimed to define predictors of improvement in semen parameters among men receiving CC. We retrospectively analyzed 151 men treated with at least 25 mg CC daily for male infertility and/or hypogonadism at two institutions between 2004 and 2014. Men previously on testosterone were excluded. The primary outcome was a change in semen parameters. Variables included baseline patient characteristics, pre‐treatment hormone profiles, and pre‐treatment semen analyses. A total of 77 men met the inclusion criteria. The median length of therapy was 2.8 months. There was a significant improvement in sperm concentration (14–21 million/ml; p = 0.002) and total motile count (TMC; 13–28 million; p = 0.04). One-third of patients who began with fewer than 5 million motile spermatozoa improved to a TMC > 5 million, increasing reproductive options to include intrauterine insemination. Patient characteristics, pre‐treatment hormone profile, and degree of oligozoospermia did not predict treatment response. While no predictors of improvement were identified, clinically useful response rates are described for use in shared decision‐making.
5 | CONCLUSIONS
Clomiphene citrate is a reasonable treatment for men with abnormal semen parameters and/or hypogonadism, with the potential of improving sperm concentration, total motile count, and serum testosterone. Patient characteristics, pre‐treatment hormone profile, and degree of oligozoospermia do not predict treatment response. Patients with a range of abnormalities on baseline hormonal assessment and semen analysis may benefit from therapy. Treatment response is variable based on the definition and modest for clinically meaningful changes in semen parameters. Providers should use these findings to help guide patient selection and in shared decision‐making.
