Follicle‐stimulating hormone modestly predicts improvement in semen parameters in men with infertility treated with clomiphene citrate. (20th February 2022)

• Record Type: Journal Article
• Authors: Lundy, Scott D.; Doolittle, Johnathan; Farber, Nicholas J.; Njemanze, Stephanie; Munoz‐Lopez, Carlos; Vij, Sarah C.
• Is Part Of: Andrologia. Volume 54:Number 6(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-02-20
• Subjects: clomiphene citrate -- empiric medical therapy -- follicle‐stimulating hormone -- male infertility -- sperm concentration; Andrology -- Periodicals; Infertility, Male -- Periodicals; 616.69
• DOI: 10.1111/and.14399
• Languages: English
• ISSNs: 0303-4569

Abstract

Abstract: Clomiphene citrate is a commonly prescribed empiric medical therapy for male infertility, but outcomes data and response rates remain incompletely understood. We retrospectively reviewed our single‐institutional experience of infertile men prescribed clomiphene. Clomiphene treatment in the final cohort of 140 men was associated with a modest increase in median sperm concentration from 2.2 to 2.5 million/ml ( p < 0.001). A total of 46/140 (33%) of men upgraded according to World Health Organization concentration categories. Clomiphene treatment in 26/113 (23%) of previously ineligible men became eligible for intrauterine insemination. Using both univariate and multivariable regression, pre‐treatment follicle‐stimulating hormone was inversely associated with change in semen concentration with clomiphene treatment. On binary logistic regression, follicle‐stimulating hormone level was inversely related to World Health Organization concentration category upgrade ( p = 0.01). Unfortunately, 17/140 (12%) of men paradoxically worsened on clomiphene, but no predictors for this could be identified. In summary, clomiphene citrate confers a clinically relevant but modest benefit in a subset (1/3 rd ) of infertile men, particularly those with lower pre‐treatment follicle‐stimulating hormone levels. Men with elevated follicle‐stimulating hormone over 15 IU/ml are less likely to benefit from treatment and should be counselled on other relevant treatment alternatives.