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* Data from 166 men seeking first medical help for primary MFI with low sperm counts who were prescribed CC 50 mg QD, with a second semen analysis available at follow-up after treatment initiation, were analyzed
* CC effectively increases both sperm concentration and total testosterone levels in most MFI men. Nevertheless, one out of four patient experience a paradoxical decline in sperm counts. Lower baseline sperm concentration was the only predictive factor for positive treatment response in terms of sperm concentration
PARADOXICAL RESPONSE TO CLOMIPHENE CITRATE IN MALE INFERTILITY: ONE OUT OF FOUR MEN EXPERIENCE SPERM COUNT DECLINE - FINDINGS FROM A REAL-LIFE CROSS-SECTIONAL STUDY
Edoardo Pozzi*, Christian Corsini, Fausto Negri, Massimiliano Raffo,Alessandro Bertini, Federico Belladelli, Andrea Folcia, Marco Malvestiti,Marco Oddo, Gabriele Birolini, Luca Boeri, Alessia D'Arma,Francesco Montorsi, Andrea Salonia, Milan, Italy
INTRODUCTION AND OBJECTIVE
Clomiphene citrate (CC) is a prescribed off-label SERM to treat hypogonadism in men with low sperm counts. Some men may experience a paradoxical decline in sperm count after starting CC. We aimed to investigate the frequency and predictive factors for this paradoxical response in men prescribed CC because of male factor infertility (MFI) at a tertiary academic center.
METHODS
Data from 166 men seeking first medical help for primary MFI with low sperm counts who were prescribed CC 50 mg QD, with a second semen analysis available at follow-up after treatment initiation, were analyzed. Sociodemographic, clinical characteristics, semen analysis and serum hormones were collected. Responders to CC were considered to be all those with an improvement in their sperm counts at follow-up semen analysis (after at least 3-mo of CC). Those who had a decline in sperm counts were considered non-responders. Descriptive statistics was used to detail the overall cohort and compare groups. Multivariate logistic regression analysis was used to explore potential predictors of responsiveness to CC.
RESULTS
Overall, the median (IQR) age was 37 (34-40) years. The median treatment duration was 4 (3-7) months. The baseline vs. follow-up median sperm concentration was 4.00 (1.42-8.00) vs. 5.60 (2.12-10.88) x106/mL, p<0.001 and, total testosterone 3.19 (2.42-4.86) vs. 4.63 (3.69-5.83) ng/mL, p=0.02, respectively. Responders were 118 (71.1%) and non-responders were 48 (28.9%). Responders had lower median baseline sperm concentration compared to non-responders: 3.20 (2.33-6.62) vs. 5.80 (3.77-9.81) x106/mL, p=0.003, and reported higher BMI 25.68 (24.19-27.76) vs. 24.90 (23.22-26.78) kg/m2, p=0.04. At multivariate logistic regression analysis, baseline lower sperm concentration was identified as predictive factor of being a responder to CC, OR: 0.87 (95% CI: 0.80-0.94) p<0.001, after adjusting for baseline FSH, total testosterone, age and therapy duration. The probability of the logistic regression model is plotted over Figure 1
CONCLUSIONS
CC effectively increases both sperm concentration and total testosterone levels in most MFI men. Nevertheless, one out of four patient experience a paradoxical decline in sperm counts. Lower baseline sperm concentration was the only predictive factor for positive treatment response in terms of sperm concentration.
* CC effectively increases both sperm concentration and total testosterone levels in most MFI men. Nevertheless, one out of four patient experience a paradoxical decline in sperm counts. Lower baseline sperm concentration was the only predictive factor for positive treatment response in terms of sperm concentration
PARADOXICAL RESPONSE TO CLOMIPHENE CITRATE IN MALE INFERTILITY: ONE OUT OF FOUR MEN EXPERIENCE SPERM COUNT DECLINE - FINDINGS FROM A REAL-LIFE CROSS-SECTIONAL STUDY
Edoardo Pozzi*, Christian Corsini, Fausto Negri, Massimiliano Raffo,Alessandro Bertini, Federico Belladelli, Andrea Folcia, Marco Malvestiti,Marco Oddo, Gabriele Birolini, Luca Boeri, Alessia D'Arma,Francesco Montorsi, Andrea Salonia, Milan, Italy
INTRODUCTION AND OBJECTIVE
Clomiphene citrate (CC) is a prescribed off-label SERM to treat hypogonadism in men with low sperm counts. Some men may experience a paradoxical decline in sperm count after starting CC. We aimed to investigate the frequency and predictive factors for this paradoxical response in men prescribed CC because of male factor infertility (MFI) at a tertiary academic center.
METHODS
Data from 166 men seeking first medical help for primary MFI with low sperm counts who were prescribed CC 50 mg QD, with a second semen analysis available at follow-up after treatment initiation, were analyzed. Sociodemographic, clinical characteristics, semen analysis and serum hormones were collected. Responders to CC were considered to be all those with an improvement in their sperm counts at follow-up semen analysis (after at least 3-mo of CC). Those who had a decline in sperm counts were considered non-responders. Descriptive statistics was used to detail the overall cohort and compare groups. Multivariate logistic regression analysis was used to explore potential predictors of responsiveness to CC.
RESULTS
Overall, the median (IQR) age was 37 (34-40) years. The median treatment duration was 4 (3-7) months. The baseline vs. follow-up median sperm concentration was 4.00 (1.42-8.00) vs. 5.60 (2.12-10.88) x106/mL, p<0.001 and, total testosterone 3.19 (2.42-4.86) vs. 4.63 (3.69-5.83) ng/mL, p=0.02, respectively. Responders were 118 (71.1%) and non-responders were 48 (28.9%). Responders had lower median baseline sperm concentration compared to non-responders: 3.20 (2.33-6.62) vs. 5.80 (3.77-9.81) x106/mL, p=0.003, and reported higher BMI 25.68 (24.19-27.76) vs. 24.90 (23.22-26.78) kg/m2, p=0.04. At multivariate logistic regression analysis, baseline lower sperm concentration was identified as predictive factor of being a responder to CC, OR: 0.87 (95% CI: 0.80-0.94) p<0.001, after adjusting for baseline FSH, total testosterone, age and therapy duration. The probability of the logistic regression model is plotted over Figure 1
CONCLUSIONS
CC effectively increases both sperm concentration and total testosterone levels in most MFI men. Nevertheless, one out of four patient experience a paradoxical decline in sperm counts. Lower baseline sperm concentration was the only predictive factor for positive treatment response in terms of sperm concentration.
