Nelson Vergel
Founder, ExcelMale.com
WHO IS THE MOST SUITABLE CANDIDATE FOR CLOMIPHENE TREATMENT? FINDINGS OF AN OBSERVATIONAL SURVEY IN A COHORT OF PRIMARY INFERTILE MEN
Comment from Nelson: Younger, thinner and with a bigger left testicle at baseline did better.
INTRODUCTION AND OBJECTIVES
Clomiphene has been widely used in idiopathic oligoasthenoteratozoospermia without proven evidence for its benefit. We assessed i) seminal outcomes after clomiphene treatment; and, ii) the most suitable candidate for clomiphene in a cohort of white-European men presenting for primary couple's infertility.
METHODS
Complete data from 307 consecutive men treated with clomiphene were analyzed. Comorbidities were scored with the Charlson Comorbidity Index (CCI; categorized 0 vs ≥1). Testicular volume (TV) was assessed with a Prader orchidometer. Semen analysis values were assessed based on the 2010 WHO reference criteria. Descriptive statistics tested the association between seminal outcome after therapy and clinical characteristics; logistic regression models tested the association between clinical parameters and clomiphene-related seminal improvement.
RESULTS
Mean (SD) age and duration of infertility was 43.36 (6.4) yrs and 28.27 (19.12) months, respectively. Baseline serum levels FSH, LH, inhibin B, AMH and total testosterone were 6.2 (4.7) mUI/mL, 4.9 (10.3) mUI/mL, 115.2 (66.7) pg/mL, 8.9 (14.2) ng/mL, and 5.0 (2.1) ng/mL, respectively. Overall, 194 (63.2%), 190 (61.9%) and 146 (47.6%) men presented with oligospermia, astenozoospermia and teratozoospermia, respectively. After 3 months of clomiphene, sperm concentration [pre vs post: 8.95 (7.5) vs 15.4 (14.11) million/mL; p<0.001] and total sperm progressive motility [11.81 (12.1) vs 18.9 (17.1); p<0.001] significantly improved. Improvement of sperm concentration was more frequently reported in younger individuals (p<0.001), with a lower BMI score (p=0.002), and with a higher left TV (p=0.03). Similar findings were also found for sperm motility (all p<0.05). Moreover, young patients (p<0.001), patients with normal BMI (p=0.02), and those with a greater left TV (p=0.003) were more likely to fall within the normal range of sperm concentration and sperm motility (all p<0.05) after treatment, respectively. At MVA, age (OR 0.86; p=0.005), BMI (OR 0.8; p=0.023) and lenght of infertility (OR 0.95; p=0.46) achieved independent predictor status for concentration improvement after clomiphene.
CONCLUSIONS
Clomiphene treatment was associated with an improvement of sperm concentration in a cohort of white-European men presenting for primary couples infertility. Patients who most benefited from this therapy are young, with a normal BMI and a short period of infertility.
Source of Funding: none
The Journal of Urology
Volume 193, Issue 4, Supplement, April 2015, Pages e946–e947
2015 Annual Meeting Program Abstracts
AUA Annual Meeting
Comment from Nelson: Younger, thinner and with a bigger left testicle at baseline did better.
INTRODUCTION AND OBJECTIVES
Clomiphene has been widely used in idiopathic oligoasthenoteratozoospermia without proven evidence for its benefit. We assessed i) seminal outcomes after clomiphene treatment; and, ii) the most suitable candidate for clomiphene in a cohort of white-European men presenting for primary couple's infertility.
METHODS
Complete data from 307 consecutive men treated with clomiphene were analyzed. Comorbidities were scored with the Charlson Comorbidity Index (CCI; categorized 0 vs ≥1). Testicular volume (TV) was assessed with a Prader orchidometer. Semen analysis values were assessed based on the 2010 WHO reference criteria. Descriptive statistics tested the association between seminal outcome after therapy and clinical characteristics; logistic regression models tested the association between clinical parameters and clomiphene-related seminal improvement.
RESULTS
Mean (SD) age and duration of infertility was 43.36 (6.4) yrs and 28.27 (19.12) months, respectively. Baseline serum levels FSH, LH, inhibin B, AMH and total testosterone were 6.2 (4.7) mUI/mL, 4.9 (10.3) mUI/mL, 115.2 (66.7) pg/mL, 8.9 (14.2) ng/mL, and 5.0 (2.1) ng/mL, respectively. Overall, 194 (63.2%), 190 (61.9%) and 146 (47.6%) men presented with oligospermia, astenozoospermia and teratozoospermia, respectively. After 3 months of clomiphene, sperm concentration [pre vs post: 8.95 (7.5) vs 15.4 (14.11) million/mL; p<0.001] and total sperm progressive motility [11.81 (12.1) vs 18.9 (17.1); p<0.001] significantly improved. Improvement of sperm concentration was more frequently reported in younger individuals (p<0.001), with a lower BMI score (p=0.002), and with a higher left TV (p=0.03). Similar findings were also found for sperm motility (all p<0.05). Moreover, young patients (p<0.001), patients with normal BMI (p=0.02), and those with a greater left TV (p=0.003) were more likely to fall within the normal range of sperm concentration and sperm motility (all p<0.05) after treatment, respectively. At MVA, age (OR 0.86; p=0.005), BMI (OR 0.8; p=0.023) and lenght of infertility (OR 0.95; p=0.46) achieved independent predictor status for concentration improvement after clomiphene.
CONCLUSIONS
Clomiphene treatment was associated with an improvement of sperm concentration in a cohort of white-European men presenting for primary couples infertility. Patients who most benefited from this therapy are young, with a normal BMI and a short period of infertility.
Source of Funding: none
The Journal of Urology
Volume 193, Issue 4, Supplement, April 2015, Pages e946–e947
2015 Annual Meeting Program Abstracts
AUA Annual Meeting
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