(149) Real-World Effectiveness of Clomiphene Citrate on Total Motile Sperm Count and Endocrine Profile in Idiopathic Male Infertility
Notice bibliographique
Résumé
Abstract Introduction Infertility affects about 16% of couples worldwide. When evaluating male infertility, clinicians rely on history, physical examination, semen analysis, and targeted hormonal or genetic tests. However, evidence for empiric medical therapy in idiopathic male-factor infertility remains limited. One treatment often used is clomiphene citrate (CC), a selective estrogen-receptor modulator that boosts endogenous gonadotropins and, in turn, spermatogenesis. Objective Our study aims to evaluate the effect of CC on total motile sperm count (TMSC) and overall hormonal profile in infertile men. Methods We conducted a single-center retrospective cohort study of men who underwent CC treatment for primary or secondary infertility. Inclusion criteria were normogonadotropic or hypogonadal men greater than or equal to 18 years old with clinical infertility, defined as the failure to achieve pregnancy after 12 months of regular unprotected intercourse with a healthy partner. Patients were excluded if they had a TMSC >20 million/mL, used exogenous testosterone, had a syndromic disorder, were lost to follow-up, were non-adherent to clomiphene, or lacked post-treatment TMSC data. The primary outcome was the change in TMSC; secondary outcomes were changes in testosterone, FSH, LH, estradiol, and 17-OHP measured before and after CC treatment. Pre- and post-treatment means were compared using paired, two-tailed t-tests. The change in TMSC was evaluated with multivariable linear regression adjusted for age, BMI, and baseline 17-OHP, testosterone, and FSH. Statistical significance was determined by p < 0.05. Results A total of 62 men with a mean age of 35.6 ± 4.6 years (range 25–45) were included in the study. The cohort had a mean BMI of 30.5 ± 6.8 kg/m2, and an average treatment duration of 13.1 ± 6.3 months. Following CC therapy, TMSC increased from 8.4 ± 18.9 to 21.9 ± 43.0 million (p = 0.017). In parallel, 17-OHP rose from 2.8 ± 1.4 to 4.6 ± 2.1 nmol/L, testosterone from 10.0 ± 5.0 to 19.8 ± 7.0 nmol/L, FSH from 6.5 ± 4.7 to 11.3 ± 10.6 IU/L, LH from 4.9 ± 2.5 to 9.7 ± 7.7 IU/L, and estradiol from 90.0 ± 35.6 to 146.1 ± 64.5 pmol/L (all p < 0.001; Table 1). A multiple linear regression found no association between TMSC change and age, BMI, baseline hormone levels, or CC-therapy duration (all p > 0.05; Table 2). Furthermore, Men with primary (n = 47) vs. secondary infertility (n = 15) did not differ in the degree of TMSC or hormonal changes (all p > 0.05), suggesting that the effectiveness of CC therapy is similar across all infertility classifications (Table 3). Conclusions Overall, CC was associated with an approximately 160% rise in TMSC with additional increases in gonadotropins and testosterone. Further, this response was independent of age, BMI, baseline hormone levels, and treatment duration, leaving no clear predictors of benefit. Larger prospective studies are needed to validate these findings and to guide optimal dosing and candidate selection. Disclosure No
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».