(149) Real-World Effectiveness of Clomiphene Citrate on Total Motile Sperm Count and Endocrine Profile in Idiopathic Male Infertility
Bibliographic record
Abstract
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
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".