ABSTRACT

When considering empirical medical management (EMT) options for men with unexplained infertility (UI), clomiphene citrate (CC) has been shown to positively influence sperm parameters in hypogonadal men. Unfortunately, the optimal cut point for defining hypogonadism for this patient population has not been established. We hypothesized that hypogonadal men with UI having the lowest serum total testosterone (TT) (<265 ng/dL) would have a significant post-CC improvement in both TT and semen characteristics compared to those in the TT > 264 ng/dL group. We performed our study based on an IRB-approved retrospective chart review of 83 males with UI receiving more than 90 days of 50 mg daily CC. Serum TT and semen characteristics were studied in 83 patients before and in 23 patients after CC treatment. Median TT level increased from 256 ng/dL to 630 ng/dL (p < 0.001, n = 83) and SC increased from 6 (${10}^6$/ml) to 20 (${10}^6$/ml) (p < 0.016, n = 23). Overall, our results demonstrated the following: (1) CC treatment at all currently used serum TT cut-points resulted in significant improvement in both TT (p < 0.001) and sperm concentration (p = 0.03). No significant change in post-CC sperm motility or morphology was noted. (2) Correlation and linear regression analyses demonstrated that CC treatment significantly increased TT in 96% (22 of 23) of patients, and (3) when grouped as two cohorts (≤264 and >264 ng/dL), sperm concentration and TT improved 2.3 to 2.6-fold (p < 0.001) and 1.45 to 2.5-fold (p < 0.01) respectively. Thus, for hypogonadal men with UI, CC significantly improved TT and sperm concentration regardless of pre-treatment, baseline serum TT level. For this reason, CC treatment should be considered in men with UI having a TT < 400 ng/dL.

摘要

在为不明原因不孕症 (UI) 的男性考虑经验医学管理 (EMT) 选择时，克罗米芬 (CC) 已被证明对性腺功能减退男性的精子参数有积极影响。不幸的是，尚未确定定义该患者群体性腺功能减退症的最佳切入点。我们假设，与 TT > 264 ng/dL 组相比，具有最低血清总睾酮 (TT) (<265 ng/dL) 的 UI 性腺机能减退男性在 TT 和精液特征方面具有显着的 CC 后改善。我们根据 IRB 批准的 83 名 UI 男性接受超过 90 天每天 50 毫克 CC 的回顾性图表审查来进行我们的研究。研究了 83 名患者在 CC 治疗前和 23 名患者中的血清 TT 和精液特征。p  < 0.001, n = 83) 并且 SC 从 6 (${10}^6$/ml) 到 20 (${10}^6$/ml) ( p  < 0.016, n = 23)。总的来说，我们的结果证明了以下几点：（1）在所有当前使用的血清 TT 切点处进行 CC 治疗导致 TT（p  < 0.001）和精子浓度（p  = 0.03）的显着改善。没有注意到 CC 后精子活力或形态的显着变化。(2) 相关性和线性回归分析表明，CC 治疗显着增加了 96%（23 名中的 22 名）患者的 TT，并且（3）当分组为两个队列（≤264 和 >264 ng/dL）时，精子浓度和 TT提高了 2.3 至 2.6 倍（p  < 0.001）和 1.45 至 2.5 倍（p < 0.01) 分别。因此，对于患有 UI 的性腺功能减退男性，无论治疗前、基线血清 TT 水平如何，CC 都显着改善了 TT 和精子浓度。因此，对于 TT < 400 ng/dL 的 UI 男性，应考虑 CC 治疗。