Effect of clomiphene citrate on sperm density in male partners of infertile couples.

ABSTRACT

Infertility is on the rise in today's world. A subnormal sperm count is frequently encountered in infertile couples. Clomiphene citrate, 1-[p-(beta-diethyl aminoethoxy) phenyl]-1,2-diphenyl chloroethylene, is an orally active nonsteroidal agent distantly related to diethylstilbestrol. It is thought to stimulate pituitary gonadotropin release by excluding estradiol from hypothalamic receptor sites. This interaction neutralizes the normal negative feedback control of estrogen and results in enhanced secretion of LH-RH, FSH-RH and gonadotropins. Testosterone is produced by the Leydig cells in response to LH secretion. The concentration of testosterone in the tubular environment is believed to maintain the gametogenic function of the testis. Clomiphene citrate in the dose of 25 mg daily for 25 days with five days rest was administered to 25 extreme oligozoospermic men (group I) and 40 moderate oligozoospermic men (group II) the cycle being continued for three months). Repeat semen analysis was done at the end of three months and all the routine seminal parameters were reevaluated. The data thus obtained was analyzed using Student's paired 't' test. The mean sperm count in Group I increased from 3.84 +/- 0.32 to 8.2 +/- 1.58 (P < 0.05) and in Group II from 13.05 +/- 0.48 to 24.55 +/- 1.73 (P < 0.001). The mean motile sperm count in Group I increased from 1.74 +/- 0.25 to 3.92 +/- 0.83 (P < 0.05) and in Group II from 8.27 +/- 0.40 to 10.05 +/- 0.56 (P < 0.01). Thus clomiphene citrate exerts its effect on spermatogenesis by raising the endogenous serum FSH, LH and testosterone levels to initiate and maintain gametogenesis (10). Researchers opined that this increase in endogenous gonadotrophins manifests itself in improving the sperm count, sperm motility and to certain extent morphology of the sperms, when there is no end-organ pathology.