THE EFFECT OF CLOMIPHENE CITRATE ON SEMEN PARAMETERS AND PREGNANCY RATES IN CASES WITH IDIOPATHIC MALE INFERTILITY

Abstract

About 15% of couples do not achieve pregnancy within 1 year. In 30-40% of cases, no male infertility associated factor is found idiopathic male infertility . A variety of empirical treatments such as androgens, hCG/human menopausal gonadotropin, bromocriptine, alpha-blockers, systemic corticosteroids, aromatase inhibitors, and antioxidants have been used in an attempt to improve semen characteristics and fertility in patients with idiopathic male infertility. Clomiphene citrate has been empirically used in cases of idiopathic oligospermia. Clomiphene increases endogenous gonadotropin-releasing hormone secretion from the hypothalamus and gonadotropin hormone secretion directly from the pituitary and, thus, increases intratesticular testosterone concentration. The aim of this study is to evaluate the effect of clomiphene citrate on semen parameters and pregnancy rates in the treatment of idiopathic male infertility.Material and Methods: Between January 2004 and October 2008 a total of 41 male with the diagnosed of idiopathic male infertility were included to this study. All cases were evaluated with physical examination, detailed medical history, semen analysis and routine hematologic and biochemical analysis. In addition hormonal parameters were evaluated. Clomiphene citrate CC orally was given to 41 men with idiopathic oligospermia at a daily dose of 50 mg. After treatment semen analysis were done and pregnancy was evaluaeted.Results: The mean age of the patients was 25.5±2.4 years. Sperm concentration increased in only 3.5% of the patients after CC treatment. Sperm motility remained unchanged. Only one spontaneous pregnancy occurred in the partners of the subjects treated with 50 mg CC/day. Clomiphene citrate therapy was not associated with a significant increase in total sperm count and in sperm motility.Conclusion: It was seen that clomiphene citrate which is frequently used in the treatment of idiopathic male infertility had no sigdavi protokollerinin uygulanmasının göz önünde bulundurulması gerektiği söylenebilir. nificant effect on seminal parameters and pregnancy rates. According to this finding it can be thought that in the treatment of male infertility other than clomiphene citrate different treatment regimens should be preferred as a first line treatment protocol

Keywords

• İdiopathic infertility,male,clomiphene citrate,semen,pregnancy

İDİOPATİK ERKEK İNFERTİLİTESİNDE KLOMİFEN SİTRATIN SEMEN PARAMETRELERİ VE GEBELİK ORANLARI ÜZERİNE ETKİSİ

Abstract

Çiftlerin yaklaşık olarak %15’i bir yıllık sürede gebeliği sağlayamamaktadırlar. Olguların %30-40’ında erkek infertilitesi ile ilgili bir faktör bulunamamaktadır idiyopatik erkek infertilitesi . İdiyopatik erkek infertilitesinde gebeliği sağlamak ve semen parametrelerini arttırmak için androjenler, hCG/human menopozal gonadotropin, bromokriptin, alfa blokörler, sistemik kortikosteroidler, aromataz inhibitörleri ve antioksidanlar gibi pek çok çeşit tedavinin farklı başarı oranlarıyla kullanıldıkları görülmektedir. Klomifen sitrat idiyopatik oligoospermi tedavisinde ampirik olarak kullanılmaktadır. Klomifen hipotalamustan endojen gonadotropin-releasing hormon ve hipofizden gonadotropin hormon sekresyonunu arttırır. Böylece intratestiküler hormon sekresyonu artar. Bu çalışmanın amacı klomifen sitratın idiyopatik erkek infertilitesinde semen parametreleri ve gebelik üzerine olan etkisi değerlendirmektir.Gereç ve Yöntem: Ocak 2004 ve Ekim 2008 tarihleri arasında idiyopatik infertilite tanısı ile klomifen sitrat tedavisi verilen toplam 41 erkek olgu çalışmaya dahil edildi. Hastalar kliniğimizde ayrıntılı öykü, fizik muayene, semen analizi ve rutin kan tetkikleri ile değerlendirildi. Yapılan değerlendirme sonucu idiyopatik infertilite tanısı konulan hastalara 3 aylık klomifen sitrat 50 mg/gün tedavisi verildi. Tedavi sonrası semen tetkikleri yapıldı ve gebelik varlığı sorgulandı.Bulgular: Olguların ortalama yaşı 25.5±2.4 yıl olarak saptandı. Klomifen sitrat tedavisi sonrası semen incelemesi sonucu sayı artışı ise %3.5 olarak saptandı. Tedavi sonrası semen parametrelerindeki artışlar istatistiksel olarak anlamlı değildi p>0.05 . Bundan başka yalnızca bir hastada spontan gebelik görüldüğü tespit edildi. Klomifen sitrat tedavisi sperm sayı ve motilite artışı açısından anlamlı değildi.Sonuçlar: İdiopatik erkek infertilite tedavisinde sıkça kullanıldığını düşündüğümüz klomifen sitratın semen parametreleri ve gebelik üzerinde anlamlı olarak etki etmediği anlaşılmakta olup bize göre bu durum dikkate alınarak tedavide ilk tercih olarak farklı te

Keywords

• İdiyopatik infertilite,erkek,klomifen sitrat,semen,gebelik

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