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

Year 2011, Volume: 6 Issue: 1, 40 - 44, 01.01.2011

Fikret Erdemir Doğan Atılgan Adem Yaşar Bekir Süha Parlaktaş Fatih Fırat

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

References

• 1. Greenhall E, Vessey M. The prevalence of subfertility: a review of the current confusion and a report of two new studies. Fertil Steril, 54: 978, 1990
• 2. Pavlovich CP, Schlegel PN. Fertility options after vasectomy: a cost-effectiveness analysis. Fertil Steril. 67:133-41, 1997
• 3. Dohle GR, Colpi GM, Hargreave TB, at al. EAU Working Group on Male Infertility. EAU guidelines on male infertility. Eur Urol. 48:703-11, 2005
• 4. Kumar R, Gautam G and Gupta NP. Drug Therapy for Idiopathic Male Infertility: Rationale Versus Evidence. J Urol. 176, 1307-12, 2006
• 5. Raman JD, Schlegel PN. Aromatase inhibitors for male infertility. J Urol. 167:624-9, 2002
• 6. M. Murad Basar, D Tuglu. Aromatase inhibitors in infertile patients: effects on seminal parameters, serum and seminal plasma testosterone levels, and estradiol levels during short-term follow-upTurk J Med Sci. 39: 519-24, 2009
• 7. Sigman M. Campbell Urology. 1475-1518, 2008
• 8. Clinical Endocrinology and Infertility.In:Sperof L, Glass R.H, Kase N.G,eds.Clinical Gynocologic Endocrinology and Infertility.6th edition. Baltimore: Lippincott Williams & Wilkins, 487-522 and 1013-132, 1999
• 9. Young S.L, Opsahi M.S, Fritz M.A. Serum concentrations of enclomiphene and zuclomiphene across consecutive cycles clomiphene citrate therapy in anovulatory infertile women. Fertility and Sterility. 71:639-44, 1999
• 10. Allag IS, Alexander NJ. Clomiphene citrate therapy for male infertility. Urology, 14: 500, 1979
• 11. Bartsch G, Scheiber K. Tamoxifen treatment in oligozoospermia. Eur Urol, 7: 283, 1981
• 12. A double-blind trial of clomiphene citrate for the treatment of idiopathic male infertility. World Health Organization Int J Androl, 15: 299, 1992
• 13. Aydos K. Erkek infertilitesi. Temel Üroloji Kitabı. Editörler; Anafarta K, Bedük Y, Arıkan N. 3. Baskı. 2007: 967-
• 14. A double-blind trial of clomiphene citrate for the treatment of idiopathic male infertility. World Health Organization Int J Androl. 15:299-307, 1992
• 15. Hussein A, Ozgok Y, Ross L, Niederberger C. Clomiphene administration for cases of nonobstructive azoospermia: a multicenter study. J Androl. 26:787-91, 2005.
• 16. Ghanem H, Shaeer O, El-Segini A. Combination clomiphene citrate and antioxidant therapy for idiopathic male infertility: a randomized controlled trial. Fertil Steril. 1;93:2232-5, 2010
• 17. Patankar SS, Kaore SB, Sawane MV,at al. Effect of clomiphene citrate on sperm density in male partners of infertile couples. Indian J Physiol Pharmacol. 51:195-8, 2007
• 18. Matsumiya K, Kitamura M, Kishikawa H, Kondoh N, at al. A prospective comparative trial of a gonadotropinreleasing hormone analogue with clomiphene citrate for the treatment of oligoasthenozoospermia. Int J Urol. 5:361-3, 1998
• 19. Vandekerckhove P, Lilford R, Vail A, Hughes E. Withdrawn: Clomiphene or tamoxifen for idiopathic oligo/asthenospermia. Cochrane Database Syst Rev. 18;CD000151, 2007
• 20. Pasqualotto FF, Fonseca GP, Pasqualotto EB. Azoospermia after treatment with clomiphene citrate in patients with oligospermia. Fertil Steril. 90:2014;11-2, 2008
• 21. Turek PJ. AUA Kılavuzları. 2008.
• 22. Kumar R, Gautam G, Gupta NP. Drug therapy for idiopathic male infertility: rationale versus evidence. J Urol. 176:1307-12, 2006