Clomiphene administration for cases of nonobstructive azoospermia: a multicenter study

Area of Science:

• Reproductive Endocrinology
• Male Infertility
• Sperm Retrieval Techniques

Background:

• Clomiphene citrate is used for idiopathic oligospermia by increasing gonadotropins and testosterone.
• Intracytoplasmic sperm injection (ICSI) requires minimal sperm for fertilization.
• Nonobstructive azoospermia presents challenges for achieving sperm for assisted reproduction.

Purpose of the Study:

• To evaluate clomiphene citrate's efficacy in producing sperm for ICSI in men with nonobstructive azoospermia.
• To determine if clomiphene citrate improves ejaculate sperm presence or surgical sperm extraction outcomes.
• To assess the impact of clomiphene citrate on testicular sperm retrieval in azoospermic patients.

Main Methods:

• Forty-two males with nonobstructive azoospermia received clomiphene citrate, titrated to achieve testosterone levels of 600–800 ng/dL.
• Regular semen analyses were conducted, and surgical testicular sperm extraction was performed for persistent azoospermia.
• Testicular biopsy patterns were analyzed for changes associated with sperm retrieval likelihood.

Main Results:

• Sperm were found in the ejaculate of 64.3% of patients after clomiphene citrate therapy (mean density 3.8 million/mL).
• Sufficient sperm for ICSI were retrieved surgically in 100% of patients, even those remaining azoospermic.
• Clomiphene citrate significantly improved testicular biopsy patterns predictive of successful surgical sperm retrieval (P < .05).

Conclusions:

• Clomiphene citrate administration can lead to sperm in the ejaculate or simplify sperm retrieval in nonobstructive azoospermia.
• Pre-treatment with clomiphene citrate may be a valuable strategy before surgical sperm retrieval.
• This approach offers a potential benefit for men with nonobstructive azoospermia seeking fertility treatments.