Why use Clomid (clomiphene) for male infertility?

From the Guidelines

Clomid (clomiphene citrate) is used for male infertility because it can increase testosterone and sperm production in men with certain fertility issues, as supported by the most recent guideline updates 1. The typical dosage ranges from 25-50mg daily or every other day for 3-6 months, with sperm parameters monitored regularly. Clomid works by blocking estrogen receptors in the hypothalamus, which tricks the body into producing more luteinizing hormone (LH) and follicle-stimulating hormone (FSH), ultimately boosting testosterone production and spermatogenesis. This medication is particularly helpful for men with low testosterone levels, especially those with secondary hypogonadism or idiopathic oligospermia. Before starting Clomid, men should have a complete fertility evaluation including hormone testing and semen analysis to determine if they're suitable candidates. Some key points to consider when using Clomid for male infertility include:

• The benefits of Clomid administration, particularly in the patient population with idiopathic infertility, are small and may be outweighed by the distinct advantages offered by other forms of medically-assisted reproduction (eg, IVF) 1.
• Exogenous FSH may be used as an adjunct for treatment of hypogonadotropic hypogonadism (HH) in order to initiate and maintain spermatogenesis with good results, but its use in idiopathic infertile men without HH has limited fertility benefits 1.
• There are no clear, reliable data to support the use of supplements (vitamins, antioxidants, nutritional supplement formulations) in improving fertility outcomes 1. Side effects of Clomid may include visual disturbances, mood changes, and rarely gynecomastia. Clomid should be used under medical supervision as part of a comprehensive fertility treatment plan, and patients should be aware that improvements in sperm parameters may take 2-3 months to become apparent due to the sperm production cycle 1. It's also important to note that exogenous testosterone therapy should be avoided in males pursuing or planning to pursue family building in the near future, as it can inhibit spermatogenesis and decrease fertility 1.

From the FDA Drug Label

There are no adequate or well-controlled studies that demonstrate the effectiveness of clomiphene citrate in the treatment of male infertility. In addition, testicular tumors and gynecomastia have been reported in males using clomiphene The cause and effect relationship between reports of testicular tumors and the administration of clomiphene citrate is not known.

The use of Clomid (clomiphene) for male infertility is not recommended due to the lack of adequate or well-controlled studies demonstrating its effectiveness in this population, and the potential for testicular tumors and gynecomastia 2.

From the Research

Uses of Clomid for Male Infertility

• Clomid (clomiphene) is used to treat male infertility by increasing the secretion of gonadotropins, which in turn stimulates the production of testosterone and improves sperm parameters 3.
• The effects of Clomid on the hypothalamic-pituitary level make it possible to use it for a dynamic evaluation of the hypothalamic-pituitary gonadal axis in males 3.
• Clomid has been shown to be effective in oligozoospermic men, who have a low or normal FSH-level, by increasing sperm concentrations 3, 4.

Treatment of Male Hypogonadism

• Clomiphene citrate has been used as an off-label treatment for male hypogonadism, which is characterized by low testosterone levels 5, 6.
• Clomiphene stimulates gonadotropin secretion, leading to increased endogenous testosterone production, which improves sperm parameters and fertility, and alleviates the symptoms of hypogonadism 5.
• Clomiphene citrate has been shown to be a cost-effective treatment option for men with hypogonadism, with fewer side effects compared to testosterone replacement therapy (TRT) 6.

Efficacy and Safety

• The efficacy and safety of clomiphene citrate in the treatment of male infertility have been evaluated in several studies, with mixed results 4.
• While some studies have shown a statistically significant increase in sperm concentrations, others have found no significant benefit on pregnancy rates 4.
• Clomiphene citrate has been shown to be well-tolerated, with no identified serious adverse effects, and may offer a promising alternative to TRT for men with hypogonadism 5, 6.

Comparison with Other Treatments

• Clomiphene citrate has been compared to testosterone gel replacement therapy (TGRT) in terms of biochemical and clinical efficacy, and cost 6.
• Clomiphene citrate has been shown to be a safe and effective therapy for men who desire to maintain fertility, and may be used as an alternative to exogenous testosterone supplementation 7.