MP31-16 GONADOTROPIN CONCENTRATION THRESHOLDS TO PREDICT IMPROVEMENTS IN TESTOSTERONE AND SEMEN PARAMETERS WITH CLOMIPHENE CITRATE

Abstract

You have accessJournal of UrologyInfertility: Therapy (MP31)1 Sep 2021MP31-16 GONADOTROPIN CONCENTRATION THRESHOLDS TO PREDICT IMPROVEMENTS IN TESTOSTERONE AND SEMEN PARAMETERS WITH CLOMIPHENE CITRATE Tommy Jiang, Alvaro Santamaria, Neilufar Modiri, Michael Zheng, Vadim Osadchiy, John Sigalos, Jesse Mills, and Sriram Eleswarapu Tommy JiangTommy Jiang More articles by this author , Alvaro SantamariaAlvaro Santamaria More articles by this author , Neilufar ModiriNeilufar Modiri More articles by this author , Michael ZhengMichael Zheng More articles by this author , Vadim OsadchiyVadim Osadchiy More articles by this author , John SigalosJohn Sigalos More articles by this author , Jesse MillsJesse Mills More articles by this author , and Sriram EleswarapuSriram Eleswarapu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002035.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Due to its indirect ability to increase pituitary gonadotropins, clomiphene citrate is prescribed off-label to men with hypogonadism or impaired sperm counts. However, threshold values for pre-treatment LH and FSH that predict response remain unknown. We sought to identify pre-treatment thresholds to guide clomiphene use in men with hypogonadism or subfertility. METHODS: Using an IRB approved database, we retrospectively extracted LH, FSH, testosterone (T), and semen analysis (SA) data in men pre- and 3 months post-treatment with clomiphene (25 mg daily). Patients with prior hormone therapy or genitourinary surgery were excluded. We determined efficacy thresholds by identifying the highest LH or FSH level at which a significant difference in initial and final values for each outcome (T and each SA parameter) could be observed, based on Student t-tests with α=0.05. A representative FSH threshold curve measuring fluctuation in P-value for effect on sperm concentration is provided in Figure 1. Men whose partners achieved pregnancy while taking clomiphene were used to contextualize the computed LH and FSH thresholds. RESULTS: Threshold determinations were made from data on 137 men; 28 had partners achieve pregnancy; 25 of these had pre-treatment LH and FSH levels. Table 1 reports thresholds for either LH or FSH for each outcome. For each given threshold, pregnancy rates are listed. For example, the highest FSH at which to achieve a significant improvement in sperm concentration with clomiphene is a level of 9.9 miU/mL, and this translated to a pregnancy rate of 80% in our cohort. Similar data are presented in Table 1 for each outcome. CONCLUSIONS: Threshold values of gonadotropins were identified, below which statistically significant improvements in testosterone, sperm concentration, total sperm count, and total motile sperm count occurred. These thresholds may be useful in guiding clomiphene use in men contending with hypogonadism or subfertility. Further prospective evaluation is needed to validate these thresholds. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e561-e561 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tommy Jiang More articles by this author Alvaro Santamaria More articles by this author Neilufar Modiri More articles by this author Michael Zheng More articles by this author Vadim Osadchiy More articles by this author John Sigalos More articles by this author Jesse Mills More articles by this author Sriram Eleswarapu More articles by this author Expand All Advertisement Loading ...