Use of Clomiphene Citrate in the Treatment of Men with High Sperm Chromatin Stability

Abstract

Objective: To determine whether improvements of the seminal vesicle function after a 5-day course with clomiphene citrate (CC) may reduce the prevalence of men with high sperm chromatin stability under conditions of sodium dodecyl sulfate (SDS)-ethylenediaminetetraacetic acid (EDTA).Design: A prospective study.Setting: Andrology laboratory at the Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Peru.Patient(s): Forty-one male partners of infertile couples attending the andrology laboratory.Intervention(s): Clomiphene citrate was administered orally twice a day. Men were treated with CC at 100 mg daily for 5 days. Blood and semen samples were collected before treatment and 24 hours after the last administration.Main Outcome Measure(s): Serum testosterone, seminal fructose, sperm motility, sperm chromatin stability after SDS and EDTA, and prevalence of high sperm chromatin stability.Result(s): The percentage of stable sperm after SDS-EDTA correlated inversely with the basal corrected concentration of seminal fructose (−1.77 ± 0.89, β ± SE). High sperm chromatin stability was observed in 53.8% of the study population and in 66.7% of patients with hypofunction of the seminal vesicles. In those men whose seminal vesicle function improved after treatment with CC, the prevalence of high sperm chromatin stability was reduced from 67% to 25% (χ2 = 5.34). Logistic regression analysis showed that the higher the basal corrected seminal fructose levels and the higher the basal serum testosterone levels, the lower the probability of nonresponse of the sperm chromatin stability to treatment with CC (0.54 ± 0.15, odds ratio ± SE for corrected fructose; and 0.50 ± 0.15, odds ratio ± SE for serum testosterone).Conclusion(s): Hypofunction of the seminal vesicles was associated with high sperm chromatin stability, and this high sperm chromatin stability under SDS-EDTA conditions may be reduced by treatment with CC.