可洛米分在男性不孕症的功效評估
林鉅棟1、張奕凱2、張宏江2
1天主教耕莘醫療財團法人耕莘醫院泌尿外科; 2國立台灣大學附設醫院 泌尿部
The effect of clomiphene citrate in infertile men
Chu-Tung Lin1, Yi-Kai Chang2, Hong-Chiang Chang2
1Divisions of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan
2Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
Purpose: Despite the established use of Clomiphene citrate in men, usage in males infertility is off-label use. There are limited data regarding dosage and duration among all infertility men treated with clomiphene citrate. We evaluate the efficacy of clomiphene citrate in infertile men in NTUH.
Materials and Methods: We completed a retrospective study during 2012~2016 in NTUH. A total 71 patients who had diagnosis of infertility received clomiphene citrate therapy (50 mg QD). 44 patients were enrolled. Baseline FSH, LH Testosterone levels was collected. We compared testosterone, FSH, LH level after 4 weeks. 32 patients have complete sperm data: sperm volume(ml), sperm concentration(million/ml) and motile concentration(million/ml). 17 patients received clomiphene citrate therapy for 4weeks, and 15 patients received for 8 weeks. We evaluated the effect of clomiphene citrate on sperm data after 4 weeks and after 8 weeks, respectively.
Results: Seventy-one men placed on clomiphene citrate were identified; however, 27 men were excluded because of incomplete baseline labs. Thus, a total of 44 men were included in this analysis. Mean age and BMI were 36.9±4.7 years and 25.8±2.9 kg/m2, respectively. Mean baseline testosterone, FSH, LH were 3.2±1.2 ng/ml, 7.1±4.4 mIU/ml and 4.1±2.1 mIU/ml, respectively. At 4 weeks, mean baseline testosterone, FSH, LH increased to 7.3±2.6 ng/ml, 14.3±8.8 mIU/ml and 9.3±4.8 mIU/ml (P< 0.05). 32 patients have complete sperm data. 17 patients received clomiphene citrate therapy for 4weeks. At 4 weeks, mean sperm volume, concentration and motile concentration increased from 3.3±1.2 ml, 11.1±9.7 millions/ml and 2.6±3.3 millions/ml at baseline to 3.1±1.3 ml(P:0.55), 18.3±30.9 millions/ml(P:0.31) and 7.8±20.7 millions/ml(P: 0..29). 15 patients received clomiphene citrate therapy for 8weeks. At 8 weeks, mean sperm volume, concentration and motile concentration increased from 4.0±2.1 ml, 6.5±7.6 millions/ml and 2.8±3.4 millions/ml at baseline to 3.4±1.7 ml(P:0.23), 13.2±13.4 millions/ml(P:0.03) and 3.2±3.9 millions/ml(P:0.08) Conclusions: In this study, patients who received clomiphene citrate for 4weeks have significant difference on serum hormone levels. Patients who received clomiphene citrate for 8 weeks have significant difference on serum sperm concentration. We hypothesize that extending the duration of treatment may has benefits on improvement of parameters.