Does Clomid work for male infertility?


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By
Claire Sissons   
Reviewed
by Lindsay Slowiczek, PharmD
What
is clomiphene citrate? | Does it work in males? | When do doctors prescribe it? | Side effects | Other male fertility treatments | Summary
Clomid is the former brand
name of the drug clomiphene citrate, which doctors use to treat infertility in
females. Sometimes, however, they may also prescribe it off-label for males
with infertility.
Infertility can affect both
males and females. According to the National Institute for Child Health and
Human Development, infertility results from:

  • male reproductive issues
    one-third of the time
  • female reproductive issues
    one-third of the time
  • unknown issues or both male
    and female reproductive issues one-third of the time
Doctors consider a person to
have infertility if they are unable to achieve pregnancy after trying for 1
year.
In this article, we discuss
what clomiphene citrate is, whether it works for males with infertility, and
when doctors prescribe it to males. We also cover its side effects and other
male fertility treatments.
What
is clomiphene citrate?
Clomiphene citrate is a type
of ovary stimulant. Doctors commonly prescribe this medication to treat
infertility in females.
Clomiphene citrate works in a
similar way to estrogen, which is a female sex hormone. Taking this drug
encourages ovulation, or the release of an egg from the ovaries. This can help
boost fertility for females who have difficulty conceiving due to issues with
ovulation.
The Food and Drug
Administration (FDA) have approved clomiphene citrate for the treatment of
infertility in females. However, doctors sometimes also prescribe clomiphene
citrate off-label for treating males with infertility.
“Off-label” means
that the FDA have not approved this particular use of the drug.
Does
it work in males?
In males, clomiphene citrate
increases levels of luteinizing hormone (LH) and follicle-stimulating hormone
(FSH). These hormones are important for fertility and are present in both males
and females.
LH encourages the release of
testosterone in males. FSH is important in the first stage of sperm production,
or spermatogenesis.
Increasing the level of these
hormones in the body can lead to an increase in testosterone and the creation
of more sperm. However, hormone interactions are complex, and there is not
currently enough research to know whether boosting LH and FSH has a direct
impact on male fertility. Taking clomiphene citrate may work for some males and
not others.
According to one 2015 review,
there have been mixed results from clinical studies testing the effectiveness
of taking clomiphene citrate for male infertility.
The drug may improve sperm
motility for some males. Motility refers to how well sperm move through the
female reproductive system to fertilize an egg.
However, using clomiphene
citrate may reduce total sperm count in some males. This reduction may relate
to dosage of the medication.
Because the FDA have not
approved clomiphene citrate for treating infertility in males, there is no
agreement on the best dosage. For this reason, doctors need to rely on their
own judgment when prescribing this drug.
However, studies suggest a
dosage of anywhere between 12.5 and 400 milligrams (mg) per day. A small
meta-analysis including three studies found that a daily dose of 50 mg may
improve fertility.
There is also no agreed length
of time for how long a male should take this medication.
Researchers need to carry out
more studies to determine whether clomiphene citrate is effective for treating
male infertility, which types of male infertility it might treat, and what the
ideal dosage may be.
When do doctors prescribe it
for males?


Doctors can choose to
prescribe a medication off-label if they believe that the benefits outweigh the
risks.
Though the FDA have only
approved clomiphene citrate for the treatment of infertility in females,
doctors may also choose to prescribe it for males with unexplained infertility
or when other treatments have been unsuccessful or are unsuitable.
However, it is important for
the doctor to explain that neither the safety nor the effectiveness of the drug
for this purpose are fully known, and to ensure that the person understands any
potential risks.
Side
effects
Clomiphene citrate can cause
side effects in some people. These can include:

  • headache
  • nausea and vomiting
  • problems with vision
  • dizziness
  • stomach pain or discomfort
  • mouth ulcers
  • cataracts
  • breast growth
If a person experiences side
effects from taking clomiphene citrate, they should seek medical advice. A
doctor may advise that they stop taking the drug or lower the dosage.
Some males may choose to take
clomiphene citrate because they believe that it will improve mood, enhance
their performance during exercise, or increase energy.
Doctors sometimes prescribe it
off-label as an alternative option for people who cannot take testosterone
therapy. Because clomiphene citrate increases testosterone levels, it may help
improve symptoms of hypogonadism in some people.
Other
male fertility treatments
Treatment for male infertility
depends on the underlying cause, but it can include medications and surgery. If
successful, these treatments will help a person conceive naturally.
Some causes of male
infertility and the medications that a doctor may recommend for them include:
Cause
of male infertility and Medication

Cause:
Hyperprolactinemia, a
condition in which the body makes too much of a hormone called prolactin.
    


Medication
Dopamine agonists such as bromocriptine.


Cause:
Hypogonadotropic hypogonadism,
which is when the testicles do not produce testosterone.   



Medication
Testosterone replacement or medications containing
gonadotropin-releasing hormone.

Cause:
High levels of reactive oxygen
species molecules in the sperm. 



Medication
Vitamin E and selenium supplements.

Cause:
Retrograde ejaculation, which
occurs when semen flows backward into the bladder.     



Medication
Initial treatment with over-the-counter decongestant
medications, such as pseudoephedrine.
For some causes of male
infertility, a doctor may recommend surgery. This can include:
Cause
of male infertility  Surgery
Cause:
Varioceles, or swollen veins
in the testicles.  



Medication
A doctor can perform
minor surgery to block blood flow to the vein.


Cause:
Azoospermia, which occurs when
a person has too little sperm in their semen.     



Medication
A
doctor may recommend surgical sperm retrieval. This involves using a small
needle to collect sperm from the testicle for use in vitro fertility
treatments.
Cause:
Ejaculatory duct blockage, which
prevents sperm ejaculation.    



Medication
A surgeon
can make a small incision in the duct to unblock it.
The cause of male infertility
is not always clear, and treatment with drugs or surgery may not be effective.
In such cases, a doctor may
recommend assisted reproductive technology. These methods can bring egg and
sperm together to create an embryo without sex.
Some
common examples include:

  • Intrauterine insemination.
    This involves taking a male’s sperm and placing it directly into a female’s
    uterus to fertilize an egg.
  • In vitro fertilization. This
    involves a healthcare provider bringing sperm and egg together in a laboratory
    to create an embryo and then placing it into a person’s uterus.
  • Intracytoplasmic sperm
    injection. This involves injecting an egg with a single sperm to create an
    embryo and then placing it into a person’s uterus.
Summary
Clomiphene citrate is a
medication for treating infertility in females. Although the FDA have not
approved clomiphene citrate for treating males with infertility, doctors
sometimes choose to prescribe it off-label for this use.
In some males, clomiphene
citrate may boost fertility, but it is not clear whether it works for all
males.
Scientists now need to carry
out more studies to fully understand the how taking clomiphene citrate affects
males hormones and fertility.
SOURCE:
MEDICAL NEWS TODAY
Kayode Ojo
Kayode Emmanuel Ojo is the Co-Founder and Managing Director at SHEFFA Limited. He is presently studying Computer Science at the National Open University, Victoria Island, Lagos.