Effectiveness of clomiphene citrate on total motile sperm count and hormonal profile in men with clinical infertility

Authors

  • Connor Roque Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
  • Yool Ko Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
  • Maximilian G. Fidel Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
  • Jainik Shah Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
  • Sahand Malek Marzban Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
  • Harliv Dhillon Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
  • Ahmed Almuhanna Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
  • Avinash Sarcar Men’s Health Clinic Manitoba, Winnipeg, MB
  • Premal Patel Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada

DOI:

https://doi.org/10.5489/cuaj.9493

Keywords:

Clomiphene Citrate, Idiopathic Male Infertility, Total Motile Sperm Count

Abstract

Introduction: Infertility affects 15% of couples worldwide, yet evidence for empiric therapy in idiopathic male factor infertility is limited. Clomiphene citrate (CC), a selective estrogen receptor modulator that stimulates gonadotropins, is widely prescribed, but its impact on total motile sperm count (TMSC) and reproductive hormones remains uncertain. This study evaluated CC therapy and subsequent changes in TMSC and hormones in infertile men.

Methods: This single-center, retrospective cohort included 60 men ≥18 years with idiopathic infertility treated with CC between January 2022 and November 2024. The primary outcome was change in TMSC; secondary outcomes were changes in testosterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and 17-hydroxyprogesterone (17-OHP) before and after CC. Hormonal changes were assessed with paired t-tests; primary vs. secondary infertility with independent t-tests; and predictors of TMSC change with multivariable linear regression.

Results: Sixty men (mean age 35.6±4.6 years) were treated for 12.9±6.1 months. Following CC, mean TMSC increased by 13.1 million (p=0.005), 17-OHP by 1.8 nmol/L, testosterone by 9.9 nmol/L, FSH by 4.9 IU/L, LH by 4.8 IU/L, and estradiol by 53.9 pmol/L (all p<0.001). TMSC change was not linked to age, body mass index (BMI), baseline hormones, or treatment duration. Men with primary (n=46) vs. secondary infertility (n=14) demonstrated similar TMSC and hormonal changes.

Conclusions: CC was associated with higher TMSC and reproductive hormones. Response was independent of age, BMI, baseline hormones, and duration. Larger, prospective studies are needed to confirm findings and guide candidate selection.

Downloads

Download data is not yet available.

Downloads

Published

2026-03-16

How to Cite

Roque, C., Ko, Y., Fidel, M. G., Shah, J., Malek Marzban, S., Dhillon, H., … Patel, P. (2026). Effectiveness of clomiphene citrate on total motile sperm count and hormonal profile in men with clinical infertility. Canadian Urological Association Journal, 20(7). https://doi.org/10.5489/cuaj.9493

Issue

Vol. 20 No. 7 (2026): CUAJ July

Section

Original Research

License

You, the Author(s), assign your copyright in and to the Article to the Canadian Urological Association. This means that you may not, without the prior written permission of the CUA:

  • Post the Article on any Web site
  • Translate or authorize a translation of the Article
  • Copy or otherwise reproduce the Article, in any format, beyond what is permitted under Canadian copyright law, or authorize others to do so
  • Copy or otherwise reproduce portions of the Article, including tables and figures, beyond what is permitted under Canadian copyright law, or authorize others to do so.

The CUA encourages use for non-commercial educational purposes and will not unreasonably deny any such permission request.

You retain your moral rights in and to the Article. This means that the CUA may not assert its copyright in such a way that would negatively reflect on your reputation or your right to be associated with the Article.

The CUA also requires you to warrant the following:

  • That you are the Author(s) and sole owner(s), that the Article is original and unpublished and that you have not previously assigned copyright or granted a licence to any other third party;
  • That all individuals who have made a substantive contribution to the article are acknowledged;
  • That the Article does not infringe any proprietary right of any third party and that you have received the permissions necessary to include the work of others in the Article; and
  • That the Article does not libel or violate the privacy rights of any third party.