Does Clomid work for male infertility?

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