HORMONAL EVALUATION IN IDIOPATHIC OLIGOZOOSPERMIA - CORRELATION WITH RESPONSE TO CLOMIPHENE CITRATE THERAPY AND SPERM MOTILITY

The reported response of sperm count to clomiphene citrate therapy in subfertile males with idiopathic oligozoospermia has been widely varia ble. The author postulates that this may be due in part to patient het erogeneity that may be reflected in pretreatment hormonal status. Seve nteen patients with idiopathic oligozoospermia (mean +/- SE sperm dens ity of 7.3 +/- 1.2 x 10(6) sperm/mL, mean FSH of 5 +/- 0.5 IU/L) were studied. Pretreatment basal LH, FSH, testosterone, free T4, and prolac tin levels as well as LHRH-stimulated LH and FSH levels were examined in relation to pretreatment semen parameters and percent change in spe rm count after a mean of 7.2 +/- 0.6 months of clomiphene citrate ther apy. The percentage of motile sperm correlated with basal LH (n = .59, p = .02; n = 16) and free T4 levels (r = .62, p = .02, n = 13). Clomi phene citrate therapy was associated with a significant increase in to tal sperm count (mean percent change 261 +/- 117, p = .02) and in tota l motile sperm count (mean percent change 370 +/- 216, p = .03). Perce nt change in total sperm counts and in total motile sperm counts corre lated positively with pretreatment prolactin levels (r = .64, p = .007 , n = 16, and r = .62, p = .01, n = 15), but not with the levels of ot her hormones. The results suggest that in patients with idiopathic oli gozoospermia (1) clomiphene citrate therapy may be more effective in t he subgroup of patients who have relatively higher prolactin levels, ( 2) basal and stimulated gonadotropin levels may not be helpful in pred icting the response to clomiphene citrate therapy, and (3) lower sperm motility is associated with relatively higher free T4 and lower LH le vels. The underlying mechanisms and the clinical utility of the curren t observations deserve further study.