NONBACTERIAL PYOSPERMIA - A CONSEQUENCE OF CLOMIPHENE CITRATE THERAPY

Objective - Since the development of nonbacterial pyospermia in previo usly nonpyospermic men treated with clomiphene citrate ICC) has been o bserved, and nonbacterial prostatitis has been seen after antiestrogen treatment in an animal model, we sought characterize the occurrence o f nonbacterial pyospermia in men treated with CC. Patients and Methods - Forty-two nonpyospermic men with low serum testosterone levels trea ted with 25 mg CC/day were retrospectively compared to 27 untreated no npyospermic men referred for infertility evaluation. Results - Spontan eous nonbacterial pyospermia developed in CC-treated men (14.3%) at ra te nearly twice that observed in controls (7.4%). Serum testosterone i ncreased in CC-treated men, both pyospermic and nonpyospermic. However , only CC-treated, nonpyospermic men demonstrated improvement in semen characteristics. CC-treated men who developed pyospermia were older t han nonpyospermic men (pyospermic, 41.7 +/- 8.1 years; nonpyospermic, 35.6 +/- 4.9 years-l) < .01). Men over 35 years of age were over six t imes as likely to develop pyospermia as men under 35 years of age (P < .05). Eight nonpyospermic, CC-treated men 18/36, 22.2%) have contribu ted to pregnancies leading to live births, whereas no pyospermic man h as done so. Conclusion-These findings support an association between a nonbacterial inflammatory response of the human male reproductive tra ct and CC treatment. This pyospermia may occur without significant det erioration of semen characteristics and with an appropriate response t o treatment in terms of serum testosterone level. Men over the age of 35 are statistically more likely to develop pyospermia with this thera py. Our results suggest that clomiphene citrate-associated pyospermia has a negative effect on male fertility.