Mp42-04 Clomiphene Citrate and Varicocelectomy vs Varicocelectomy Alone: Impact on Semen Parameters and Pregnancy Rates

You have accessJournal of UrologyInfertility: Therapy (MP42)1 May 2024MP42-04 CLOMIPHENE CITRATE AND VARICOCELECTOMY VS VARICOCELECTOMY ALONE: IMPACT ON SEMEN PARAMETERS AND PREGNANCY RATES Andrew Watts, Daniel Pelzman, Eric Bejarano, and Peter Dietrich Andrew WattsAndrew Watts , Daniel PelzmanDaniel Pelzman , Eric BejaranoEric Bejarano , and Peter DietrichPeter Dietrich View All Author Informationhttps://doi.org/10.1097/01.JU.0001008688.39367.31.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Various studies have demonstrated the benefit of varicocelectomy on both semen parameters as well as conception rates in infertile males. Off-label use of clomiphene citrate has also been shown to improve semen parameters and conception rates, but this has seen a significant nationwide shortage. Our study aims to investigate whether the combined use of clomiphene citrate and varicocelectomy increases the chance of semen analysis parameter improvement and pregnancy rates compared to varicocelectomy alone. METHODS: We conducted a retrospective analysis of male patients presenting to a single center with infertility. Patients were included if they had tried to conceive for 12 months without success, hypogonadism, abnormal semen parameters and a varicocele identified on physical exam by a fellowship trained urologist. Hypogonadism was defined as total testosterone<400 and FSH<7.6. Abnormal semen parameters included<40 million total sperm (TS), <20 million total motile sperm (TMS) and/or<10 million total progressive motile sperm (TPMS). Patients with azoospermia were excluded from the study. Treatment included a subinguinal microscopic varicocelectomy only (VO group) or both clomiphene and varicocelectomy (dual therapy group), and was decided by the patient after counseling on treatment options. Pre- and post-treatment semen analysis parameters, hormone levels and pregnancy rates were analyzed. Multiple comparisons tests were performed to assess statistical differences between the two groups. A 50% improvement was used to establish a clinically relevant increase in semen parameters. RESULTS: 17 patients were included in the VO group and 25 in the dual therapy group. The groups did not significantly differ in pre-treatment semen analysis parameters. Post-treatment, 13 (76.5%) patients in the VO group and 13 (52%) patients in the dual therapy group had at least a 50% improvement in TMS. 12 (70.6%) patients in the VO group and 13 (52%) patients in the dual therapy group had at least a 50% improvement in TPMS. Overall pregnancy rates (including spontaneous and assisted) were statistically similar at 53% in the VO group and 56% in the dual therapy group. CONCLUSIONS: Our study suggests that combination treatment with clomiphene citrate and varicocelectomy for infertile men with varicoceles does not add any synergistic benefit for semen parameters or pregnancy over varicocele alone. This may improve counseling for patients who have the option of combination treatment that they can proceed with surgery alone without inferior outcomes. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e684 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Andrew Watts More articles by this author Daniel Pelzman More articles by this author Eric Bejarano More articles by this author Peter Dietrich More articles by this author Expand All Advertisement PDF downloadLoading ...