(120) EVALUATING THE IMPACT OF CLOMIPHENE CITRATE USE PRIOR TO VARICOCELECTOMY ON FERTILITY OUTCOMES IN MEN WITH INFERTILITYSHAPE
Authors: Duan M , Saffati G , Orozco Rendon D , Hinojosa-Gonzalez D , Kronstedt S , Khera M 
Published: December 2024

Abstract

Introduction
Varicoceles and hypogonadism have both been implicated as impacting fertility in men. Varicoceles can cause global testicular dysfunction which affects spermatogenesis, DNA fragmentation and in turn testosterone levels. Men, particularly young men, who are diagnosed with hypogonadism will pursue management with clomiphene, a selective estrogen receptor modulator, which has been shown to preserve fertility in men. There have been studies looking at the impact of both clomiphene treatment and varicocelectomy repair on fertility separately. However, to our knowledge, there has not been a study in the literature to determine if combining both treatment modalities of clomiphene and varicocelectomy leads to improved fertility outcomes in men with infertility.

Objective
The aim of this study is to determine whether the use of clomiphene citrate prior to varicocelectomy in patients with male infertility and varicocele has a predictive effect on fertility outcome.

Methods
A retrospective chart review was conducted on patients at a single urban center who presented with male infertility and received a varicocelectomy during their follow ups. Patients were compiled by searching the EHR for ICD code 606.9. Demographic and clinical characteristics were extracted, including age, race, relevant past medical history (hypertension, diabetes mellitus, and hyperlipidemia), hormone levels, semen analysis parameters (volume, total sperm count, and presence of sperm) prior to and post-procedure, and longitudinal success with achieving fertility. Patients were then stratified by whether they used clomiphene before varicocelectomy. Fertility was assessed using semen analysis parameters and patients reported fertility success. Two-way T tests were performed to determine statistical significance.

Results
The study included 79 total patients; 49 (62%) used clomiphene citrate prior to varicocelectomy and 30 (38%) did not. The average age of the cohort was 42.7 (SD 0.6) with 67.1% of the cohort identifying as white. In those who used Clomiphene prior to varicocelectomy 16 (33%) achieved fertility and in those who did not use Clomiphene only 9 (30%) achieved fertility (p = 0.806). Comparing the clomiphene group with the group that did not receive clomiphene failed to show a significant difference in the change in semen analysis parameters after varicocelectomy including total sperm count (p = 0.330), Presence of sperm (p = 0.520) and sperm volume (p = 0.419). There was no difference in the age of men who achieved fertility and that of men who did not (p = 0.066). Analysis of race demonstrated no variances between the treatment groups. Table 1 summarizes the demographics and fertility outcomes of the full cohort along with those of the clomiphene and non-clomiphene cohorts.

Conclusions
Male infertility patients with a diagnosis of varicocele showed similar changes in semen analysis and rates of fertility after varicocelectomy, regardless of whether clomiphene citrate was started prior. Despite each individual treatment modality showing improvement in fertility outcomes, their combination does not improve fertility outcomes for infertile men.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Disclosures: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast, Halozyme Investor: Sprout.