Nonbacterial pyospermia: a consequence of clomiphene citrate therapy.
OBJECTIVE
Since the development of nonbacterial pyospermia in previously nonpyospermic men treated with clomiphene citrate (CC) has been observed, and nonbacterial prostatitis has been after antiestrogen treatment in an animal model, we sought characterize the occurrence of nonbacterial pyospermia in men treated with CC.


METHODS
Forty-two nonpyospermic men with low serum testosterone levels treated with 25 mg CC/day were retrospectively compared to 27 untreated nonpyospermic men referred for infertility evaluation.


RESULTS
Spontaneous nonbacterial pyospermia developed in CC-treated men [14.3%] at rate nearly twice that observed in controls [7.4%]. Serum testosterone increased 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 than nonpyospermic men [pyospermic, 41.7 +/- 8.1 years; nonpyospermic, 35.6 +/- 4.9 years-P < .01). Men over 35 years of age were over six times as likely to develop pyospermia as men under 35 years of age (P < .05). Eight nonpyospermic, CC-treated men (8/36, 22.2%) have contributed to pregnancies leading to live births, whereas no pyospermic man has done so.


CONCLUSIONS
These findings support an association between a nonbacterial inflammatory response of the human male reproductive tract and CC treatment. This pyospermia may occur without significant deterioration of semen characteristics and with an appropriate response to treatment in terms of serum testosterone level. Men over the age of 35 are statistically more likely to develop pyospermia with this therapy. Our results suggest that clomiphene citrate-associated pyospermia has a negative effect on male fertility.
James Buchanan Brady Foundation, Department of Urology, New York Hospital-Cornell University Medical Center, New York, USA.
G J
GJ
Matthews
M
M
Goldstein
J M
JM
Henry
P N
PN
Schlegel
D000328:Adult; D000367:Age Factors; D002996:Clomiphene / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D005303:Fertility Agents, Male / Q000009:adverse effects* / Q000494:pharmacology; D005640:Follicle Stimulating Hormone / Q000097:blood; D005832:Genital Diseases, Male / Q000097:blood / Q000139:chemically induced* / Q000473:pathology*; D006801:Humans; D007248:Infertility, Male / Q000097:blood / Q000188:drug therapy; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012661:Semen / Q000166:cytology* / Q000187:drug effects / Q000502:physiology; D013081:Sperm Motility / Q000502:physiology; D013492:Suppuration / Q000097:blood / Q000139:chemically induced / Q000473:pathology; D013739:Testosterone / Q000097:blood
D005303:Fertility Agents, Male; D002996:Clomiphene; D013739:Testosterone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone