Clomid for Men: Does it Increase Fertility?

Overview

Clomid is a popular brand name and nickname for generic clomiphene citrate.

The U.S. Food and Drug Administration (FDA) approved this oral fertility medication for use in women who are unable to become pregnant. It affects the hormone balance within the body and promotes ovulation.

The FDA approved Clomid only for use in women. It’s sometimes prescribed off-label as an infertility treatment in men. Learn more about off-label prescription drug use.

Is Clomid an effective treatment for male infertility? Read on to learn more.

How does Clomid work?

Clomid blocks the hormone estrogen from interacting with the pituitary gland. When estrogen interacts with the pituitary gland, less luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are produced.

This leads to a decrease in testosterone and therefore decreased sperm production. Because Clomid blocks estrogen’s interaction with the pituitary gland, there’s an increase in LH, FSH, and testosterone in the body.

Optimal dosing in males hasn’t been established. The dose given can range from 12.5 to 400 milligrams (mg) per day.

A recent review recommends a starting dosage of 25 mg three days per week and then slowly titrating — or adjusting the dosage — until the dose is 50 mg per day as needed.

High doses of Clomid can actually have a negative effect on sperm count and motility. Always work with your healthcare provider to ensure proper dosage.

When is Clomid prescribed?

Clomid is prescribed off-label for male infertility, particularly where low testosterone levels are observed.

According to the Centers for Disease Control and Prevention, both a male and a female factor are identified in 35 percent of couples who encounter challenges trying to conceive. In 8 percent of couples, only a male factor is identified.

Many things can contribute to male infertility. These include:

  • injury to the testicles
    • age
  • overweight or obesity
  • heavy use of alcohol, anabolic steroids, or cigarettes
  • hormonal imbalance, caused by improper function of the pituitary gland or exposure to too much estrogen or testosterone
  • medical conditions, including diabetes, cystic fibrosis, and some types of autoimmune disorders
  • cancer treatment involving certain types of chemotherapy or radiation
  • varicoceles, which are enlarged veins that cause the testicles to overheat
  • genetic disorders, such as a microdeletion in the Y-chromosome or Klinefelter syndrome

If the doctor suspects male infertility, they’ll order a semen analysis. They’ll use a sample of semen to assess the sperm count as well as sperm shape and movement.

What are the side effects of this medication?

There are few controlled studies of Clomid use in males. However, possible side effects due to induced hormonal changes include:

  • tenderness of the pectoral muscle
  • irritability
    • acne
  • acceleration of prostate cancer growth (if cancer is already present)
  • changes in vision that are caused by a swelling of the pituitary gland (rare)

The side effects of Clomid are typically reversible after stopping the medication. If any of the side effects listed above occur while taking Clomid, discontinue taking Clomid and seek medical treatment.

Efficacy for fertility

A recent review of Clomid use in male infertility cases found mixed results regarding efficacy, or effectiveness.

Some of the studies reviewed demonstrated a moderate improvement in sperm count in males with low sperm count or unexplained infertility.

Others indicated no improvement when compared to either placebo or an untreated control. This was especially true when looking at pregnancy outcomes.

A recent study showed an increase in pregnancies when infertile males took a combination of Clomid and vitamin E when compared to placebo.

However, the study didn’t compare the Clomid/vitamin E group with a group taking Clomid alone. As a result, the study was unable to provide information regarding whether combining Clomid with vitamin E increases efficacy as it relates to pregnancy.

In a 2015 study, researchers divided participants diagnosed with male infertility into three groups:

  • Group A: Participants taking vitamin E only
  • Group B: Participants taking Clomid only
  • Group C: Participants taking Clomid and vitamin E

The study results showed an increase in the average sperm concentration across all three groups. Group C showed the highest increase. Group A showed the second-highest increase. This was a limited study. Limitations include:

  • small sample size
  • no placebo
  • absence of pregnancy rates across all three groups

Another recent review suggested that the most likely population to benefit from Clomid treatment is males with both unexplained infertility and normal to below- average sperm motility and shape.

It’s believed that males in this population would be able to use Clomid to reach a sperm count that would make them good candidates for artificial insemination.

Other treatments for male factor infertility

Depending on the cause, male infertility may be treated using several different methods:

Medications

There are other medications available that your doctor can prescribe for hormonal imbalance. These drugs also increase the amount of testosterone and decrease the amount of estrogen in the body.

  • Human chorionic gonadotropin (hCG) can be given as an injection. It can stimulate the testes to generate testosterone.
  • Anastrozole (Arimidex) is a drug that was developed for breast cancer. It prevents testosterone from being converted to estrogen within the body.
Surgery

If there’s a blockage that prevents transportation of sperm, the doctor may recommend surgery to repair this. Surgery can also correct varicoceles.

Artificial insemination

In this treatment, a special preparation of sperm is placed into a mother’s uterus. Before artificial insemination, the mother may take medication that promotes ovulation. Read these encouraging artificial insemination success stories.

In vitro fertilization

In vitro fertilization (IVF) involves handling both the egg and the fertilized embryo outside of the body. Eggs are removed from the mother’s ovaries using a needle. The eggs are then combined with sperm in the laboratory. The resulting embryo is then returned to the mother’s body.

A specific form of IVF called intracytoplasmic sperm injection (ICSI) can be used in cases of male infertility. ICSI involves injection of a single sperm into the egg.

The takeaway

Clomid is typically used as an infertility treatment in females. It’s not approved by the FDA for use in males, but it’s often prescribed off-label for treatment of male infertility.

Taking Clomid can lead to an increase in testosterone and sperm count. Studies on its efficacy in males have had mixed results.

There are additional treatments for male infertility, including:

  • other medications
  • surgery to remove blockages
  • artificial insemination
    • IVF

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