Comparison of Letrozole and Clomiphene in Infertile Male Patients with Oligoasthenozoospermia

Comparison of Letrozole and Clomiphene in Male Infertility

Authors

  • Muhammad Seerwan Department of Urology, Gomal Medical College, Dera Ismail Khan, Pakistan
  • Muhammad Ilyas Department of Urology, Gomal Medical College, Dera Ismail Khan, Pakistan
  • Muhammad Adnan Department of Urology, Bakhtawar Amin Medical College, Multan, Pakistan
  • Muhammad Muzammil Department of Nephrology, Bakhtawar Amin Medical College, Multan, Pakistan
  • . Saifullah Department of Urology, Bakhtawar Amin Medical College, Multan, Pakistan
  • Ali Shandar Durrani Department of Urology, Sheikh Zayed Hospital, Lahore, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i11.3372

Keywords:

Oligoasthenozoospermia, Letrozole, Clomiphene Citrate, Sperm Concentration, Sperm Motility

Abstract

Infertility often causes significant emotional distress, and in about 50% of cases, male factors such as oligoasthenozoospermia play a key role in the challenges you're facing. Objectives: To compare two medications, clomiphene citrate and letrozole, to see which one works better for improving sperm count and motility in men with oligoasthenozoospermia. Methods: This non-randomized controlled study was conducted at DHQ Teaching Hospital in D.I. Khan with 140 men diagnosed with oligoasthenozoospermia. Participants were divided into two groups of 70, receiving either letrozole or clomiphene citrate. Sperm concentration and motility were measured at three months, with improvements compared between the two groups. Statistical analysis was performed using SPSS version 21, with p-values <0.05 considered significant. Results: Both letrozole and clomiphene significantly improved sperm concentration and motility, with letrozole showing greater improvement in both parameters compared to clomiphene citrate. An increase of 48.23% in sperm concentration was observed in the letrozole group, while the clomiphene citrate group showed a 26.26% increase at 12 weeks post-treatment. Sperm motility improved by 42.08% with letrozole and by 18.55% with clomiphene citrate at the 12-week mark. Conclusions: Both letrozole and clomiphene citrate have been shown to improve sperm parameters in men diagnosed with oligoasthenozoospermia. The letrozole group showed a more significant effect than the clomiphene group.

References

Larsen U, Hollos M, Obono O, Whitehouse B. Suffering Infertility: The Impact of Infertility on Women's Life Experiences in Two Nigerian Communities. Journal of Biosocial Science. 2010 Nov; 42(6): 787-814. doi: 10.1017/S0021932010000271. DOI: https://doi.org/10.1017/S0021932010000271

Babakhanzadeh E, Nazari M, Ghasemifar S, Khodadadian A. Some Of the Factors Involved in Male Infertility: A Prospective Review. International Journal of General Medicine. 2020 Feb: 29-41. doi: 10.2147/IJGM.S241099 DOI: https://doi.org/10.2147/IJGM.S241099

Centers for Disease Control and Prevention. Infertility: Frequently Asked Questions. 2024 May. Accessed: December 5, 2024. https://www.cdc.gov/reproductivehealth/infertility-faq/index.html.

Virtanen HE, Jørgensen N, Toppari J. Semen quality in the 21st Century. Nature Reviews Urology. 2017 Feb; 14(2): 120-30. doi: 10.1038/nrurol.2016.261. DOI: https://doi.org/10.1038/nrurol.2016.261

Mazzilli R, Rucci C, Vaiarelli A, Cimadomo D, Ubaldi FM, Foresta C, et al. Male factor infertility and assisted reproductive technologies: indications, minimum access criteria and outcomes. Journal of Endocrinological Investigation. 2023 Jun; 46(6): 1079-85. DOI: https://doi.org/10.1007/s40618-022-02000-4

Nayan M, Punjani N, Grober E, Lo K, Jarvi K. The use of assisted reproductive technology before male factor infertility evaluation. Translational andrology and urology. 2018 Aug; 7(4): 678. DOI: https://doi.org/10.21037/tau.2018.06.08

Amor DJ, Kerr A, Somanathan N, McEwen A, Tome M, Hodgson J, Lewis S. Attitudes of Sperm, Egg and Embryo Donors and Recipients Towards Genetic Information and Screening of Donors. Reproductive Health. 2018 Feb; 15(1): 26. doi: 10.1186/s12978-018-0468-9. DOI: https://doi.org/10.1186/s12978-018-0468-9

Agarwal A, Mulgund A, Hamada A, Chayatte MR. A Unique View on Male Infertility Around the Globe. Reproductive Biology and Endocrinology. 2015; 13: 37. doi: 10.1186/s12958-015-0032-1. DOI: https://doi.org/10.1186/s12958-015-0032-1

Barak S, Baker HG. Clinical Management of Male Infertility. Endotext [Internet]. 2016; Updated edition. doi: 10.1016/B978-0-323-18907-1.00141-4. DOI: https://doi.org/10.1016/B978-0-323-18907-1.00141-4

Çayan S, Altay AB, Rambhatla A, Colpi GM, Agarwal A. Is There a Role for Hormonal Therapy in Men with Oligoasthenoteratozoospermia (OAT)? Journal of Clinical Medicine. 2025; 14(1): 185. doi: 10.3390/jcm14010185. DOI: https://doi.org/10.3390/jcm14010185

Earl JA, Kim ED. Enclomiphene Citrate: A Treatment that Maintains Fertility in Men with Secondary Hypogonadism. Expert Review of Endocrinology and Metabolism. 2019; 14(3): 157–165. doi: 10.1080/17446651.2019.1612239. DOI: https://doi.org/10.1080/17446651.2019.1612239

Gurung P, Jialal I. Physiology of the Male Reproductive System. StatPearls Publishing, Treasure Island. 2019; Updated edition.

Duca Y, Calogero AE, Cannarella R, Condorelli RA, La Vignera S. Current and Emerging Medical Therapeutic Agents for Idiopathic Male Infertility. Expert Opinion on Pharmacotherapy. 2019; 20(1): 55–67. doi: 10.1080/14656566.2018.1543405. DOI: https://doi.org/10.1080/14656566.2018.1543405

Zubair M, Sajid S. Effects of Clomiphene Citrate on the Reproductive System of Birds and Mammals. Veterinary Science Research Reviews. 2015; 1(1): 1–5.

Ambar RF, Maziotis E, Simopoulou M. Sperm Concentration and Total Sperm Count. InHuman Semen Analysis: From the WHO Manual to the Clinical Management of Infertile Men. 2024 Jul; 31-60. Cham: Springer International Publishing. doi: 10.1007/978-3-031-55337-0_4 DOI: https://doi.org/10.1007/978-3-031-55337-0_4

Maleki-Saghooni N, Mirzaeii K, Hosseinzadeh H, Sadeghi R, Irani M. A Systematic Review and Meta-Analysis of Clinical Trials on Saffron (Crocus sativus) Effectiveness and Safety on Erectile Dysfunction and Semen Parameters. Avicenna Journal of Phytomedicine. 2018; 8(3): 198–210.

Eisenberg ML, Lathi RB, Baker VL, Westphal LM, Miliki AA, Nangia AK. Frequency of Male Infertility Evaluation: Data from the National Survey of Family Growth. Journal of Urology. 2013; 189(3): 1030–1034. doi: 10.1016/j.juro.2012.08.239. DOI: https://doi.org/10.1016/j.juro.2012.08.239

Sokol P, Drakopoulos P, Polyzos NP. The Effect of Ejaculatory Abstinence Interval on Sperm Parameters and Clinical Outcome of ART: A Systematic Review. Journal of Clinical Medicine. 2021; 10(15): 3213. doi: 10.3390/jcm10153213. DOI: https://doi.org/10.3390/jcm10153213

Hulley SB, Cummings SR, Browner WS, Grady D, Newman TB. Designing Clinical Research: An Epidemiologic Approach. 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2013; Appendix 6C: 79.

Bozhedomov VA, Lipatova NA, Bozhedomov GE, Rokhlikov IM, Shcherbakova EV, Komarina RA. Using L- and Acetyl-L-Carnitines in Combination with Clomiphene Citrate and Antioxidant Complex for Treating Idiopathic Male Infertility: A Prospective Randomized Trial. Urological Journal. 2017; 3: 22–32. doi: 10.18565/urol.2017.3.22-32. DOI: https://doi.org/10.18565/urol.2017.3.22-32

Wiehle RD, Fontenot GK, Wike J, Hsu K, Nydell J, et al. Enclomiphene Citrate Stimulates Testosterone Production while Preventing Oligospermia: A Randomized Phase 2 Clinical Trial. Fertility and Sterility. 2014; 102: 720–727. doi: 10.1016/j.fertnstert.2014.06.004. DOI: https://doi.org/10.1016/j.fertnstert.2014.06.004

Bridges N, Trofimenko V, Fields S, Carrel D, Aston K, et al. Male Factor Infertility and Clomiphene Citrate: A Meta-Analysis. Urology Practice. 2015; 2: 199–205. doi: 10.1016/j.urpr.2014.10.007. DOI: https://doi.org/10.1016/j.urpr.2014.10.007

Majzoub A, Agarwal A. Systematic Review of Antioxidant Types and Doses in Male Infertility: Benefits on Semen Parameters, Assisted Reproduction, and Live-Birth Rate. Arab Journal of Urology. 2018; 16(1): 113–124. doi: 10.1016/j.aju.2017.11.013. DOI: https://doi.org/10.1016/j.aju.2017.11.013

Chelab M, Madala A, Trussell JC. On-Label and Off-Label Drugs Used in the Treatment of Male Infertility. Fertility and Sterility. 2015; 103: 595–604. doi: 10.1016/j.fertnstert.2014.12.122. DOI: https://doi.org/10.1016/j.fertnstert.2014.12.122

Puia D and Pricop C. Effectiveness of Clomiphene Citrate for Improving Sperm Concentration: a Literature Review and Meta-Analysis. Cureus. 2022 May; 14(5). DOI: https://doi.org/10.7759/cureus.25093

Pate DP, Brant WO, Myers JB, et al. The Safety and Efficacy of Clomiphene Citrate in Hypoandrogenic and Subfertile Men. International Journal of Impotence Research. 2015; 27: 221–224. doi: 10.1038/ijir.2015.21. DOI: https://doi.org/10.1038/ijir.2015.21

Garcia-Velasco J. Office Management of Endometriosis. Office Care of Women. 2016 Jun: 274. DOI: https://doi.org/10.1017/CBO9781316084380.026

Liu S, Matthew LS, Seyed ES, Zheng J, Tan TY, Jessie PW, et al. Do Men with Normal Testosterone: Oestradiol Ratios Benefit from Letrozole for the Treatment of Male Infertility? Journal of Reproductive Biomedicine. 2019; 38(1): 39–45. doi: 10.1016/j.rbmo.2018.09.016. DOI: https://doi.org/10.1016/j.rbmo.2018.09.016

Downloads

Published

2025-11-30
CITATION
DOI: 10.54393/pjhs.v6i11.3372
Published: 2025-11-30

How to Cite

Seerwan, M., Ilyas, M., Adnan, M., Muzammil, M., Saifullah, ., & Durrani, A. S. (2025). Comparison of Letrozole and Clomiphene in Infertile Male Patients with Oligoasthenozoospermia: Comparison of Letrozole and Clomiphene in Male Infertility. Pakistan Journal of Health Sciences, 6(11), 48–52. https://doi.org/10.54393/pjhs.v6i11.3372

Issue

Section

Original Article

Plaudit

Most read articles by the same author(s)