Tuesday, May 01, 2007

Clomid and Male Fertility

I like clomid--AKA clomiphene citrate. It is a good drug and very effective for the right patient at the right time. Unfortunately, clomid is not indicated or approved for use in men and it is expensive. Clomid is indicated for use in infertile woman and is used to induce ovulation. Men don't ovulate. Prescribing clomid for men is difficult due to insurance coverage issues. Every time I write for clomid, I get a flurry of phone calls, first from the pharmacist who informs that the clomid is only for women, then from the patient who informs me that the pharmacist informed them that clomid is only for women, and then I get the phone calls back and forth to the insurance carrier as I try to get the medication covered for the patient. As you can imagine, prescribing clomid to men is a royal pain and I, therefore, really and truly only do it when it is indicated.

Here is when I think it works.

  • Men with low AM testosterone and low sperm counts AND low or low normal FSH and LH levels.

Other male infertility specialists that I know and respect use clomid in other situations as well, such as for men with low testosterone and sperm counts but high/high normal FSH/LH levels. Personally, I don't do this, but they do and claim to have results.

When I have men on clomid, I like to check hormone levels, specifically testosterone and estradiol, every 2 or so weeks, at least until hormone levels stabilize. Why do I check estradiol levels? Testosterone can be converted to estradiol, which can then cause breast enlargement.

There you have it.


Dr S.