A paradoxical decline in semen parameters in men treated with clomiphene citrate: A systematic review

Tejas Gundewar, Manish Kuchakulla, Ranjith Ramasamy

Research output: Contribution to journalArticlepeer-review


Clomiphene, a selective oestrogen receptor modulator, has been utilised in managing male sub-fertility since 1967. Numerous controlled and uncontrolled studies have been published regarding the efficacy of clomiphene citrate in male sub-fertility cohorts. Although the primary intention of treating men with clomiphene citrate is to improve sperm parameters and testosterone levels, some studies have reported paradoxical decline in semen parameters. The information available on decline in sperm parameters following treatment with clomiphene is sparse. We conducted a systemic review using PubMed, Embase, Cochrane Library and Scopus databases for original studies reporting adverse effects of clomiphene citrate therapy on sperm parameters. This systematic review includes 384 men from 11 different studies that reported adverse effects of clomiphene citrate therapy. Of the men included in these studies, 19%, 21%, 17% and 24% of clomiphene-treated men demonstrated a decrease in sperm count, concentration, motility and total motile sperm count respectively. In up to 17% of patients, deterioration of semen parameters did not recover following discontinuation of therapy. In the future, more studies should report on this aspect so the magnitude of this effect can be more clearly understood.

Original languageEnglish (US)
Article numbere13848
Issue number1
StatePublished - Feb 2021


  • adverse effects
  • azoospermia
  • clomiphene citrate
  • infertility
  • male infertility
  • oligozoospermia
  • semen parameters
  • side effects
  • sperm parameters

ASJC Scopus subject areas

  • Endocrinology
  • Urology


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