Efficacy of clomiphene citrate and tamoxifen on pregnancy rates in idiopathic male subfertility: A systematic review and meta-analysis
Objective: Selective estrogen receptor modulators (SERMs) have demonstrated efficacy in the treatment of hypogonadism in males and male factor infertility. Two SERMs, clomiphene citrate and tamoxifen, are now prescribed for off-label use to treat both conditions in males. However, existing literatur...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-01-01
|
| Series: | Asian Journal of Urology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214388224001139 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832582143199412224 |
|---|---|
| author | Shadi Khashaba Shehab Khashaba Anil Krishan Angus Bruce Abdullatif Almaghlouth Jason Huang Mahmoud Mima Craig Niederberger |
| author_facet | Shadi Khashaba Shehab Khashaba Anil Krishan Angus Bruce Abdullatif Almaghlouth Jason Huang Mahmoud Mima Craig Niederberger |
| author_sort | Shadi Khashaba |
| collection | DOAJ |
| description | Objective: Selective estrogen receptor modulators (SERMs) have demonstrated efficacy in the treatment of hypogonadism in males and male factor infertility. Two SERMs, clomiphene citrate and tamoxifen, are now prescribed for off-label use to treat both conditions in males. However, existing literature compares mixed protocols with active management. We aimed to conduct a meta-analysis to evaluate the effect of clomiphene and tamoxifen versus placebo on natural pregnancy rates. Methods: We conducted a comprehensive systematic review of electronic databases: MEDLINE, PubMed/PMC, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, Google Scholar, and Web of Science. Articles satisfying all selection criteria were analyzed. The primary outcome was the incidence of pregnancy after receiving the treatment. Secondary outcomes included serum follicle-stimulating hormone, luteinizing hormone, and testosterone levels, and sperm count and motility. We calculated the pooled odds ratio, risk ratio, and risk difference to ascertain possible alterations in the direction of the pooled effect size. Results: Ten randomized controlled trials were ultimately included and underwent data extraction. Clomiphene citrate and placebo groups had similar pregnancy rates (10.4% and 7.1%, respectively; odds ratio 1.30 [95% confidence interval 0.27–6.17]; p=0.74). No meta-analysis could be calculated for pregnancy rates in tamoxifen versus placebo groups. Heterogeneity among the studies of both SERMs ranged from low to high. Conclusion: Although clomiphene citrate and tamoxifen are often used off-label for the treatment of male infertility secondary to hypogonadism, studies of SERMs in the treatment of idiopathic male factor infertility are limited and heterogenous, preventing this meta-analysis from investigating the efficacy of SERMs on male infertility. The effect of clomiphene citrate or tamoxifen on the pregnancy rate remains uncertain. |
| format | Article |
| id | doaj-art-1065efb32a724ebcb14ff11309a2c334 |
| institution | Kabale University |
| issn | 2214-3882 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Asian Journal of Urology |
| spelling | doaj-art-1065efb32a724ebcb14ff11309a2c3342025-01-30T05:14:17ZengElsevierAsian Journal of Urology2214-38822025-01-011211522Efficacy of clomiphene citrate and tamoxifen on pregnancy rates in idiopathic male subfertility: A systematic review and meta-analysisShadi Khashaba0Shehab Khashaba1Anil Krishan2Angus Bruce3Abdullatif Almaghlouth4Jason Huang5Mahmoud Mima6Craig Niederberger7IVFAustralia, Sydney, AustraliaKing Hamad University Hospital, Busaiteen, BahrainGeorge Eliot Hospital, Nuneaton, UKGuy's Hospital, London, UKKing Faisal University, Riyadh, Kingdom of Saudi ArabiaDepartment of Urology, University of Illinois at Chicago, Chicago, IL, USADepartment of Urology, University of Illinois at Chicago, Chicago, IL, USA; Corresponding author.Department of Urology, University of Illinois at Chicago, Chicago, IL, USAObjective: Selective estrogen receptor modulators (SERMs) have demonstrated efficacy in the treatment of hypogonadism in males and male factor infertility. Two SERMs, clomiphene citrate and tamoxifen, are now prescribed for off-label use to treat both conditions in males. However, existing literature compares mixed protocols with active management. We aimed to conduct a meta-analysis to evaluate the effect of clomiphene and tamoxifen versus placebo on natural pregnancy rates. Methods: We conducted a comprehensive systematic review of electronic databases: MEDLINE, PubMed/PMC, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, Google Scholar, and Web of Science. Articles satisfying all selection criteria were analyzed. The primary outcome was the incidence of pregnancy after receiving the treatment. Secondary outcomes included serum follicle-stimulating hormone, luteinizing hormone, and testosterone levels, and sperm count and motility. We calculated the pooled odds ratio, risk ratio, and risk difference to ascertain possible alterations in the direction of the pooled effect size. Results: Ten randomized controlled trials were ultimately included and underwent data extraction. Clomiphene citrate and placebo groups had similar pregnancy rates (10.4% and 7.1%, respectively; odds ratio 1.30 [95% confidence interval 0.27–6.17]; p=0.74). No meta-analysis could be calculated for pregnancy rates in tamoxifen versus placebo groups. Heterogeneity among the studies of both SERMs ranged from low to high. Conclusion: Although clomiphene citrate and tamoxifen are often used off-label for the treatment of male infertility secondary to hypogonadism, studies of SERMs in the treatment of idiopathic male factor infertility are limited and heterogenous, preventing this meta-analysis from investigating the efficacy of SERMs on male infertility. The effect of clomiphene citrate or tamoxifen on the pregnancy rate remains uncertain.http://www.sciencedirect.com/science/article/pii/S2214388224001139Male fertilityMale infertilityClomiphene citrateTamoxifenSelective estrogen receptor modulator |
| spellingShingle | Shadi Khashaba Shehab Khashaba Anil Krishan Angus Bruce Abdullatif Almaghlouth Jason Huang Mahmoud Mima Craig Niederberger Efficacy of clomiphene citrate and tamoxifen on pregnancy rates in idiopathic male subfertility: A systematic review and meta-analysis Asian Journal of Urology Male fertility Male infertility Clomiphene citrate Tamoxifen Selective estrogen receptor modulator |
| title | Efficacy of clomiphene citrate and tamoxifen on pregnancy rates in idiopathic male subfertility: A systematic review and meta-analysis |
| title_full | Efficacy of clomiphene citrate and tamoxifen on pregnancy rates in idiopathic male subfertility: A systematic review and meta-analysis |
| title_fullStr | Efficacy of clomiphene citrate and tamoxifen on pregnancy rates in idiopathic male subfertility: A systematic review and meta-analysis |
| title_full_unstemmed | Efficacy of clomiphene citrate and tamoxifen on pregnancy rates in idiopathic male subfertility: A systematic review and meta-analysis |
| title_short | Efficacy of clomiphene citrate and tamoxifen on pregnancy rates in idiopathic male subfertility: A systematic review and meta-analysis |
| title_sort | efficacy of clomiphene citrate and tamoxifen on pregnancy rates in idiopathic male subfertility a systematic review and meta analysis |
| topic | Male fertility Male infertility Clomiphene citrate Tamoxifen Selective estrogen receptor modulator |
| url | http://www.sciencedirect.com/science/article/pii/S2214388224001139 |
| work_keys_str_mv | AT shadikhashaba efficacyofclomiphenecitrateandtamoxifenonpregnancyratesinidiopathicmalesubfertilityasystematicreviewandmetaanalysis AT shehabkhashaba efficacyofclomiphenecitrateandtamoxifenonpregnancyratesinidiopathicmalesubfertilityasystematicreviewandmetaanalysis AT anilkrishan efficacyofclomiphenecitrateandtamoxifenonpregnancyratesinidiopathicmalesubfertilityasystematicreviewandmetaanalysis AT angusbruce efficacyofclomiphenecitrateandtamoxifenonpregnancyratesinidiopathicmalesubfertilityasystematicreviewandmetaanalysis AT abdullatifalmaghlouth efficacyofclomiphenecitrateandtamoxifenonpregnancyratesinidiopathicmalesubfertilityasystematicreviewandmetaanalysis AT jasonhuang efficacyofclomiphenecitrateandtamoxifenonpregnancyratesinidiopathicmalesubfertilityasystematicreviewandmetaanalysis AT mahmoudmima efficacyofclomiphenecitrateandtamoxifenonpregnancyratesinidiopathicmalesubfertilityasystematicreviewandmetaanalysis AT craigniederberger efficacyofclomiphenecitrateandtamoxifenonpregnancyratesinidiopathicmalesubfertilityasystematicreviewandmetaanalysis |