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k'?if jfFemf]kg
Male infertility is a relatively common condition
caused by low sperm production, immobile sperm,
or blockages that prevent the delivery of sperm.
This condition can be caused by a variety of
illnesses, injuries, chronic health problems, lifestyle
choices, other factors, or idiopathic, in which
abnormal semen parameters occur without an
identifiable cause. Medical management
traditionally focuses on correcting endocrine
abnormalities related to hormone deficiencies.
Clomiphene citrate is an antiestrogen thought to
increase sperm parameters in males attempting to
conceive.

con...

The objective of this review was to evaluate the

efficacy and safety of clomiphene citrate in the
treatment of male patients with infertility. A literature
search of MEDLINE (1966-June 2012) and EMBASE
(1980-June 2012) was conducted using the medical
terms clomiphene and male infertility and 9 clinical
studies were identified. Overall, only 1 study detected
a statistically significant benefit on the pregnancy
rate in the clomiphene group; however, the majority
of the studies demonstrated a statistically significant
increase in sperm concentrations. At doses used to
treat male infertility, clomiphene was well tolerated
with no identified serious adverse effects. Based on
the reviewed studies there is insufficient evidence to
indicate that clomiphene is effective for the
treatment of male infertility.

Infertility definitions and

terminology
Clinical definitions
Infertility is a disease of the reproductive system

defined by the failure to achieve a clinical

pregnancy after 12 months or more of regular
unprotected sexual intercourse. (WHO-ICMART
glossary1).
Infertility is the inability of a sexually active, noncontracepting couple to achieve pregnancy in one
year. The male partner can be evaluated for
infertility or subfertility using a variety of clinical
interventions, and also from a laboratory
evaluation of semen. (Semen manual, 5th
Edition3).

con...
Demographic definitions of infertility
An inability of those of reproductive age (15-49 years) to

become or remain pregnant within five years of

exposure to pregnancy. (DHS2)
An inability to become pregnant with a live birth, within
five years of exposure based upon a consistent union
status, lack of contraceptive use, non-lactating and
maintaining a desire for a child. (Trends in prevalence4).

Epidemiological definition of infertility

(for monitoring and surveillance) Women of reproductive

age (1549 years) at risk of becoming pregnant (not

pregnant, sexually active, not using contraception and
not lactating) who report trying unsuccessfully for a
pregnancy for two years or more. (Reproductive Health
Indicators)

con...
Infertility as a disability
Disability: Infertility generates disability (an

impairment of function), and thus access to

health care falls under the Convention on the
Rights of Persons with Disability. An estimated
34 million women, predominantly from
developing countries, have infertility which
resulted from maternal sepsis and unsafe
abortion (long term maternal morbidity resulting
in a disability). Infertility in women was ranked
the 5th highest serious global
disability5&6(among populations under the age
of 60).

con...
Primary infertility
When a woman is unable to ever bear a child,

either due to the inability to become pregnant

or the inability to carry a pregnancy to a live
birth she would be classified as having
primary infertility. Thus women whose
pregnancy spontaneously miscarries, or whose
pregnancy results in a still born child, without
ever having had a live birth would present
with primarily infertility. (Trends in
prevalence4).

con...
Secondary infertility
When a woman is unable to bear a child, either

due to the inability to become pregnant or the

inability to carry a pregnancy to a live birth
following either a previous pregnancy or a
previous ability to carry a pregnancy to a live
birth, she would be classified as having secondary
infertility. Thus those who repeatedly
spontaneously miscarry or whose pregnancy
results in a stillbirth, or following a previous
pregnancy or a previous ability to do so, are then
not unable to carry a pregnancy to a live birth
would present with secondarily infertile. (Trends in
prevalence4).