Comparison of Micro-TESE Outcomes With and Without Pre-Treatment Clomiphene Citrate in Men With Non-Obstructive Azoospermia

Abstract

Background

Non-obstructive azoospermia (NOA) results from impaired spermatogenesis and remains a major cause of male infertility. Microdissection testicular sperm extraction (micro-TESE) is the preferred method for sperm retrieval. Clomiphene citrate, by improving endogenous gonadotropin release, may enhance testicular testosterone production and support spermatogenesis, potentially improving surgical retrieval outcomes.

Objectives

To compare sperm retrieval rates and hormonal outcomes in NOA patients undergoing micro-TESE with preoperative Clomiphene citrate therapy versus those undergoing micro-TESE without hormonal stimulation.

Methodology

This comparative observational study included men diagnosed with NOA scheduled for micro-TESE. Group A received Clomiphene citrate 25–50 mg daily for 3–6 months prior to surgery, while Group B underwent micro-TESE without medical therapy. Baseline and preoperative hormonal profiles, testicular volume, and intraoperative sperm retrieval rates were recorded. Statistical comparison was performed using independent t-test and Chi-square test, considering p < 0.05 significant.

Results

A total of 60 patients were included, 30 in each group. The mean age in Group A was 33.6 ± 5.2 years, while in Group B it was 34.1 ± 4.9 years (p = 0.62, not significant). The sperm retrieval rate was significantly higher in the Clomiphene-treated group (46.7%) compared to the non-treated group (26.7%), with a statistically significant difference (p = 0.04). Serum testosterone levels increased significantly in Group A after therapy (from 310 ± 75 ng/dL to 520 ± 95 ng/dL, p < 0.01), whereas no substantial change was noted in Group B.

Conclusion

Pre-treatment with Clomiphene citrate prior to micro-TESE improves hormonal profile and significantly increases sperm retrieval rates in selected NOA patients. The therapy appears most beneficial in patients with partial spermatogenic activity and normal or mildly reduced testicular volume. Patients with severe testicular failure may show limited benefit. Clomiphene citrate can be considered a safe, cost-effective adjunct before surgical sperm retrieval.