Matthews G J, Goldstein M, Henry J M, Schlegel P N
James Buchanan Brady Foundation, Department of Urology, New York Hospital-Cornell University Medical Center, New York, USA.
Int J Fertil Menopausal Stud. 1995 Jul-Aug;40(4):187-91.
Since the development of nonbacterial pyospermia in previously nonpyospermic men treated with clomiphene citrate (CC) has been observed, and nonbacterial prostatitis has been after antiestrogen treatment in an animal model, we sought characterize the occurrence of nonbacterial pyospermia in men treated with CC.
Forty-two nonpyospermic men with low serum testosterone levels treated with 25 mg CC/day were retrospectively compared to 27 untreated nonpyospermic men referred for infertility evaluation.
Spontaneous nonbacterial pyospermia developed in CC-treated men [14.3%] at rate nearly twice that observed in controls [7.4%]. Serum testosterone increased in CC-treated men, both pyospermic and nonpyospermic. However, only CC-treated, nonpyospermic men demonstrated improvement in semen characteristics. CC-treated men who developed pyospermia were older than nonpyospermic men [pyospermic, 41.7 +/- 8.1 years; nonpyospermic, 35.6 +/- 4.9 years-P < .01). Men over 35 years of age were over six times as likely to develop pyospermia as men under 35 years of age (P < .05). Eight nonpyospermic, CC-treated men (8/36, 22.2%) have contributed to pregnancies leading to live births, whereas no pyospermic man has done so.
These findings support an association between a nonbacterial inflammatory response of the human male reproductive tract and CC treatment. This pyospermia may occur without significant deterioration of semen characteristics and with an appropriate response to treatment in terms of serum testosterone level. Men over the age of 35 are statistically more likely to develop pyospermia with this therapy. Our results suggest that clomiphene citrate-associated pyospermia has a negative effect on male fertility.
鉴于已观察到在先前无精液脓细胞的男性接受枸橼酸氯米芬（CC）治疗后出现了非细菌性精液脓细胞增多症，并且在动物模型中抗雌激素治疗后出现了非细菌性前列腺炎，我们试图对接受CC治疗的男性中非细菌性精液脓细胞增多症的发生情况进行特征描述。
对42名血清睾酮水平低且接受每日25mg CC治疗的无精液脓细胞的男性进行回顾性研究，并与27名因不育评估而转诊的未接受治疗的无精液脓细胞的男性进行比较。
接受CC治疗的男性中出现了自发性非细菌性精液脓细胞增多症[14.3%]，其发生率几乎是对照组[7.4%]的两倍。接受CC治疗的男性，无论有无精液脓细胞增多症，血清睾酮均升高。然而，只有接受CC治疗的无精液脓细胞增多症的男性精液特征有改善。出现精液脓细胞增多症的接受CC治疗的男性比无精液脓细胞增多症的男性年龄更大[精液脓细胞增多症患者，41.7±8.1岁；无精液脓细胞增多症患者，35.6±4.9岁 - P <.01]。35岁以上的男性发生精液脓细胞增多症的可能性是35岁以下男性的六倍多（P <.05）。8名接受CC治疗的无精液脓细胞增多症的男性（8/36，22.2%）已成功受孕并生育活产婴儿，而无精液脓细胞增多症的男性无人如此。
这些发现支持人类男性生殖道的非细菌性炎症反应与CC治疗之间存在关联。这种精液脓细胞增多症可能在精液特征无明显恶化的情况下发生，并且在血清睾酮水平方面对治疗有适当反应。从统计学角度来看，35岁以上的男性接受这种治疗时更易发生精液脓细胞增多症。我们的结果表明，枸橼酸氯米芬相关的精液脓细胞增多症对男性生育能力有负面影响。
