My husband has just been put on Clomid for 25 days to try and increase his sperm count. Can you tell me the effectiveness of this drug on sperm count less than a few hundred thousand?

--Karen

I believe that this is likely a waste of time for someone with such a low sperm count. Clomiphene (Clomid) is often prescribed to "see what happens," but it rarely helps. There are, however, a few cases in which it may be of benefit.

First, I would review his entire medical history and perform a complete physical exam. You did not state whether the amount or volume of the ejaculate was normal. If the ejaculate volume is low, I might look to see if the sperm are being ejaculated into the bladder instead of the penis (see my column titled "No Semen Comes Out during Intercourse"). I would also determine whether any environmental factors, chemicals, medications or lifestyle factors may play a role.

Clomiphene works by increasing FSH and LH, the hormones that stimulate the gonads. If the levels of these hormones are normal or elevated, Clomid will provide no benefit. To decide when to use this medication, I measure levels of the hormones LH, FSH and testosterone. If they are low, the man may benefit with a three-month trial. Frequently, men with these low levels complain of loss of libido and impotence and note that they are shaving less often. If I notice during a physical exam that the testicles are smaller and less firm than normal, clomiphene may help.

Clomiphene can impair liver function when used continuously. If your husband responds to this treatment and plans to remain on it for any length of time, your doctor may wish to monitor his liver with blood tests.

But with such severe abnormalities, I would suggest a chromosomal evaluation and chromosomal microdeletion test to help determine whether the poor sperm count is due to genetic abnormalities. Then I would recommend in vitro fertilization with ICSI (intracytoplasmic sperm injection). This is about the only reasonable way to be successful.