Abstrak
Infertility is defined as the inability of the couple to conceive despite one year of frequent unprotected intercourse. In those couples male has a significant contribution to the infertility occurrence. However not all causes can be identified and so called idiopathic infertile. According to Horstein MD and Gibbons WE reported that the percentage of couples who experience infertile caused by unexplained infertility was 15%. The sperm parameter in infertile males usually has lower in concentration, motility, and morphology compared to fertile male. Various treatments have been used to surmount these problem including clomiphen citrate (CC) and antioxidant. Unfortunately by using both of modality did not indicate the increase of pregnancy rate. The purpose of this paper is to discuss about how CC and antioxidant combination have effect upon the sperm parameters and pregnancy rate improvement. CC constitutes a mixture of two isomers which are enclomiphen and zuclomiphen. Like tamoxifen CC is a non steroidal triphenylethylene derivation, indicating both estrogen agonist and antagonist properties. In one side estrogenic agonist properties are generally manifest only in the moment of estrogen level is extremely low. On the other side CC able to act solely as a competitive estrogen antagonist. Various evident show that CC increase endogenous GnRH secretion from hypothalamus and gonadotropin (FSH, LH) from pituitary, thus increasing intra testicular testosterone, constituting a fundamental condition for spermatogenesis. As Hussein reported that CC administration for cases of non obstructive azoospermia allowed for both the appearance of sperm in ejaculate and in those patients were remain azoospermia, successful sperm retrieval for ICSI can be achieved. After 3 - 9 months of treatment using CC, 64.3% of patients manifested sperm in their ejaculate. The mean of sperm density in this study was 3.8 million/mt., even the partner of one patient achieve spontaneous pregnancy. Meanwhile the ejaculate remainder of these patients contained sufficient sperm for NF or ICSI. In addition according to double blind study was reported by Guay showed that treatment with CC during two months to impotent men with secondary hyphogonadism could increase LH, FSH, and Testosterone levels.