Yea I have seen that study by Pasqualotto. It is unique, hard to explain why that would happen as it contrasts with other research. Hopefully if it is a potential problem I would avoid it with Enclomiphene.
It's also odd as there is no mention of the clomid dose used here, so you can't really say it's due to "excessive dosing" as we have no idea what the dosing was. They also had high-normal FSH the entire time, even off Clomid, so I'm wondering why they were infertile in the first place and why it was presumed that clomid would help if they already had normal gonadotropins.
I will note that if you look at the discussion section below, this is precisely why I was challenging people about it being of any benefit to me, and this is also why all doctors I've spoken to on the topic have said it wouldn't benefit me. Very little evidence for it especially if already taking HCG and FSH:
"
Discussion
Clomiphene citrate is a nonsteroidal antiestrogen that binds to hypothalamic estrogen receptors and weakens the negative feedback mechanism of LHRH secretion by estrogens. This leads to increased secretion of FSH and LH. The increased LH stimulates production of T by Leydig cells, whereas FSH and T stimulate Sertoli cells and germinal cells (
**broken link removed**). On the basis of four trials that evaluated the effect of this drug in unexplained infertility, CC has a small and nonsignificant effect, producing 1 additional pregnancy in 76 CC cycles compared with untreated control cycles (
2). A randomized, double-blind, multicenter study from the World Health Organization evaluated 109 couples with idiopathic male infertility and failed to show any improvement in pregnancy rates after 6 months of treatment with CC (
3). The potential side effects of this drug include headaches, nausea, visual disturbances, dizziness, abdominal discomfort, mouth ulcers, and cataract formation (
3).This study shows that there is a real possibility for a decrease in semen quality, even azoospermia, after the use of CC in patients with severe idiopathic oligospermia. Therefore, the benefits of empiric treatment with CC must be balanced with the possible undesirable effects, such as azoospermia. "