Inflammatory arthritis diagnosis prior to age 30 years 'impairs' male fertility
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Male patients diagnosed with inflammatory arthritis at or before peak reproductive age have a lower fertility rate, a higher childlessness rate, and more fertility issues, according to data published in the Annals of the Rheumatic Diseases.
“Spondyloarthritis (SpA) and rheumatoid arthritis (RA) are frequent causes of inflammatory arthritis (IA) that can affect men before or during the peak of their reproductive age,” Luis Fernando Perez-Garcia, MD, of Erasmus Medical Center, in Rotterdam, Netherlands, and colleagues wrote. “Even though IA is associated with male infertility, erectile dysfunction and hypogonadism, the impact of IA on male fertility remains largely unexplored.”
“This is even more striking if we consider that several frequently prescribed anti-rheumatic drugs have been associated with reversible or irreversible testicular toxicity,” they added. “In women diagnosed with IA, several factors related to IA have been associated with lower fertility rates. It can be expected that some of these factors could also influence the fertility rate of men diagnosed with IA, such as impaired sexual function, lower intercourse frequency, deciding not to have a family or to have smaller families due to concerns about the impact of IA or antirheumatic treatment.”
To analyze the impact of inflammatory arthritis on male fertility outcomes, including fertility rate, childlessness, fertility problems and family planning, Perez-Garcia and colleagues conducted a multicenter, cross-sectional iFAME-Fertility study. Stretching across eight Dutch hospitals, the study enrolled 628 male patients, aged 40 years or older at inclusion, who demonstrated inflammatory arthritis and indicated their current family size was complete.
The researchers defined inflammatory arthritis as a diagnosis of RA, juvenile idiopathic arthritis, ankylosing spondylitis, psoriatic arthritis, reactive arthritis or enteropathic arthritis.
Participants completed a questionnaire that collected demographic, medical and fertility information. The researchers grouped the participants based on their age at diagnosis. The first group were those aged 30 years or younger at diagnosis, or “before peak reproductive age;” those between 31 and 40 years, or “peak reproductive age;” and those diagnosed at 41 years or older, or “after peak reproductive age.”
According to the researchers, participants who were diagnosed with inflammatory arthritis at age 30 years or younger had a lower mean number of number of children — 1.32 (SD = 1.14) — compared with those who were diagnosed at or after reproductive peak — 1.6 (SD = 1.35) and 1.88 (SD = 1.14), respectively (P = .0004).
“For the first time, it has been suggested that inflammatory arthritis impairs male fertility,” Perez-Garcia told Healio Rheumatology. “Our findings are of extreme value as our findings are increasing the awareness of this problematic and justify further research that corroborates this association and help us understand how inflammatory arthritis impacts male fertility.”
The rates of involuntary childlessness were 12.03% and 10.34% for those diagnosed before or at peak reproductive age, respectively, compared with 3.98% of those diagnosed at age 41 years or older. Among all three groups, 20.61%, 20.69% and 11.36%, respectively, received medical evaluations for fertility problems. Both findings were significant (P = .027), the researchers wrote.
“Rheumatologists should be aware that IA may impair male fertility,” Perez-Garcia told Healio Rheumatology. “Accordingly, it is important that rheumatologists identify their male patients diagnosed with IA who have a desire to become fathers and approach this topic with them. There are several things that can be done for this group of men, to mention a few: Adjust treatment to avoid testicular or reproductive toxicity, and give them general reproductive advice and screen for important sexual and reproductive health comorbidities that have been associated with IA, including sexual dysfunction, low sperm quality and hypogonadism.”
Perspective
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Adrienne Hollander, MD
While it is known that inflammatory arthritis is associated with male infertility, hypogonadism and erectile dysfunction, the extent of the impact of inflammatory arthritis on males’ reproductive health – more specifically fertility rate – has not been studied. Perez- Garcia and colleagues decided to tackle this question in the iFAME-Fertility study by investigating the impact of inflammatory arthritis on fertility in men in the Netherlands, where most men become fathers between the ages of 30 and 40 years old.
This study demonstrated that inflammatory arthritis can significantly impair male fertility. The diagnosis of inflammatory arthritis before or during peak reproductive years significantly reduced fertility rates and number of pregnancies. In addition, higher rates of involuntary childlessness and fertility problems were observed.
The authors suggested several possible mechanisms that could contribute to these findings. First, inflammation due to IA and medications given for IA may have contributed to impaired fertility, while psychosocial factors may also have contributed to lower fertility.
This study demonstrates the impact of IA on fertility and family planning in men who are diagnosed before the age of 41, which has many implications for rheumatologists when diagnosing and treating men with inflammatory arthritis. The clinician will need to be aware that the disease, medications and psychosocial factors may play a role in fertility in men and inform and educate patients along their disease journey. Hopefully, further studies will help expand this body of knowledge so we can optimize treatment in men.
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