Arthritis and male fertility, what is their relationship?

This pathology is associated with male infertility, erectile dysfunction and insufficient testosterone production.

Several inflammatory proteins involved in the immune response associated with inflammatory arthritis play a key role in regulating sperm production. Photo: Shutterstock.

Rheumatoid arthritis, or one of the other types of inflammatory arthritis diagnosed before or during peak reproductive years, can impair male fertility, according to a study published online in “Annals of rheumatic diseases “.

Inflammatory arthritis is associated with fewer children, a higher rate of infertility, the involuntary absence of childrenand fertility problems, such as poor sperm quality, according to the results of this study.

This pathology, which includes rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis and ankylosing spondylitis, is associated with male infertility, erectile dysfunction and insufficient testosterone production and / or semen (hypogonadism). But the impact of inflammatory arthritis in the ability of men to bear children remains largely unknown.

To study this question, researchers led by Luis Fernando Perez-Garcia, a rheumatologist at the Erasmus Medical Center in the Netherlands, compared the fertility rate or number of children per man, among men diagnosed with inflammatory arthritis based on their age at diagnosis; 30 years or younger; between 31 and 40 years (considered the maximum reproductive age); and 41 years or older.

Participants were withdrawn from 8 different hospitals in the Netherlands between September 2019 and January 2021. About 628, over the age of 40 and indicating the size of their family as complete, filled questionnaire for medical problems and fertility they had before and after being diagnosed with inflammatory arthritis.

The researchers also compared the total number of pregnancies related to each man, the desired size of the family, the the share of men without children and on results of medical examinations for fertility problems.

After adjusting for potentially influential factors such as current age, educational level, history of cardiovascular disease and partner infertility, men diagnosed with any type of inflammatory arthritis before the age of 30 had significantly fewer children than men in the other two. age groups.

These men had an average of 1.32 children, compared with 1.56 for those diagnosed between the ages of 31 and 40 and 1.88 for those diagnosed when they were 41 or older.

Men diagnosed before or when they were 30 years old also had fewer pregnancies (1.45) than those diagnosed between 31 and 40 years (1.73) or more (1.98). In the Netherlands, between 1 in 5 and 1 in 4 men are childless. Among the participants, 143 (just over 22%) were childless, of which approximately two thirds (99; 69%) were voluntarily childless.

Again, the percentage of men without children is significantly higher among those diagnosed before or at the age of 30 (45; 34%) than among those diagnosed between the ages of 31 and 40 (39; 27%) and those diagnosed at the age of 40 (59 ; 17%).

In addition, the the share of men without children unintentionally significantly different between the 3 groups: 16 (12%) respectively; 15 (10%); and 13 (4%). Voluntary childlessness is also different: 29 (25%); 24 (18%); and 46 (15%).

But among those who did not have children voluntarily, the statement “My illness reduced my desire to have children” was rated higher by men diagnosed at a young age than by those in either of the other two age groups. .

In addition, significantly more men diagnosed before or at the age of 30 (17%) and between 31 and 40 (10%) reported being dissatisfied with their final number of children than men diagnosed when they were older. (5.5%). About a third of these men cite their diagnosis and / or related medical treatment as the main reason for fewer children.

Compared to the older age group, significantly more than those diagnosed before or during the peak years of fertility reported being medically evaluated for fertility problems, leading to poor sperm quality.

Although the number of desired children is lower in men diagnosed before and during their peak years of fertility, there is no significant difference between the 3 groups as a whole and it is similar to the figure reported per capita. The Netherlands.

However, the researchers emphasize, “the difference between the desired number of children and the final number of children is significantly greater in men diagnosed before and during their reproductive years, which shows that lower fertility levels are mainly affected by reduced control of fertility potential. ā€¯fertility potential. and not because of a reduced desire to be parents.

This is an observational study and as such cannot determine the cause, but there are some plausible biological explanations for the discovered associations, the researchers explain.

Several inflammatory proteins involved in the immune response associated with inflammatory arthritis, such as tumor necrosis factor (TNF), play a key role in regulating testicular stability and sperm production.

Medications used to treat arthritis may also play a role, they suggest. Side effects such as hypogonadism and poor sperm quality are associated with commonly used immunosuppressive agents.

It is estimated that among childless men who inadvertently visit infertility clinics, 1 in 4 take drugs that can affect sexual function, while 1 in 10 take drugs related to impaired fertility.

Similarly, various psychosocial factors associated with their diagnosis may also have contributed to lower fertility rates, the researchers suggest.

“Due to problems or concerns related to diagnosis and treatment and based on medical advice (or lack thereof), men with inflammatory arthritis and their partners decided to voluntarily lose their children or postpone their plans to become parents,” they explained. psychosocial factors were particularly important for men diagnosed before peak reproductive age. “

Source consulted here.