A diagnosis of inflammatory arthritis (IA) was found to be associated with impaired male fertility, according to the results of a large multicenter study published in Annals of the Rheumatic Diseases.
Although previous studies have shown an association between IA and male infertility, erectile dysfunction, and hypogonadism, the impact of the inflammatory disease on male fertility has not been well understood.
The objective of the current study was to determine the impact of IA on several markers of male fertility. The primary outcome was male fertility rate, calculated using the question “How many biological children did you have?” Secondary outcomes included the total number of pregnancies per man, desired family size, percentage of men without biological children, and fertility outcomes.
The multicenter cross-sectional study (iFAME-Fertility) included patients from 8 hospitals in the Netherlands with a prior diagnosis of IA, including rheumatoid arthritis, juvenile idiopathic arthritis, and spondyloarthritis (ankylosing spondylitis, reactive arthritis, psoriatic arthritis, enteropathic arthritis). All men reported that their “family size was completed.”
Participants completed a questionnaire and provided demographic information, data on medical history, family planning, and fertility outcomes. To determine the impact of IA on male fertility, patients were classified into 3 study groups, according to age at diagnosis of IA: diagnosis at 30 years of age and younger (considered before the peak of reproductive age), diagnosis between 31 and 40 years of age (considered the peak of reproductive age), and diagnosis at 41 years of age and older (considered after the peak of reproductive age).
The study sample included 628 patients (mean age, 57.17 years), including 137 patients diagnosed before the peak of reproductive age, 149 diagnosed during the peak of reproductive age, and 342 patients diagnosed after the peak of reproductive age.
Mean number of children was lower among men diagnosed with IA at 30 years of age and younger compared with those diagnosed with IA between 31 and 40 years of age and those diagnosed with IA at 41 years of age and older (1.32 vs 1.56 vs 1.88, respectively; P =.0004). Although the difference in the total number of children was not statistically significant between men diagnosed before and during the peak of reproductive age, the total number of children was statistically significantly lower among men diagnosed with IA before 30 years of age and in those diagnosed with IA between the ages of 31 and 40 years compared with those diagnosed with IA after 41 years of age (P <.001 and P =.020, respectively).
Men diagnosed with IA before and during the peak of reproductive age were 2 times more likely to remain without biological children (12% and 10%, respectively) compared with men diagnosed with IA after the peak of reproductive age (4%; P =.001).
The diagnosis of IA before and during the peak of reproductive age vs after the peak of reproductive age was associated with higher rates of medical evaluation for fertility problems (20.61% and 20.69% vs 11.36%, respectively; P =.027) and receiving a diagnosis of abnormal sperm quality (6.57% and 8.05% vs 3.51%, respectively; P =.086).
The study had several limitations, including the retrospective design, low response rate, and potential selection bias.
“[T]he diagnosis of IA before or during the peak of the reproductive age can result in impaired male fertility. Rheumatologists should be aware of this novel association and approach their patients accordingly. Multiple biological and non-biological mechanisms can be responsible for this association and more research is urgently needed to improve the quality of care for men diagnosed with IA and a desire for parenthood,” the researchers concluded.
Disclosure: Some study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Perez-Garcia LF, Röder E, Goekoop RJ, et al. Impaired fertility in men diagnosed with inflammatory arthritis: results of a large multicentre study (iFAME-Fertility). Ann Rheum Dis. Published online August 9, 2021. doi:10.1136/annrheumdis-2021-220709