Lupus Treatments Increase Risk of Infertility in Men

SO PAULO, Brazil, June 28 -- Men with systemic lupus erythematosus, especially those who begin treatment with intravenous cyclophosphamide after puberty, are at risk for sperm abnormalities associated with infertility.

Compared with healthy males, lupus patients had significantly lower sperm volume (P=0.015), a lower sperm count (P=0.002) and less motile sperm (P=0.004), according to findings reported in the July issue of Arthritis & Rheumatism.

Pollyanna Maria F. Soares, M.D., of the University of So Paulo, and colleagues, said it is not possible to predict which patients will become infertile but, they said, abnormal testicular function appears to be persistent after five or more years of IV cyclophosphamide therapy.

Moreover only 20% of the lupus patients versus 80% of the controls had fathered children (P=0.0001).

The study findings, they wrote, "support the notion of an irreversible lesion and reinforces the need for sperm cryopreservation for male SLE patients who undergo CYC therapy."

They added that "cryopreservation should be discussed early in the disease course to assure an optimal condition to preserve fertility in all men with lupus, since a causal factor has not been recognized in almost one-third of patients with severe semen alterations."

Dr. Soares and colleagues performed measurements of testicular volume and sperm analysis on 35 consecutive lupus patients. The results were compared with 35 age-matched healthy controls.

The mean age of patients and controls was 29.

All lupus patients had evidence of sperm alterations; 18 --group one -- had morphologic changes characteristic of teratozoospermia and 17 -- group two -- had mixed alterations including no evidence of sperm (azoospermia), low sperm count, low sperm motility, or a combination of low sperm count or low motility with abnormal sperm.

More patients who started IV cyclophosphamide after puberty were in group two and testicular volume measured by ultrasound was lower in group two than in group one. Follicle-stimulated hormone levels were higher in group two than group one.

Among the findings:

• The lupus patients had a lower median total sperm count (70 X 10⁶ versus 172 X 10⁶, P=0.002).
• Lupus patients had a lower median motile sperm count (32 X 10⁶ versus 119 X 10⁶, P=0.004).
• Assessment of sperm morphology by World Health Organization guidelines (P=0.011) demonstrated a significantly lower rate of normally formed sperm but by the stricter Kruger criteria the difference was not statistically significant (2.5% versus 5.0% P=0.075).

The authors conclude that because "this disease occurs mainly during reproductive age, a multidisciplinary approach is essential to identify the potential risk factors for infertility and to offer preventive measures for these patients."