Why All Men in Couples Having Trouble Conceiving Should Have a Fertility Evaluation
For men with fertility issues like abnormal semen analysis test results, there are 2 primary reasons why is it important to have a thorough evaluation by a male fertility specialist:
#1) Improved semen parameters can improve a couple’s chances of initiating and maintaining a healthy pregnancy.
#2) Male factor infertility significantly increases the chances of having general health problems that are otherwise silent, or of developing these problems within the next 5-10 years.
The close association between a man’s general health and his fertility potential is often underappreciated by both medical professionals and the general public alike. Over the past decade there has been an explosion of research in this field clearly illustrating that a man’s fertility status can be an indicator of his overall current health as well as his chances of developing problems such as cardiovascular disease or diabetes in the near future. This information is important for men to know, since young males commonly avoid seeking professional medical care for problems and basic disease prevention.(1) Studies have shown that men utilize basic primary care services almost 1/3rdless often than their age-matched female peers.(2)
This association between a man’s fertility and his overall health should not be too surprising when one considers that approximately 10-15% of the male genome is associated with fertility-related processes.(3) When this much of a man’s genetic material is involved, it only makes sense that there is going to be some overlap with general health-related areas as well.(4) In addition to genetics, many risk factors that are known to be detrimental to sperm quality (e.g. tobacco use, obesity, excessive alcohol use) can also negatively affect a man’s overall health. Gestational issues and early development abnormalities have also been shown to have the potential to impact both a man’s future health as well as his fertility potential.(3)
Infertility and the Risk of Current Health Problems
Several studies have now established a clear link between abnormal semen parameters and the presence of potentially serious (but otherwise silent) medical problems. A study of 536 men with fertility problems found that significant health problems (including cancer, diabetes, and genetic abnormalities) were present in up to 6% of men who underwent a thorough male fertility evaluation.(5) These findings have been backed up by multiple studies which have found that the quality of semen parameters can indeed serve as a reflection of a man’s current health. A study in Europe looking at 637 men found decreasing sperm quality to be associated with a higher risk of having general health problems. The men’s state of general health was based upon their score on the Charleston Comorbity Index which assesses a man’s predicted mortality risk based upon a collection of 22 health factors such as heart disease, diabetes, cancer, hypertension, and liver disease.(6) A more recent and larger study of 9,387 men (average age 38 years) confirmed these earlier findings of increasing Charleston Index scores in men who had abnormalities in their sperm counts, motility, and/or morphology.3 Low counts and motility have also been found to be associated with other health issues such as sleep disturbances.(7) In addition to abnormal semen parameters, other fertility risk factors that are often present in men with abnormal semen analysis testing have been associated with general health problems as well. The classic example is erectile dysfunction, which is a well-recognized health risk factor and has been clearly shown to be a common first sign of otherwise undetected significant cardiovascular disease.(8-10)
Infertility and the Risk of Future Medical Problems
Men who are currently healthy but have abnormal semen parameters have also been found to be at an increased risk of developing significant health problems in the future. A study looking at 36,887 healthy men with an average age of 33 years found that those with fertility problems had a 30% higher chance of developing diabetes and a 48% higher risk of developing ischemic heart disease than their fertile peers over an eight year study period.(11) Another study of healthy men followed over seven years found that those with fertility problems were over three times more likely to develop a general immune disorder (such as systemic lupus erythematosus) than were men without fertility issues.(12) Other specific immune-related problems were also increased in these men with fertility issues, including rheumatoid arthritis (56% higher risk), thyroiditis (60% higher risk, and multiple sclerosis (91% higher risk). Other fertility-related factors have also been associated with an increased risk of developing health problems. As mentioned above, erectile dysfunction is a common sign of underlying vascular and/or neurologic dysfunction, and is associated with a significantly higher risk of developing heart disease.(8-10) Men with varicoceles were also found to have a 22% increased risk of developing heart problems and a 77% higher risk of being diagnosed with diabetes mellitus compared with fertility controls when studied over an 8 year time period.(13)
In addition to these general health concerns, men with fertility problems have also been shown to be at a significantly higher risk of developing malignancies. Higher rates of being diagnosed with thyroid cancer (52% higher), prostate cancer (78% higher), leukemia (82% higher), and bladder cancer (229% higher) were found in over 76,000 otherwise healthy men with fertility problems (average age 35 years) when followed over an eight year time period.(14) A study of 40,826 men also found that men with oligospermia were 11.9 times more likely to develop testicular cancer when compared to fertile controls their same age.(15) Another study found this risk of testicular cancer to be 20 times greater in the infertile population.(16) As one would predict from these prior studies, men with fertility problems have higher rates of hospitalization as well as an increased risk of mortality.(17) A study of 11,935 men (average age 36.6 years) found the risk of death over a study period of 22 years was 2.3 times higher in men who had ≥2 abnormalities found on their semen analysis testing.(18)
How A Man’s General Health and His Fertility Impact Each Other
Accumulating scientific evidence over the past 10 years has now shown the clear association that exists between a man’s health and his fertility status.(19) But how do these two factors impact each other? Is is well known that general health problems can certainly decrease a man’s fertility potential. Decreased testosterone levels can significantly impact a man’s sperm production since high intratesticular levels of sperm are necessary for optimal spermatogenesis. Diabetes can impair erections and ejaculation as well as cause problems with ductal transport of sperm. Hypertension and diabetes can also both result in end-organ (i.e. testicular) damage, as can other health related problems such as sickle cell anemia and hemochromatosis.(20,21) Polycystic kidney disease can cause blockages of sperm flow due to the development of large cysts within the seminal vesicles.
In addition to general health issues causing fertility problems, fertility problems can in turn lead to general health issues as well. Hypogonadism is a common finding in the infertile male population, and is a known risk factor for both cardiovascular disease as well as osteoporosis.(22) Male fertility is also often very stressful, predisposing men to problems such as anxiety and depression. The elevated cortisol levels typically seen with elevated stress and anxiety are also known risk factors for a range of medical problems including:
1) Hypertension/Heart disease
2) Elevated cholesterol
3) Increased blood sugar
4) Decreased immune function/Increased risk of infections
5) Sleep problems
6) Digestive abnormalities
7) Problems with memory and concentration
Conclusion: the connection between a man’s health and his fertility potential
The official guidelines for the American Society of Reproductive Medicine (ASRM) recommend that all men with abnormal fertility testing receive a thorough evaluation by a male fertility specialist. The old approach of ignoring abnormal semen analysis results so long as enough sperm are present to proceed with female fertility treatments is no longer considered to be an acceptable approach for an infertile couple. It is clear that fully evaluating men with fertility problems offers many advantages. Not only does this approach help couples to optimize their fertility chances as well as potentially the health of their future children, but this evaluation is also a golden opportunity to assess the general health of the male partner. Study after study has now shown that men with fertility problems are at a significantly increased risk of harboring otherwise silent health problems and/or are at a significantly higher risk of developing potentially serious health issues in the future. These men need counseling on the risks associated with their conditions, recommendations on preventative health screening based on their particular risk factors, and resources to get plugged into the primary healthcare system. For years the focus of fertility couples has been primarily on the female side, but it is now recognized that it is equally important that the male partners are no longer ignored. They deserve the same thorough evaluation that can improve both their overall health as well as their chances of becoming a father.
References
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