Anti-TNF agents and potential effects on male fertility: are men being counseled?
Anti-TNF
Autoimmune
Counseling
Infertility
Sperm cryopreservation
Journal
BMC urology
ISSN: 1471-2490
Titre abrégé: BMC Urol
Pays: England
ID NLM: 100968571
Informations de publication
Date de publication:
27 Jul 2020
27 Jul 2020
Historique:
received:
18
08
2019
accepted:
22
06
2020
entrez:
29
7
2020
pubmed:
29
7
2020
medline:
23
4
2021
Statut:
epublish
Résumé
Adult men with autoimmune conditions are commonly prescribed anti-tumor necrosis factor (anti-TNF) agents; however, there is a paucity of quality evidence as to their effect on male fertility (e.g. semen parameters and sperm quality). Our objective was to determine if men with autoimmune conditions are being counseled regarding the unknown reproductive effects of anti-TNF agents prior to initiation of therapy. A retrospective analysis of 1010 male patients age 18-45 who were prescribed an anti-TNF agent were assessed for (1) receipt of counseling regarding potential reproductive effects; (2) screening for anatomic or laboratory abnormalities associated with infertility; (3) election for sperm cryopreservation. Only 10.3% of men received counseling, and this was not associated with age (p = 0.77). Those who received counseling were significantly more likely to have a genitourinary exam performed, be assessed for presence of a varicocele, be asked about or endorse low libido or erectile dysfunction, have a testosterone, LH, FSH, or prolactin level checked, and have a semen analysis performed (all, p < 0.0001). Rates of sperm cryopreservation were low, but statistically higher in men who received counseling (5.77% (+) counseling, 1.10% (-) counseling) (p = 0.002). The limited current literature lacks a consensus regarding the short- and long-term male reproductive effects of anti-TNF therapy. Despite this lack of clarity, rates of pre-initiation counseling were low. Rates of sperm cryopreservation, while improved in the counseled group remained low, suggesting prescribing physicians may be unaware of this option for patients.
Sections du résumé
BACKGROUND
BACKGROUND
Adult men with autoimmune conditions are commonly prescribed anti-tumor necrosis factor (anti-TNF) agents; however, there is a paucity of quality evidence as to their effect on male fertility (e.g. semen parameters and sperm quality). Our objective was to determine if men with autoimmune conditions are being counseled regarding the unknown reproductive effects of anti-TNF agents prior to initiation of therapy.
METHODS
METHODS
A retrospective analysis of 1010 male patients age 18-45 who were prescribed an anti-TNF agent were assessed for (1) receipt of counseling regarding potential reproductive effects; (2) screening for anatomic or laboratory abnormalities associated with infertility; (3) election for sperm cryopreservation.
RESULTS
RESULTS
Only 10.3% of men received counseling, and this was not associated with age (p = 0.77). Those who received counseling were significantly more likely to have a genitourinary exam performed, be assessed for presence of a varicocele, be asked about or endorse low libido or erectile dysfunction, have a testosterone, LH, FSH, or prolactin level checked, and have a semen analysis performed (all, p < 0.0001). Rates of sperm cryopreservation were low, but statistically higher in men who received counseling (5.77% (+) counseling, 1.10% (-) counseling) (p = 0.002).
CONCLUSIONS
CONCLUSIONS
The limited current literature lacks a consensus regarding the short- and long-term male reproductive effects of anti-TNF therapy. Despite this lack of clarity, rates of pre-initiation counseling were low. Rates of sperm cryopreservation, while improved in the counseled group remained low, suggesting prescribing physicians may be unaware of this option for patients.
Identifiants
pubmed: 32718310
doi: 10.1186/s12894-020-00658-7
pii: 10.1186/s12894-020-00658-7
pmc: PMC7385975
doi:
Substances chimiques
Tumor Necrosis Factor-alpha
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
111Références
J Crohns Colitis. 2013 Oct;7(9):e344-50
pubmed: 23453888
Rheumatology (Oxford). 2014 Jul;53(7):1250-5
pubmed: 24599921
Clin Rheumatol. 2016 Dec;35(12):2983-2987
pubmed: 27325124
Ann Rheum Dis. 2005 Nov;64(11):1667
pubmed: 16227427
Eur J Endocrinol. 2004 Nov;151(5):629-40
pubmed: 15538942
Dig Liver Dis. 2016 Jun;48(6):620-5
pubmed: 27017107
Andrology. 2017 Jul;5(4):640-663
pubmed: 28622464
Front Endocrinol (Lausanne). 2017 Nov 20;8:307
pubmed: 29250030
Inflamm Bowel Dis. 2007 Oct;13(10):1236-43
pubmed: 17508419
Ann Rheum Dis. 2010 Oct;69(10):1842-4
pubmed: 20610443
Urol Ann. 2014 Jan;6(1):13-7
pubmed: 24669115
Front Pharmacol. 2017 Jul 12;8:460
pubmed: 28785220
Clin Ther. 2011 Jun;33(6):679-707
pubmed: 21704234
Exp Ther Med. 2015 Apr;9(4):1501-1507
pubmed: 25780459
J Immunol. 2000 Jul 15;165(2):743-9
pubmed: 10878347
Psychooncology. 2017 Jan;26(1):4-14
pubmed: 26890220
Ann Rheum Dis. 2012 Mar;71(3):473-4
pubmed: 22138196
Adv Exp Med Biol. 2008;636:92-114
pubmed: 19856164
PLoS One. 2014 Apr 15;9(4):e93926
pubmed: 24736722
Ann N Y Acad Sci. 2006 Jun;1069:391-400
pubmed: 16855166
Inflamm Bowel Dis. 2005 Apr;11(4):395-9
pubmed: 15803031
Gut. 2006 Aug;55(8):1198-206
pubmed: 16849349
Tunis Med. 2010 Sep;88(9):623-8
pubmed: 20812173
J Endocrinol. 2006 Aug;190(2):313-29
pubmed: 16899565