1. The severity of medical comorbidities was inversely associated with semen quality.
2. Hypertension, peripheral vascular and cerebrovascular disease, and nonischemic heart disease were associated with higher rates of semen abnormalities.
Evidence Rating Level: 3 (Average)
Study Rundown: Infertility, defined as the inability to become pregnant after one year of regular unprotected intercourse or after 6 months of regular unprotected intercourse after the age of age 35, affects roughly 15 percent of couples in the United States trying to conceive each year. As couples wait until older ages to have children, these numbers are likely to increase. Many think of infertility as associated solely with women, but in a 2002 CDC study, 7.5 percent of all sexually experienced men under 45 reported having seen a fertility doctor. In this study, researchers aimed to identify an association between semen quality and current health status in a cohort of men presenting for infertility workup.
Men with higher comorbidity scores at the time of infertility evaluation were more likely to have abnormal semen parameters, including lower semen volume, concentration, motility, total sperm count and morphology scores. Specifically, men with hypertension, peripheral vascular and cerebrovascular disease, and nonischemic heart disease had higher rates of semen abnormalities. While prior studies have found a link between individual diseases such as metabolic syndrome and male infertility, this is the first study to look at comprehensive health and semen quality. Limitations included the study population, which was composed solely of men who presented for infertility evaluation at a specialized medical center and likely do not reflect the general population. Additionally, researchers did not account for a number of potential confounders, including treatment regimen and lifestyle factors. Prospective studies including a non-fertile control group are needed to further explore these findings.
Relevant Reading: Semen quality, infertility and mortality in the USA
In-Depth [cross-sectional study]: Researchers collected semen data from 9387 men evaluated for infertility from 1994-2011 at a high volume fertility clinic. The cohort was stratified based on the Charlson comorbidity index, a measurement that assesses the severity of comorbid medical conditions by predicting a patient’s 10-year mortality, and relationship with semen quality was assessed.
A higher Charlson comorbidity index was associated with lower semen volume, concentration, motility, total sperm count and morphology scores (p-trend<0.01 for all parameters except morphology, where p-trend=0.04). When diseases (excluding cancers) were stratified by organ system, endocrine (p=0.02), genitourinary (p<0.01) and skin diseases (p=0.01) were associated with abnormal semen parameters. Within circulatory system diseases, hypertension (p=0.02), peripheral vascular and cerebrovascular disease (p=0.05), and nonischemic heart disease (p=0.04) were associated with semen abnormalities.
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