Men’s fertility may be affected if they are diagnosed with inflammatory arthritis before or during peak reproductive years, according to new Dutch research published today.
A study by scientists at the Erasmus Medical Centre, Rotterdam, found that inflammatory arthritis, which includes rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis and ankylosing spondylitis, is associated with fathering fewer children, higher rates of infertility, involuntary childlessness, and fertility issues, such as poor sperm quality.
The team set out to explore the impact of inflammatory arthritis on men’s ability to father children and compared the fertility rate among men diagnosed with inflammatory arthritis based on their age at diagnosis: 30 or younger; between 31 and 40; and 41 and older.
Participants were drawn from eight different hospitals across The Netherlands between September 2019 and January 2021 and a questionnaire was completed by 628 men over the age of 40, who said their family size was complete.
The questions focused on the medical and fertility issues they had had before and after being diagnosed with inflammatory arthritis.
The researchers also compared the total number of pregnancies for each man, desired family size, the proportion of childless men and the results of medical assessments for fertility issues.
Writing in the latest edition of the Annals of the Rheumatic Diseases, they say after adjusting for potentially influential factors, men diagnosed with any type of inflammatory arthritis before the age of 30 had significantly fewer children than men in the two other age groups.
These men had an average of 1.32 children compared with 1.56 for those diagnosed between 31 and 40, and 1.88 for those diagnosed when they were 41 or older.
Men diagnosed before or when they were 30 also had fewer pregnancies at 1.45 than those diagnosed between 31 and 40, at 1.73, or the older men (1.98).
In the Netherlands, between one in five and one in four men are childless. Among the participants, 143 (just over 22%) were childless, 99 (69%) of whom were voluntarily childless.
The percentage of childless men was significantly higher among those diagnosed before or at the age of 30 (45; 34%) than it was among those diagnosed between 31 and 40 (39; 27%) and those diagnosed in their 40s (59; 17%).
More men diagnosed before or at the age of 30 (17%) and between 31 and 40 (10%) said they were dissatisfied with their final number of children than men diagnosed when they were older (5.5%).
About one third of these men gave as their primary reason for having fewer children their diagnosis and/or the medical treatment associated with it.
“The difference between the desired and final number of children was significantly larger in men diagnosed before and during the reproductive [years], indicating that the lower fertility rates are primarily affected by reduced fertility potential and not by a reduced desire for parenthood,” write the researchers.
While this is an observational study and cannot establish cause, the team says there are some plausible biological explanations for the associations found.
Several inflammatory proteins that feature in the immune response associated with inflammatory arthritis, such as tumour necrosis factor (TNF), have key roles in regulating testicular stability and sperm production, the researchers say.
They also suggest the drugs used to treat arthritis may also have a role, because side effects such as hypogonadism and poor sperm quality have been associated with frequently used immunosuppressive agents.
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). Annals of the Rheumatic Diseases 10 August 2021
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