The Effect of Ethnicity and Race on Semen Analysis and Hormones in the Infertile Patient
Numerous studies have shown differences in disease biology, outcomes and treatment based on race and ethnicity. However, there are no published studies on the effect of race or ethnicity on semen parameters or hormones for men with infertility. Our objective was to determine if ethnicity and race had any impact on semen analysis parameters and baseline hormonal profiles for men with infertility.
Data from all men between 2008 and 2017 presenting for infertility assessment at a single institution was prospectively collected and retrospectively reviewed. Demographic and clinical history was self-reported by patients. Semen analysis data included volume, count, motility, morphology and vitality. The 2010 World Health Organization semen parameters were used as appropriate cut-offs. Baseline total testosterone and FSH levels were recorded. Ethnicity and race data was classified as Caucasian, African-Canadian, Asian, Indo-Canadian, Native-Canadian, Hispanic and Middle Eastern. All patients with complete data were included, and statistical analysis was performed.
A total of 9079 patients were reviewed, of which 3956 patients had documented semen analysis, hormone profiles and ethnicity data. Of these, 839 (21.2%) were azoospermic. After adjusting for age, we found that African-Canadians (OR 1.70, p<0.01) and Asians (1.34, p<0.01) were more likely to be azoospermic. African Canadians (OR 1.75, p<0.01) were more likely to be oligospermic and Asians (OR 0.82, p=0.01) less likely to be oligospermic. Low volume ejaculate was more commonly found in African-Canadian (OR 1.42, p=0.02), Asians (OR 1.23, p=0.04) and Indo-Canadians (1.47, p=0.05). Furthermore, Asians (OR 0.73, p=0.01) and Hispanics (OR 0.58, p=0.04) were less likely to have asthenospermia. Asians (OR 0.73, p=0.01) and Indo-Canadians (OR 0.58, p=0.05) were less likely to have teratozospermia. No differences were seen for vitality. With respect to hormonal parameters, no differences were seen for FSH levels, however, Asians (p<0.01) and Indo-Canadians (p<0.01) were more likely to have lower total testosterone levels.</p>
Our study illustrates that different ethnic and racial groups with male infertility have different types of abnormalities in their semen analyses and hormone levels. This may provide insight into the work-up and management for infertile men from different ethnic and racial backgrounds.