Uncertain impact of anti-TNF agents on male fertility: Are men being counseled?
Adult men with autoimmune conditions are commonly prescribed anti-TNF agents. Literature on the effect of anti-TNF agents on male fertility is sparse, under-powered and with mixed results; but, some studies have reported adverse effects on semen parameters and sperm quality. Given this lack of clear evidence, our objective was to see if men receiving anti-TNF agents are being (1) counseled regarding potential adverse reproductive effects, (2) screened for anatomic or laboratory abnormalities associated with infertility and (3) offered sperm cryopreservation.
A single-center, retrospective analysis of 1012 male patients prescribed an anti-TNF agent between ages 18-45 from 1/1/2008 to 8/1/2017. Our retrospective database review determined if men received (1) counseling regarding risk to fertility, (2) a genitourinary exam (penis, urethra, testicles), (3) screening for varicocele, (4) diagnosis or assessment for low libido or ED, (5) testosterone level, (6) semen analysis, (7) sperm cryopreservation. Chi square test compared proportions between those who did and did not receive counseling. p<0.05=significant.</p>
Of 1012 men started on anti-TNF agents, only 10.2% received counseling regarding the potential adverse effect of these agents on fertility. Age was not a statistically significant factor related to likelihood to receive counseling (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 ED, have a testosterone level checked, and have a semen analysis performed before or during treatment (all, p<0.0001). There was no statistical difference found between rates of sperm cryopreservation between those who did or did not receive counseling (p=0.7923) and overall rates of cryopreservation were low: 3.4% (no counseling) and 3.9% (counseling).</p>
The impact of anti-TNF agents on male fertility is unknown. Our study is the first to demonstrate the lack of patient education regarding the potential for adverse reproductive effects with only 10.2% of men receiving counseling. Those who were counseled were more likely to be screened for anatomic, hormonal, and semen analysis parameters that could impact fertility. Lastly, sperm cryopreservation was rarely offered suggesting prescribing physicians may be unaware of this option for patients. Until a prospective trial is performed to better understand the impact of anti-TNF agents on male fertility, men should be counseled about the possible risk and fertility preservation.