Uncertain impact of anti-TNF agents on male fertility: Are men being counseled?

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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