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Sperm Abnormalities Seen In Male Lupus Patients
June 28, 2007
The prognosis for systemic lupus erythematosus (SLE), an autoimmune
disease that mainly affects women in their reproductive years, has
improved recently, prompting a shift toward improving quality of life.
For men with SLE, concerns have been raised about their future
fertility. However, no studies have been conducted to date on testes
function and its relevance to sperm abnormalities in male SLE patients.
A new study published in the July 2007 issue of Arthritis &
Rheumatism examined gonad function in male SLE patients and found that
they have a high frequency of sperm abnormalities associated with
reduced testicular volume. In addition, the study identified
intravenous treatment with the immunosuppressant cyclophosphamide (IV
CYC) as the major factor in permanent damage to the testes.
Led by Polyanna Maria F. Soares of the University of São Paulo
in São Paulo, Brazil, the study included 35 men with SLE and 35 healthy
controls, who underwent an exam of the genitalia, and semen analysis to
determine sperm count, morphology and motility. For SLE patients,
analysis of antisperm antibodies (which can adversely affect
fertilization), testicular ultrasound, and hormone evaluation were also
The results showed that SLE patients had lower median
testicular volumes in both testes, compared with controls, a lower
median sperm count, and lower motility. SLE patients also had lower
sperm volume and a lower percentage of normally formed sperm. Since all
SLE patients had some type of semen abnormality, they were divided into
two groups according to the severity: group 1 had abnormal sperm
morphology, while group 2 had no sperm or abnormal sperm morphology,
coupled with low sperm count and/or low sperm motility. Those in group
2 had a higher frequency of treatment with IV CYC than those in group
1, along with lower testicular volumes and higher levels of
"To our knowledge, this is the first systematic
evaluation that has specifically addressed sperm abnormalities in SLE
and that clearly demonstrates a high frequency of severe alterations,"
the researchers state, adding that the study also identifies IV CYC
treatment given after puberty as the major factor in permanent sperm
damage. IV CYC induces long-lasting damage to developing sperm cells
that leads to significant semen alterations. The researchers note that
the striking reduction of testicular volumes paralleled the severity of
sperm abnormalities, suggesting severe damage to the seminiferous
tubules (the tiny tubes in which sperm are produced) in SLE.
Follicle-stimulating hormone (FSH) is a major marker of the function of
the cells lining the seminiferous tubules and its higher levels in the
group 2 SLE patients suggest testicular damage.
The researchers point out that although it is not possible to predict
which SLE patients will become infertile, the persistence of abnormal
testicular function after approximately five years of IV CYC treatment,
combined with elevated FSH and lower testicular volumes, reinforces the
need for sperm cryopreservation for male SLE patients undergoing this
treatment. Freezing and storing sperm should actually be discussed with
all male SLE patients early in the disease course, since for almost a
third of patients with semen alterations, the cause has not been
recognized. The researchers conclude: "Considering that this disease
occurs mainly during reproductive age, a multi-disciplinary approach is
essential to identify the potential risk factors for infertility and to
offer preventive measures for these patients."
Article: "Gonad Evaluation in Male Systemic Lupus
Erythematosus," Pollyana Maria F. Soares, Eduardo Ferreira Borba,
Eloisa Bonfa, Jorge Hallak, André Luiz Corrêa, Clovis Artur A. Silva,
Arthritis & Rheumatism, July 2007; (DOI: 10.1002/art.22660).
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