News from ASRM 2018: Some interesting research papers on male factor infertility

The American Society of Reproductive Medicine just wrapped up its 2018 scientific congress and expo at Denver, Colorado.  Here are some of the research highlights presented at the society about male factor infertility. 

A diagnosis of azoospermia puts men at increased risk of death

Results of a large prospective cohort study report a link between azoospermia and increase the risk of mortality. The study findings were jointly presented by Scandinavian and American researchers at the meeting. Interestingly, the increased risk of dying was not observed for men with oligospermia. 

The authors analyzed data of 51,289 men from the Danish National IVF register from 2006 through 2016 and followed those with azoospermia till the end of study period, death or till they emigrated from Denmark. Vasectomized men and men with normal semen parameters were used as a reference.

The average follow-up period was eight years. Men with azoospermia faced twice the increased risk of dying as compared to men with oligospermia and normal semen parameters.  The mean age at death was 48.8, and the most common cause of death was CVD and cancer.  

Another previous cohort study from Denmark also documented that as the percentages of motile and morphologically normal spermatozoa and semen volume increased, mortality decreased in a dose-response manner (P(trend) < 0.05).

Peter Schlegel, MD, ASRM President-Elect, noted, “A man’s infertility status is a component of his whole health status. Semen analysis results exist on a continuum, but a diagnosis of azoospermia may be a call to take a closer look at a man’s overall health in addition to his reproductive function.”

Thus, Semen parameters could be a key biomarker of overall male health.

Abstract: Male factor infertility and risk of mortality: a register-based cohort study

Inadequate sleep is linked to Low Testosterone Levels in Men

Lack of sleep is associated with decreasing testosterone levels in US male reports the results of a study presented at the ASRM scientific congress at Denver, Colorado. The other culprits for low testosterone were aging, increasing BMI and alcohol consumption.

The researchers examined the data on nearly 2300 males, aged 16-80 years from The National Health and Nutrition Examination Survey (NHANES). The subjects reported an average sleep duration of 6.86 hours (2-12 hours) and had average serum testosterone levels of 303.33 ng/dL (43.39 ng/dL to 779.2 ng/dL).

After accounting for confounders, the researchers noted that serum testosterone levels decreased by 0.49 ng/dL per year of age, 5.85 ng/dL per lost hour of sleep, 6.18 ng/dL per BMI unit increase, and 2.99 ng/dL per each unit increase in alcohol consumption.

Robert Brannigan, MD, a member of ASRM’s Board of Directors, remarked “Reduction in testosterone level can have deleterious effects on a man’s health beyond his fertility and sexual function.  Testosterone is essential for good metabolic function and decreased levels of the hormone are associated with metabolic syndrome and cardiovascular disease.  Low testosterone can contribute to fatigue and depression, as well. A balanced diet and a healthy sleep routine are interventions a man can take on his own to help keep his T levels stable.”

Abstract: Impaired sleep is associated with low testosterone in us adult males: results from the national health and nutrition survey

A decline in sperm count and motility observed in North America and Europe

Two studies presented at the ASRM scientific congress showed that semen quality has seen a decline in patients undergoing fertility treatment and donors in this century. In the first study, researchers from one European and the other North American center evaluated the results of semen analysis from 119,972 men seeking infertility treatment between 2002 through 2017.

The researchers looked at the most reliable indicator of male fertility, the total motile sperm count (TMSC) and grouped the study population into 3 groups: TMSC greater than 15 million; TMSC 5 to 15 million: and TMSC zero to 15 million.

The percentage of patients in Group 1 (highest TMSC) declined from 84.7% in the time period 2002-2005 to 79.1% in 2014-2017, while the percentage in Group 3 (lowest TMSC) rose from 8.9% to 11.6% over those time periods.

TMSC decreased by 1.1% per year as the men aged and thus patients who belonged to Group 1 were slowly slipped into Group 2 as they age.   

For the second study researchers from the Ichan School of Medicine at Mount Sinai, California Cryobank, and Reproductive Medical Associates of New York observed a progressive decline in semen quality in donors over 11 years in six cities:  Los Angeles, Palo Alto, Houston, Boston, Indianapolis, and New York City.

Over a period of 10 years, the researchers analyzed 124,107 semen specimens provided by 2586 donors aged 19 to 38. They looked at three semen parameters- total count, average concentration, and TMSC-  as a whole and region by region.

A decrease in all three parameters was observed in all regions, except New York. ASRM President-elect Peter Schlegel, MD, said, “The trend toward lower sperm counts in this study is concerning.  Whether the causes underlying it are environmental or lifestyle-related, they will be difficult to parse out.  Pollution, endocrine disrupting chemicals, poor exercise habits and convenient, yet nutritionally poor, dietary choices could all play a part.  Similarly, men may now be referred for advanced medical care despite having lower sperm numbers, reflecting our improved reproductive treatments.  Men planning to conceive should do what they can to achieve their best overall health to optimize their sperm quality.”

Abstract: Total motile sperm count trend over time across two continents: evaluation of semen analyses from 119,972 infertile men

Abstract: Eleven-year longitudinal study of U.S. sperm donors demonstrates declining sperm count and motility

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