Low sperm count not just a problem for fertility

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A man’s semen count is a marker of his general health, according to the largest study to date evaluating semen quality, reproductive function and metabolic risk in men referred for fertility evaluation. The study results, in 5,177 male partners of infertile couples from Italy, will be presented Sunday at ENDO 2018, the Endocrine Society’s 100th annual meeting in Chicago, Ill.

“Our study clearly shows that low sperm count by itself is associated with metabolic alterations, cardiovascular risk and low bone mass,” said the study’s lead investigator, Alberto Ferlin, M.D., Ph.D. He recently moved as associate professor of endocrinology to Italy’s University of Brescia from the University of Padova, where the study took place in collaboration with professor Carlo Foresta, M.D.

“Infertile men are likely to have important co-existing health problems or risk factors that can impair quality of life and shorten their lives,” said Ferlin, who is also president of the Italian Society of Andrology and Sexual Medicine. “Fertility evaluation gives men the unique opportunity for health assessment and disease prevention.”

Specifically, Ferlin and his colleagues found that about half the men had low sperm counts and were 1.2 times more likely than those with normal sperm counts to have greater body fat (bigger waistline and higher body mass index, or BMI); higher blood pressure (systolic, or top reading), “bad” (LDL) cholesterol and triglycerides; and lower “good” (HDL) cholesterol. They also had a higher frequency of metabolic syndrome, a cluster of these and other metabolic risk factors that increase the chance of developing diabetes, heart disease and stroke, the investigators reported. A measure of insulin resistance, another problem that can lead to diabetes, also was higher in men with low sperm counts.

Low sperm count was defined as less than 39 million per ejaculate, a value also used in the U.S. All the men in the study had a sperm analysis as part of a comprehensive health evaluation in the university’s fertility clinic, which included measurement of their reproductive hormones and metabolic parameters.

The researchers found a 12-fold increased risk of hypogonadism, or low testosterone levels, in men with low sperm counts. Half the men with low testosterone had osteoporosis or low bone mass, a possible precursor to osteoporosis, as found on a bone density scan.

These study findings, according to Ferlin, suggest that low sperm count of itself is associated with poorer measures of cardiometabolic health but that hypogonadism is mainly involved in this association. He cautioned that their study does not prove that low sperm counts cause metabolic derangements, but rather that sperm quality is a mirror of the general male health.

The bottom line, Ferlin stressed, is that treatment of male infertility should not focus only on having a child when diagnostic testing finds other health risks, such as overweight, high cholesterol or high blood pressure.

“Men of couples having difficulties achieving pregnancy should be correctly diagnosed and followed up by their fertility specialists and primary care doctor because they could have an increased chance of morbidity and mortality,” he said.

Article Source: https://www.eurekalert.org/pub_releases/2018-03/tes-lsc031418.php

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Infertility in men could point to more serious health problems later in life

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Poor sperm quality affects about one in ten men and may lead to fertility problems. These men also have an increased risk of developing testicular cancer, which is the most common malignant disease of young males. And, even if they don’t develop testicular cancer, men with poor sperm quality tend to die younger than men who don’t have fertility problems.

Couples who can’t achieve pregnancy usually go to fertility clinics for treatment. At these clinics, emphasis is put on deciding whether the couple needs assisted reproduction or not, and, if so, to choose between different methods (such as IVF, IUI, or ICSI) for doing this. In most cases, these treatments lead to pregnancy and a live birth. So the problem seems to be solved. But if infertility is an early symptom of an underlying disease in the man, fertility clinics won’t pick it up.

Missed opportunity

Testicular cancer is easy to detect. In men seeking treatment for fertility problems, a simple ultrasound scan of the testes can reveal early cancer, so a life-threatening tumour can be prevented. If detected, 95% of all cases can be cured. But, unfortunately, testicular ultrasound scans are rarely performed at fertility clinics as the focus tends to be on sperm numbers and which method of assisted reproduction to use.

And testicular cancer is not the only threat to young infertile men’s health. Serious health problems, such as metabolic syndrome (high blood pressure, high blood sugar and obesity), type 2 diabetes and loss of bone mass are also much more common conditions among infertile men. These disorders are possible to prevent, but if left untreated often lead to premature death.

A possible culprit

At Lund University in Malmö, Sweden, we have – together with other research groups – made a number of studies focusing on the link between male fertility problems and subsequent risk of serious diseases. We cannot yet explain the causes, but testosterone deficiency is a strong candidate. My research team found that 30% of all men with impaired semen quality have low testosterone levels. And men totally lacking the hormone have early signs of diabetes and bone loss.

We recently conducted a study in which we investigated almost 4,000 men below the age of 50 and who had had their testosterone measured 25 years ago. We found that the risk of dying at a young age was doubled among those with low testosterone levels compared with men with normal levels of this hormone.

Although testosterone treatment may not necessarily be the best preventive measure, these findings makes it possible to identify men at high risk so that they can be advised about lifestyle changes, such as losing weight or quitting smoking – lifestyle changes that will help reduce the risk of developing type 2 diabetes, cardiovascular disease and osteoporosis.

A relatively high proportion of men get in touch with their doctor about infertility problems and, as they represent a high-risk group for some of the most common diseases occurring later in life, perhaps it is time to change the routines for managing them. With the knowledge we now have regarding these men’s health, the least we can demand from doctors is to identify those who are at risk of serious diseases after they have become fathers. This is cheap and only requires simple tests. It is no longer enough to just evaluate the number of sperm.

 

Written by:  Aleksander Giwercman And Yvonne Lundberg Giwercman, The Conversation

Article Source: https://medicalxpress.com/news/2017-05-infertility-men-health-problems-life.html

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