COMPARISON OF IMPAIRED FERTILITY IN MEN NEWLY DIAGNOSED RHEUMATOID ARTHRITIS WITH GENERAL POPULATION

Abstract

Background: Inflammatory arthritis (IA) is increasingly recognized as a condition that may compromise male reproductive health, yet this area remains substantially underexplored. Chronic inflammation, hormonal alterations, sexual dysfunction, and the potential gonadotoxic effects of anti-rheumatic therapies collectively pose risks to fertility in affected men. Conditions such as rheumatoid arthritis (RA), spondyloarthritis (SpA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), and juvenile idiopathic arthritis (JIA) often occur during peak reproductive years, making the assessment of male fertility essential for comprehensive clinical care.

Objective: To evaluate the impact of inflammatory arthritis on male fertility by assessing semen quality, hormonal profiles, sexual function, and the association between disease activity and reproductive outcomes.

Methods: A cross-sectional observational study was conducted involving 120 males aged 18–45 years, including 80 diagnosed with IA and 40 age-matched healthy controls. Clinical characteristics, medication exposure, and disease activity scores (DAS28, BASDAI) were documented. Semen analysis was performed using WHO 2010 criteria, and hormonal assays included follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone, and prolactin. Sexual function and quality of life were assessed using the International Index of Erectile Function (IIEF) and SF-36 questionnaires. Comparative analyses were used to evaluate group differences, and regression models were applied to determine associations between disease activity, therapy type, and fertility outcomes.

Results: IA patients demonstrated significantly reduced semen volume (2.1 ± 0.6 mL vs. 2.6 ± 0.5 mL; p = 0.003), sperm concentration (31.4 ± 12.7 vs. 48.5 ± 15.2 million/mL; p < 0.001), progressive motility (39.2 ± 11.8% vs. 52.6 ± 10.3%; p < 0.001), and normal morphology (3.6 ± 1.4% vs. 5.4 ± 1.7%; p < 0.001). Testosterone levels were lower (365 ± 95 vs. 472 ± 88 ng/dL; p < 0.001), while FSH (8.2 ± 2.3 vs. 5.6 ± 1.8 IU/L; p = 0.004) and LH (6.9 ± 1.9 vs. 4.8 ± 1.4 IU/L; p = 0.005) were elevated. Erectile dysfunction was more prevalent in IA patients (35% vs. 12.5%; p = 0.012), and fatigue scores were significantly higher. Disease activity showed an inverse correlation with semen quality (r = –0.42; p = 0.002). Patients on biologic therapies exhibited better fertility profiles compared with those receiving NSAIDs or conventional DMARDs.

Conclusion: Inflammatory arthritis adversely impacts male reproductive health through impaired semen parameters, hormonal dysregulation, and reduced sexual function. Early fertility evaluation and personalized treatment—particularly biologic therapy—may help mitigate these effects and improve long-term reproductive outcomes.