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 conducted.
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 follicle-stimulating hormone.
"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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