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Anti-TNF agents and potential effects on male fertility: are men being counseled?

Lauren Folgosa Cooley1, James Wren1, Mary Kate Keeter1

  • 1Department of Urology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Arkes 23-015, Chicago, IL, 60611, USA.

BMC Urology
|July 29, 2020
PubMed
Abstract

Insights

Few men with autoimmune conditions receive counseling on anti-tumor necrosis factor (anti-TNF) agent reproductive risks. Sperm cryopreservation rates remain low, even for counseled patients, indicating a need for greater physician awareness.

Area of Science:

  • Reproductive Endocrinology
  • Immunology
  • Urology

Background:

  • Adult men with autoimmune conditions often receive anti-tumor necrosis factor (anti-TNF) agents.
  • Evidence on anti-TNF agents' effects on male fertility, including semen parameters and sperm quality, is limited.
  • Physician counseling regarding these reproductive risks prior to therapy initiation is not well-documented.

Purpose of the Study:

  • To assess the frequency of counseling provided to men with autoimmune conditions about the reproductive effects of anti-TNF agents.
  • To identify factors associated with counseling and sperm cryopreservation.
  • To evaluate the impact of counseling on fertility screening and sperm banking.

Main Methods:

  • Retrospective analysis of 1010 male patients aged 18-45 prescribed anti-TNF agents.
  • Assessment of counseling receipt, fertility screening (genitourinary exam, varicocele assessment, libido/erectile dysfunction inquiry, hormone levels, semen analysis), and sperm cryopreservation.
  • Statistical analysis to determine associations between counseling, screening, and cryopreservation.

Main Results:

  • Only 10.3% of patients received counseling regarding anti-TNF agent reproductive effects.
  • Counseling was significantly associated with increased rates of fertility screening, including semen analysis and hormone level checks (p < 0.0001).
  • Sperm cryopreservation rates were low but higher in counseled patients (5.77%) compared to un-counseled patients (1.10%) (p = 0.002).

Conclusions:

  • Current literature lacks consensus on anti-TNF therapy's male reproductive effects.
  • Pre-initiation counseling rates for these potential risks are notably low.
  • Low sperm cryopreservation rates suggest prescribing physicians may not be fully aware of or offering this fertility preservation option.
Keywords:
Anti-TNFAutoimmuneCounselingInfertilitySperm cryopreservation

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