Effect of Methotrexate on Semen Parameters in Psoriatic Male Patients

Background Psoriasis is a chronic, immune-mediated inflammatory skin disease that affects approximately 60 million people worldwide. Methotrexate (MTX), a folate antagonist, is frequently prescribed as a systemic treatment for moderate-to-severe psoriasis due to its immunosuppressive efficacy and cost-effectiveness. Despite its long-standing use, concerns persist regarding its potential impact on male fertility, particularly on semen parameters. Objective To evaluate the impact of methotrexate treatment on semen parameters in male patients with psoriasis. Methods This prospective pre-post cohort study included 31 male psoriasis patients aged 18-50, treated with MTX for at least three months. Patients with systemic illnesses (e.g., diabetes, cardiovascular disease), endocrine disorders (e.g., thyroid dysfunction), autoimmune diseases (e.g., lupus, rheumatoid arthritis), genetic syndromes, or recent hormonal therapy (e.g., testosterone, anabolic steroids, or gonadotropins) within three months were excluded. Semen analyses were conducted immediately before initiating MTX therapy and again after completing three continuous months of treatment, without discontinuation, Data were analyzed using a paired t-test to compare pre- and post-treatment continuous variables, including semen volume, pH, sperm concentration, motility, morphology, and pus cell count (WBCs) using WHO 2010 criteria. Categorical data were summarized using frequencies and percentages. A p-value < 0.05 was considered statistically significant. Results The mean age of the study participants was 34.84 ± 9.78 years. No statistically significant differences (all p > 0.05) were observed pre- and post-treatment in semen volume (3.01 ± 1.61 vs. 3.12 ± 0.88 mL), pH (7.57 ± 0.11 vs. 7.56 ± 0.096), total sperm motility (46.61 ± 20.97% vs. 46.01 ± 21.14%), sperm morphology (19.26 ± 9.99% vs. 19.49 ± 11.90%), sperm concentration (50.21 ± 21.75 vs. 61.20 ± 29.56 million/mL), or pus cell count in semen (2.94 ± 2.29 vs. 2.80 ± 2.28). Conclusion Methotrexate treatment over three months did not lead to statistically significant changes in semen parameters among psoriatic male patients, indicating no observed short-term adverse effects on male reproductive indicators. Given the small sample size and absence of a control group, these findings should be considered preliminary and warrant further validation in larger, controlled studies.