Chronic prostatitis and male infertility: association mechanism and research progress

To systematically examine the association between chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and male infertility, elucidate the pathophysiological mechanisms by which CP/CPPS impairs fertility, summarize current research advancements, and establish a foundation for targeted diagnosis and treatment strategies.

This study synthesizes clinical research, meta-analyses, and experimental model evidence to examine alterations in semen parameters (concentration, motility, morphology, DNA fragmentation rate) and seminal plasma biomarkers (PSA, cytokines, hormones). It explores the interactions across various systems, including neuro-immune-endocrine dysregulation, metabolic diseases, microcirculatory dysfunction, aberrant intestinal-prostate axis activity, and mitochondrial autophagy. The study assesses diagnostic frameworks such as NIH-CPSI and UPOINT, along with their therapeutic effectiveness.

CP/CPPS markedly decreased sperm concentration (SMD= - 14.12), forward motility (SMD= - 5.94), and normal morphology rate (SMD= - 8.26), while elevating DNA fragmentation rates (> 30%). Principal mechanisms comprise: (1) Pro-inflammatory cytokines (e.g., IL-6, TNF-α) impairing mitochondrial function and DNA integrity; (2) Neuroendocrine dysfunction inhibiting the hypothalamic-pituitary-testicular axis; (3) Metabolic syndrome comorbidity (OR = 2.10) inducing an energy crisis via mitochondrial dysfunction; (4) Gut microbiota dysbiosis diminishing anti-inflammatory short-chain fatty acids (SCFAs), intensifying systemic and reproductive tract inflammation; (5) Mitophagy impairments (e.g., PINK1 dysfunction) resulting in the accumulation of damaged sperm mitochondria. UPOINTs phenotype-guided multimodal therapy mitigates clinical symptoms, with 77.5% of patients attaining a reduction of at least 6 points in the NIH chronic prostatitis symptom index (NIH-CPSI) scores within 6 months.

The intricate pathogenesis of male infertility in CP/CPPS encompasses a diverse array of pathways: inflammatory, autoimmune, neuroendocrine, metabolic, and mitochondrial. Future investigations should concentrate on the mechanisms of mitochondrial autophagy and the regulation of epigenetics. Clinical management may contemplate the implementation of multidisciplinary, collaborative, phenotype-oriented, comprehensive therapies to disrupt the "chronic pain-inflammation-infertility" vicious cycle and protect fertility health.