Arthritis And Male Fertility, What Is Their Relationship?

This pathology has been related to male infertility, erectile dysfunction and insufficient production of testosterone.

Several inflammatory proteins involved in the immune response associated with inflammatory arthritis play a key role in the regulation of sperm production. Photo: Shutterstock.

The rheumatoid arthritis or one of the other types of arthritis inflammatory, diagnosed before or during the years of maximum reproductive activity, can reduce the fertility of mensaccording to research published online in the Annals of the Rheumatic Diseases.


Inflammatory arthritis is associated with having fewer children, higher rates of infertility, involuntary childlessness, and fertility problems such as poor sperm quality, according to the results of this study.

This condition, which includes rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis, and ankylosing spondylitis, has been linked to male infertility, erectile dysfunction, and insufficient production of testosterone and/or sperm (hypogonadism). But the impact of inflammatory arthritis on men’s ability to father children remains largely unknown.

To explore this question, the researchers, led by Luis Fernando Perez-Garcia, a rheumatologist at Erasmus Medical Center in the Netherlands, compared the fertility rate, or number of children per man, among men diagnosed with inflammatory arthritis based on your age at diagnosis; 30 years or younger; between 31 and 40 years (considered the maximum reproductive age); and 41 years or older.

Participants were drawn from 8 different hospitals in the Netherlands between September 2019 and January 2021. Some 628, aged over 40 and indicating their family size was complete, filled out a questionnaire about medical and fertility problems they had had before and after being diagnosed with inflammatory arthritis.

The researchers also compared the total number of pregnancies linked to each man, desired family size, the proportion of men without children, and the results of medical evaluations for fertility problems.

After adjusting for potentially influential factors, such as current age, educational level, history of cardiovascular disease, and partner infertility, men diagnosed with any type of inflammatory arthritis before age 30 had significantly fewer children than men in the other two age groups.

These men had an average of 1.32 children, compared to 1.56 for those diagnosed between 31 and 40 years of age, and 1.88 for those diagnosed when they were 41 years of age or older.

Men diagnosed before or when they were 30 years old also had fewer pregnancies (1.45) than those diagnosed between 31 and 40 years old (1.73) or older (1.98). In the Netherlands, between 1 in 5 and 1 in 4 men are childless. Among the participants, 143 (just over 22%) were childless, of whom approximately two-thirds (99; 69%) were voluntarily childless.

Once again, the percentage of men without children was significantly higher among those diagnosed before or at the age of 30 (45;34%), than among those diagnosed between 31 and 40 years (39;27%) and those diagnosed at 40 years (59;17%).

Furthermore, the proportion of men involuntarily childless was significantly different between the 3 groups: respectively, 16 (12%); 15 (10%); and 13 (4%). Voluntary childlessness was also different: 29 (25%); 24 (18%); and 46 (15%).

But among those who did not voluntarily have children, the statement ‘My illness reduced my desire to have children’ was rated higher by men diagnosed at the youngest age than by those in either of the other two age groups.

In addition, significantly more men diagnosed before or at the age of 30 (17%) and between 31 and 40 years (10%) reported being dissatisfied with their final number of children than men diagnosed when they were older (5.5 %). About a third of these men indicated their diagnosis and/or associated medical treatment as the main reason for having fewer children.

Compared with the older age group, significantly more of those diagnosed before or during peak fertility years reported having been medically evaluated for fertility problems, resulting in poor sperm quality.

Although the number of desired children was lower in men previously diagnosed and during their peak fertility years, there was no significant difference between the 3 groups overall and was similar to the figure reported per man for the general population of the Netherlands .

But, the researchers stress, “the difference between the desired number of children and the final number of children was significantly greater in men diagnosed before and during their reproductive years, indicating that lower fertility rates are affected primarily by reduced birth control.” fertility potential and not because of a diminished desire to be parents.

This is an observational study and as such cannot establish cause, however there are some plausible biological explanations for the associations found, the researchers explain.

Several inflammatory proteins involved in the immune response associated with inflammatory arthritis, such as tumor necrosis factor (TNF), play a key role in regulating the stability testicular and sperm production.

Drugs used to treat arthritis may also play a role, they suggest. Side effects such as hypogonadism and poor sperm quality have been associated with commonly used immunosuppressive agents.

And it has been estimated that among childless men who involuntarily attend infertility clinics, 1 in 4 take drugs that could affect sexual function, while 1 in 10 take drugs associated with impaired fertility.

Likewise, various psychosocial factors associated with their diagnosis may also have contributed to the lower fertility rate, the researchers suggest.

“Because of problems or concerns associated with diagnosis and treatment, and based on medical advice (or lack of it), men with inflammatory arthritis and their partners decided to voluntarily remain childless or delay their plans to be parents,” they explain. “These psychosocial factors were especially important for men diagnosed before peak reproductive age.”

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