Complete urological evaluation including sperm DNA fragmentation in male systemic lupus erythematosus patients

Abstract

Objective To evaluate sperm DNA fragmentation analysis in non-azoospermic male systemic lupus erythematosus (SLE) patients. Methods Twenty-eight consecutive male SLE patients (American College of Rheumatology criteria) and 34 healthy controls were evaluated for demographic/exposures data, urological evaluation, hormone profile and sperm analysis (including sperm DNA fragmentation). Clinical features, disease activity/damage scores and treatment were also evaluated. Results The median age (33 (20–52) vs. 36.5 (25–54) years, P = 0.329) and frequency of varicocele (25% vs. 32%, P = 0.183) were similar in SLE patients and healthy controls. Sperm DNA fragmentation showed significantly higher levels of cells class III (44 (9–88) vs. 16.5 (0–80)%, P = 0.001) and cell class IV (10.5 (3–86) vs. 7 (0–36)%, P = 0.039) in SLE. The sperm DNA fragmentation index was also significantly higher in SLE patients (62 (31–97) vs. 25.5 (0–100)%, P < 0.001). Conventional sperm parameters (including sperm count, motility and morphology) were similar in both groups. In SLE patients no correlations were observed between sperm DNA fragmentation index and age, disease duration, Systemic Lupus Erythematosus Disease Activity Index 2000 and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index scores, and cumulative dose of prednisone, hydroxychloroquine, intravenous cyclophosphamide, methotrexate, azathioprine and mycophenolate mofetil ( P > 0.05). Further analysis of SLE patients treated with and without intravenous cyclophosphamide showed that total sperm motility was significantly lower in the former group (64% (15–83) vs. 72% (57–86), P = 0.024). The sperm DNA fragmentation index was alike in both groups (52.5 (31–95) vs. 67.5 (34–97)%, P = 0.185). Conclusions To our knowledge, this is the first demonstration that male non-azoospermic SLE patients have increased sperm DNA fragmentation without evident gonadal dysfunction. Intravenous cyclophosphamide does not seem to be a major determinant for this abnormality. Future prospective study is necessary to determine the impact of this alteration in these patients' fertility.

A systematic overview of the spermatotoxic and genotoxic effects of methotrexate, ganciclovir and mycophenolate mofetil

“…However, higher sperm DNA fragmentation rate was observed. In contrast to these findings, Tiseo et al (2019) 51 found no correlation between sperm DNA damage and cumulative doses of MMF in male SLE patients.…”

The impact of autoimmune systemic inflammation and associated medications on male reproductive health in patients with chronic rheumatological, dermatological, and gastroenterological diseases: A systematic review

“…Moreover, several studies reported lower semen quality in patients treated with cyclophosphamide (CYC) 23‐25 . However, Tiseo et al did not observe any difference in semen parameters of SLE patients and those treated with CYC, but did report a significant increase in sperm DNA fragmentation 26 . Although there is some suggestion FSH may be increased in these patients, primary hypogonadism was not common in SLE or CYC treatment.…”

Influence of the Period of Abstinence on Semen Quality in a Patient with Systemic Lupus Erythematosus: A Case Report and Review of the Literature

“…However, in the literature, there appears to be no guideline to suggest the optimum period of abstinence in relation to semen parameters and DNA fragmentation level for patients with SLE or in those who have had prior exposure to gonadotoxic treatment. A very recent study by Tiseo et al [31] revealed the DNA fragmentation level to be significantly higher in nonazoospermic patients with SLE when compared with a non-SLE control group. However, the period of abstinence in this study was not mentioned.…”