Gonad evaluation in male systemic lupus erythematosus

Abstract

Objective. To assess gonad function in male patients with systemic lupus erythematosus (SLE).Methods. Thirty-five consecutive male patients with SLE according to the criteria of the American College of Rheumatology were prospectively evaluated for demographic and clinical features as well as previous and current treatment. Patients underwent urologic evaluation and testicular Doppler ultrasound. We obtained a hormone profile and performed a semen analysis including morphology and testing for the presence of antisperm antibodies. Patients were compared with 35 age-matched healthy controls.Results. Compared with controls, SLE patients had lower median testicular volumes in both testes, a lower median total sperm count, and a lower median total motile sperm count. The mean sperm volume and percentage of normally formed sperm were lower in SLE patients than in controls. Since all SLE patients had semen alterations, they were further subdivided into 2 groups according to the severity of these abnormalities (group 1, with teratozoospermia [n ‫؍‬ 18], and group 2, with azoospermia or teratozoospermia in combination with oligozoospermia and/or asthenozoospermia [n ‫؍‬ 17]). The frequency of treatment with intravenous cyclophosphamide (IV CYC) after the first ejaculation was higher in group 2 than in group 1. The median testicular volumes measured by ultrasound in both testicles were lower in group 2 than in group 1. Follicle-stimulating hormone levels were higher in group 2 than in group 1. The overall frequency of antisperm antibodies in SLE patients was 40%. The apparent higher frequency of antisperm antibodies in group 1 than in group 2 did not reach significance.Conclusion. SLE patients have a high frequency of sperm abnormalities associated with reduced testicular volume. Postpubertal IV CYC treatment was the major factor in potential permanent damage to the testes.

Aspectos da saúde reprodutiva em homens com miopatia inflamatória idiopática: um estudo multicêntrico

“…In fact, FSH is a marker of the function of the seminiferous epithelium [9][10][11] and elevated levels suggest testicular lesion, according to what was observed previously by our group in male patients with SLE, reinforcing the need for cryopreservation of the semen, even without prior use of immunosuppresants, such as cyclophosphamide. 9,10 It is also relevant that, despite the testicular dysfunction observed in our study, most patients still had satisfactory sexual function despite the reduced frequency of pregnancy in their partners after the onset of the disease. Another study that evaluated gonadal function based on dysfunction of Sertoli cells will be undertaken.…”

“…6 In systemic lupus erythematosus (SLE), those changes were associated with the use of intravenous cyclophosphamide. [7][8][9][10] Changes in the reproductive health of male adolescents with JDM have also been reported in the literature 4 . However, the literature lacks studies evaluating sexual and/or erectile function in IIM patients using adequately the word infertility, according to the definition of the World Health Organization (WHO).…”

Minor sperm abnormalities in young male post-pubertal patients with juvenile dermatomyositis

“…Soares et al (4) showed a higher frequency of these antibodies in Brazilian SLE patients with teratozoospermia (56%) versus SLE with azoospermia or oligoasthenoteratozoospermia (24%), with the same methodology as the present study. The testis is susceptible to the toxic effects of IVCYC therapy, which might produce long-lasting or persistent damage to primordial sperm cells, leading to oligoasthenoteratozoospermia in patients with juvenile SLE (2,3) or SLE (4). Indeed, sperm cryopreservation should be discussed as a routine part of therapeutic management to preserve fertility in patients who will receive IVCYC (2).…”

“…Evaluation of young male gonadal function requires a complete urological examination in order to determine minor or major sperm alterations due to age, genital system abnormalities [e.g., hydrocele, hypospadia, cryptorchidism, testicular infection (e.g., mumps), testicular cancer], influence of drugs especially intravenous cyclophosphamide (IVCYC), and antisperm antibodies (2). Of note, we recently identified sperm abnormalities in young (2,3) and adult male systemic lupus erythematosus (SLE) patients associated with IVCYC treatment (4). In JDM, disease activity may be an additional contributing factor for possible testicular damage, supported by the report of one case of testicular vasculitis in a 7-year-old boy (5).…”

Autoimmune Orchitis

“…Approximately half of the systemic lupus erythematosus (SLE) patients also have ASA antibodies, without a definite clinical association with infertility (4,5). Testicular involvement occurs in up to 18% of patients with systemic polyarteritis nodosa (PAN), although autopsy frequencies as high as 93% have been reported (6,7,8).…”