Investigation of racial disparities in semen parameters among white, black, and Asian men

Abstract

Background: Male factor infertility is the primary cause of infertility in 20% of couples. Primary evaluation of male factor infertility includes a semen analysis (SA). The World Health Organization (WHO) criteria are widely used to interpret SA. However, the current normative values seen in WHO criteria have led to research showing racial disparities in prevalence of abnormal SA.Objective: To assess the relationship between different self-reported racial groups and rates of abnormal SA. Materials & Methods:We conducted a retrospective cohort study at a single large tertiary care facility. All men who underwent a SA for evaluation of suspected male infertility, unexplained infertility, intrauterine insemination, and in vitro fertilization between January 1, 2017 and December 31, 2019, were considered for inclusion in the study.Exclusion criteria were unreported race or ethnicity, SA for fertility preservation only, history of varicocele or testicular surgery, chromosomal abnormalities, congenital bilateral absence of vas deferens, prior testosterone use, or prior exposure to chemotherapy and/or radiation. Samples obtained via testicular sperm extraction or post-ejaculatory urine collection, or those analyzed ≥1 h from ejaculation, were also excluded.Results: 872 SAs were identified, of which 615 met inclusion criteria, yielding 384 normal and 231 abnormal results. Only race (p < 0.0001) and age (p = 0.002) were statistically significant. Black men had the highest rate of abnormal SA (54%) and were significantly more likely to have lower semen volume, sperm concentration, total sperm count, percent motile sperm, and total motile sperm (p < 0.05). In a logistic regression model, controlling for age and using White Non-Hispanic as the referent group, only Blacks had lower odds for a normal SA (OR = 0.41, 95% CI 0.28, 0.60). Discussion and Conclusions:Black men are more likely to have an abnormal SA based on the 2010 WHO criteria. Black men seeking infertility treatment should be educated on the incidence of abnormal SA and actively seek infertility evaluation.

Self-Reported Race/Ethnicity Is Not Associated with Abnormal Semen Parameters after Accounting for Body Mass Index and Socioeconomic Status

“…We observed that Black men did have higher odds of abnormal sperm concentration and TMSC compared to men from other racial/ethnic groups after adjusting for age alone, which is consistent with prior studies. 14 However, this association was rendered insignificant after adjusting for BMI, insurance status and neighborhood income, suggesting that differences in semen parameters among racial and ethnic groups may be mediated through known comorbid risk factors and social determinants of health. These individual social determinants of health were weakly correlated (all Cramer V correlations <0.3) with one another and with Black race and abnormal semen parameters.…”

“…After Institutional Review Board approval (IRB No. STU00211618) was obtained, we conducted a retrospective review of all men who underwent SA for fertility evaluation at an integrated academic health care system from January 2002 to May 2021 (14,319). Men with missing semen parameters were excluded (1,593).…”

“…Multiple studies have shown an association between race/ethnicity and abnormal semen parameters. 9–14 A recent study reported that Black men were more likely to have an abnormal semen analysis (SA) including significantly lower semen volume, sperm concentration and total motile sperm count (TMSC), and had lower odds of having a normal SA after controlling for age. 14 However, this and other studies do not control for other important potential confounders such as body mass index (BMI) and social determinants of health that may impact semen parameters through delayed presentation for evaluation and environmental exposures.…”