Review: Gonadal functioning and preservation of reproductive fitness with juvenile systemic lupus erythematosus

Abstract

Increased survival of children with juvenile systemic lupus erythematosus (jSLE) and improved prognosis have led to a change in the long-term health issues arising for jSLE patients. Preservation of gonadal functioning and fertility are of increasing importance for young adults with jSLE. Events during childhood, such as exposure to alkylating agents, may compromise the reproductive potential. Even in the absence of gonadotoxic therapies, fertility may be decreased through organs specific involvement with jSLE. Strategies to preserve the reproductive potential of girl and boys with jSLE are discussed.

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

“…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).…”

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

“…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).…”

“…34 Similarly to menarche in females, spermarche represents an important pubertal landmark in the reproductive capacity of males. 8 The age of the first ejaculation was not delayed in patients with inflammatory myopathies when compared to the control group. This finding was different from that of female patients with SLE whose menarche was delayed one year when compared to a group of healthy Brazilian adolescents.…”

“…11 Sexual characteristics were evaluated according to the pubertal criteria proposed by Tanner, i.e., distribution of pubic hair and characteristics of the genitalia. 15 Testicular volume was measured with a Prader orchidometer, which consists of 12 numbered beads from 1 to 25 mL (1 to 6,8,10,12,15,20, and 25 mL). 16 In post-pubertal adolescents and adult males, testicular atrophy was defined as a testicular volume < 12 mL.…”