Seminal, ultrasound and psychobiological parameters correlate with metabolic syndrome in male members of infertile couples

Abstract

SUMMARYMetabolic syndrome (MetS) is a diagnostic category which identifies subjects at high risk for diabetes and cardiovascular diseases, erectile dysfunction (ED) and male hypogonadism. However, MetS impact on male infertility has been poorly studied. We systematically evaluated possible associations between MetS and clinical characteristics in men with couple infertility. Out of 367 consecutive subjects, 351 men without genetic abnormalities were studied. MetS was defined according to the International Diabetes Federation&American Heart Association/National Heart,Lung, and Blood Institute classification. All men underwent physical, hormonal, seminal and scrotal ultrasound evaluation. Erectile and ejaculatory functions were assessed by International Index of Erectile Function-15 erectile function domain (IIEF-15-EFD) and Premature Ejaculation Diagnostic Tool (PEDT), respectively, while psychological symptoms by Middlesex Hospital Questionnaire. Out of 351 patients, 27 (7.7%) fulfilled MetS criteria. Among ultrasound features, in an age-adjusted logistic model, only testis inhomogeneity was significantly associated with increasing MetS factors (HR = 1.36 [1.09-1.70]; p < 0.01). In an age-adjusted model, MetS was associated with a stepwise decline in total testosterone (TT) (B = À1.25 ± 0.33; p < 0.0001), without a concomitant rise in gonadotropins. At univariate analysis, progressive motility and normal morphology were negatively related to the number of MetS components (both p < 0.0001), but when age and TT were introduced in a multivariate model, only sperm morphology retained a significant association (B = À1.418 ± 0.42; p = 0.001). The risk of ED (IIEF-15-EFD score <26) increased as a function of the number of MetS factors, even after adjusting for age and TT (HR = 1.45[1.08-1.95]; p < 0.02). No association between PEDT score and MetS was observed. Finally, after adjusting for age and TT, somatization and depressive symptoms were associated with increasing MetS components (B = 0.66 ± 0.03, p < 0.05; B = 0.69 ± 0.03, p < 0.02; respectively). In conclusion, in men with couple infertility, MetS is associated with hypogonadism, poor sperm morphology, testis ultrasound inhomogeneity, ED, somatization and depression. Recognizing MetS could help patients to improve not only fertility but also sexual and overall health.

Metabolic syndrome in White-European men presenting for secondary couple′s infertility: an investigation of the clinical and reproductive burden

“…We may speculate that several factors might account for these differences. Emphasis on obesity when defining MetS (such as the case of Lotti et al 22. using the International Diabetes Federation worldwide definition) and older age (as observed in our secondary infertile patients) might unveil the impact of MetS on seminal parameters whereas younger age and NCEP-ATP III definition, as observed in our sample of primary infertile men, would not 34…”

“…We found that tT was reduced in +MetS patients compared to the –MetS group whereas cfT did not seem to be affected by this condition. In contrast, Lotti et al 22. reported decreased values of both tT and fT, while Leisegang et al 23.…”

“…To this regard, the relationship between MetS and seminal parameters remains controversial. Indeed, two observational studies2223 have shown an association between MetS and poor sperm parameters in men broadly presenting for couple infertility. Conversely, our previous findings regarding primary infertile men reported no noticeable detrimental effect induced by MetS 34.…”

“…Although MetS was shown to have a detrimental effect on male reproductive health2223 in primary infertile men, the impact of MetS on male reproductive function has never been analyzed before in White-European men seeking medical help for secondary infertility. Likewise, the lack of previous clinical evidence and the increasing prevalence of MetS,24 with its potential impact on both the hormonal milieu and the overall health status of men, prompted us to investigate the role of MetS in male secondary infertility, assessing (i) the prevalence of MetS, (ii) correlations between MetS and clinical characteristics, and (iii) the impact of MetS on semen and hormonal parameters in a cohort of White-European men presenting for secondary couple's infertility.…”

Diagnostic value of qualitative and strain ratio elastography in the differential diagnosis of non‐palpable testicular lesions

“…Standardized protocols with axial and transverse examinations of the lesions were performed (Oyen, 2002, Bhatt et al ., 2006; American Institute of Ultrasound in M edicine et al . 2011; Lotti et al ., 2013). Two experienced sonographers (A.M.I.…”