Objective
To further understand the association between semen quality and cancer risk using well-defined semen parameters.
Design
Retrospective cohort study.
Setting
Subfertility Heath and Assisted Reproduction (SHARE) study in Utah from 1994 to 2011.
Patients
20,433 men from that underwent semen analysis (SA) and a sample of 20,433 fertile controls matched on age and birth year
Interventions
none.
Main Outcome Measures
Risk of all cancers, as well as site-specific results for prostate, testicular, and melanoma.
Results
Relative to fertile men, men with SA have an increased risk of testicular cancer (Hazard Rate Ratio (HR) =3.3). When the characterization of infertility is refined using individual semen parameters, we find that oligozoospermic men have an increased risk of cancer relative to fertile controls. This association is particularly strong for testicular cancer, with increased risk in men with oligozoospermia based on concentration (HR=11.9) and sperm count (HR=10.3). Men in the in the lowest quartile of motility (HR=4.1), viability (HR=6.6), morphology (HR=4.2) or total motile count (HR=6.9) have higher risk of testicular compared to fertile men. Men with sperm concentration and count in the 90th percentile of the distribution (≥178 M/ml and ≥579, respectively) and total motile count (TMC) have an increased risk of melanoma (HRConcentration=2.1; HRCount=2.7; HRTMC=2.0). We find no differences in cancer risk between azoospermic and fertile men.
Conclusions
Men with SA have an increased risk of testicular cancer that varies by semen quality. Unlike prior work, we did not find an association between azoospermia and increased cancer or testicular cancer risk.
Capsule
Subfertile men have an increased risk of testicular cancer that varies by semen quality. We did not find an association between azoospermia and increased cancer or testicular cancer risk.