title: Are infertile men less healthy than fertile men? Results of a prospective case-control survey.
abstract: BACKGROUND
  An association between either subfertility or infertility and an elevated risk of certain male cancers has been previously reported. Nothing is known about abnormalities in infertility and general health conditions.
  
  
  OBJECTIVE
  To assess whether men with male factor infertility (MFI) are overall less healthy than fertile men, regardless of the reasons for infertility.
  
  
  METHODS
  From September 2006 to September 2007, 344 consecutive European Caucasian men with MFI were enrolled in this prospective case-controlled study. Patients were compared with a control group of 293 consecutive age-comparable fertile men. Infertile men were consecutively attending the outpatient male reproductive clinic at a tertiary academic center. Fertile controls were consecutively recruited by use of advertisements posted within our hospital.
  
  
  METHODS
  Comorbidities of patients and fertile men were objectively scored with the Charlson Comorbidity Index (CCI) according to the International Classification of Diseases modified ninth version (ICD-9-CM) codes. Multivariate linear regression models tested the association between predictors and CCI score, as a proxy of general health status.
  
  
  RESULTS
  According to the CCI scores, infertile men had a significantly higher rate of comorbidities compared with the fertile controls (CCI: 0.33 [0.8] vs 0.14 [0.5]; p<0.001; 95% CI: 0.08-0.29). Linear regression analyses showed that although educational status did not have an impact on CCI (β: 0.035; p=0.365), while CCI linearly increased with age (β: 0.196; p<0.001) and body mass index (BMI; β: 0.161; p<0.001). After adjusting for age, BMI, and educational status, a significantly lower CCI was calculated for fertile men and compared with MFI patients (β: -0.199; p<0.001).
  
  
  CONCLUSIONS
  These results show that MFI accounts for a higher CCI, which may be considered a reliable proxy of a lower general health status.
authors.affiliation: Department of Urology, University Vita-Salute San Raffaele, Milan, Italy. salonia.andrea@hsr.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.forename: Rayan
authors.initials: R
authors.lastname: Matloob
authors.forename: Andrea
authors.initials: A
authors.lastname: Gallina
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Antonino
authors.initials: A
authors.lastname: Saccà
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.forename: Renzo
authors.initials: R
authors.lastname: Colombo
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Rocchini
authors.forename: Giorgio
authors.initials: G
authors.lastname: Guazzoni
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016022:Case-Control Studies; D015897:Comorbidity; D004522:Educational Status; D005298:Fertility; D006304:Health Status; D006801:Humans; D007248:Infertility, Male / Q000453:epidemiology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult