title: TNF-α inhibitors do not impair sperm quality in males with ankylosing spondylitis after short-term or long-term treatment.
abstract: OBJECTIVE
  The aim of this study was to study the influence of active disease status and TNF-α antagonists on sperm quality in a group of AS patients.
  
  
  METHODS
  Twenty-three active AS patients and 42 controls were recruited. Patients' sperm samples were analysed at baseline (previous to) and at 3-6 months after TNF-α therapy (adalimumab, infliximab, etanercept) administration. Baseline assessment was made for only 20 patients, 2 of them proving to have normal fertility, 2 having a pregnant stable partner and the third having a 9-month-old child. Six patients were retested after 12 months of biologic therapy. Each patient acted as his own comparator. Results were further compared with sperm samples from age-matched controls. Sperm analysis was performed according to the World Health Organization (WHO) 1999 guidelines.
  
  
  RESULTS
  Patients' baseline assessment showed normozoospermia in 91% and oligozoospermia in 9% of patients. No significant differences in sperm quality were noticed at follow-up visits compared with baseline. Comparison to controls showed no statistically significant differences in semen quality, with some exceptions: the control group presented a higher percentage of non-progressive and immobile sperm cells and higher numbers of head and tail atypias.
  
  
  CONCLUSIONS
  Sperm quality in patients with active AS and after receiving short- and long-term TNF-α blocker therapy is comparable to sperm quality in healthy controls. Our study confirms that the disease process of AS does not have a major impact on sperm quality and that treatment with anti-TNF has no negative impact on sperm quality even under long-term treatment.
authors.affiliation: Division of Rheumatology, Department of Rehabilitation II, Clinical Rehabilitation Hospital, Assisted Reproduction Department, Gynecology I Clinic, Department of Medical Informatics and Biostatistics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania and National Center of Pregnancy and Rheumatic Disease, Department of Rheumatology, Trondheim University Hospital, Trondheim and Sörlandet Sykehus, Kristiansand, Norway. mcmicu@yahoo.com.
authors.forename: Mihaela C
authors.initials: MC
authors.lastname: Micu
authors.affiliation: Division of Rheumatology, Department of Rehabilitation II, Clinical Rehabilitation Hospital, Assisted Reproduction Department, Gynecology I Clinic, Department of Medical Informatics and Biostatistics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania and National Center of Pregnancy and Rheumatic Disease, Department of Rheumatology, Trondheim University Hospital, Trondheim and Sörlandet Sykehus, Kristiansand, Norway.
authors.forename: Romeo
authors.initials: R
authors.lastname: Micu
authors.affiliation: Division of Rheumatology, Department of Rehabilitation II, Clinical Rehabilitation Hospital, Assisted Reproduction Department, Gynecology I Clinic, Department of Medical Informatics and Biostatistics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania and National Center of Pregnancy and Rheumatic Disease, Department of Rheumatology, Trondheim University Hospital, Trondheim and Sörlandet Sykehus, Kristiansand, Norway.
authors.forename: Stela
authors.initials: S
authors.lastname: Surd
authors.affiliation: Division of Rheumatology, Department of Rehabilitation II, Clinical Rehabilitation Hospital, Assisted Reproduction Department, Gynecology I Clinic, Department of Medical Informatics and Biostatistics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania and National Center of Pregnancy and Rheumatic Disease, Department of Rheumatology, Trondheim University Hospital, Trondheim and Sörlandet Sykehus, Kristiansand, Norway.
authors.forename: Marinela
authors.initials: M
authors.lastname: Gîrlovanu
authors.affiliation: Division of Rheumatology, Department of Rehabilitation II, Clinical Rehabilitation Hospital, Assisted Reproduction Department, Gynecology I Clinic, Department of Medical Informatics and Biostatistics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania and National Center of Pregnancy and Rheumatic Disease, Department of Rheumatology, Trondheim University Hospital, Trondheim and Sörlandet Sykehus, Kristiansand, Norway.
authors.forename: Sorana D
authors.initials: SD
authors.lastname: Bolboacă
authors.affiliation: Division of Rheumatology, Department of Rehabilitation II, Clinical Rehabilitation Hospital, Assisted Reproduction Department, Gynecology I Clinic, Department of Medical Informatics and Biostatistics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania and National Center of Pregnancy and Rheumatic Disease, Department of Rheumatology, Trondheim University Hospital, Trondheim and Sörlandet Sykehus, Kristiansand, Norway.Division of Rheumatology, Department of Rehabilitation II, Clinical Rehabilitation Hospital, Assisted Reproduction Department, Gynecology I Clinic, Department of Medical Informatics and Biostatistics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania and National Center of Pregnancy and Rheumatic Disease, Department of Rheumatology, Trondheim University Hospital, Trondheim and Sörlandet Sykehus, Kristiansand, Norway.
authors.forename: Monika
authors.initials: M
authors.lastname: Ostensen
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D016022:Case-Control Studies; D004305:Dose-Response Relationship, Drug; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D015994:Incidence; D000069285:Infliximab; D008297:Male; D009845:Oligospermia / Q000453:epidemiology; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012307:Risk Factors; D055101:Semen Analysis; D013094:Spermatozoa / Q000166:cytology* / Q000187:drug effects; D013167:Spondylitis, Ankylosing / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept
keywords: TNF-α blockers; active disease; ankylosing spondylitis; biologic therapy; fatherhood; fertility; reproduction; sperm parameters; spermatogenesis; treatment