title: Infertility as a proxy of general male health: results of a cross-sectional survey.
abstract: OBJECTIVE
  To evaluate the prevalence, and clinical and seminal impact of comorbidities in white European men presenting for couple infertility.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Academic reproductive medicine outpatient clinic.
  
  
  METHODS
  Cohort of 2,100 consecutive infertile men (noninterracial infertile couples).
  
  
  METHODS
  Obtaining complete demographic, clinical, and laboratory data from 2,100 consecutive infertile men with health-significant comorbidities scored via the Charlson comorbidity index (CCI; categorized 0 vs. 1 vs. ≥2) and semen analysis values assessed based on 2010 World Health Organization reference criteria.
  
  
  METHODS
  Assessment of the rate of comorbidities by means of CCI scores and possible associations between CCI, semen and hormonal parameters.
  
  
  RESULTS
  Descriptive statistics and regression models tested the associations among semen parameters, clinical characteristics, and CCI. When assessing general comorbidity prevalence, CCI 0, CCI 1, and CCI ≥2 was found in 1,921 (91.5%), 102 (4.9%), and 77 (3.6%) patients, respectively. Patient age and follicle-stimulating hormone levels increased as the general health status decreased. Conversely, the total testosterone levels and sperm concentration decreased as CCI scores increased. A higher rate of oligozoospermia and nonobstructive azoospermia was observed in patients with CCI ≥1. No differences were observed among the considered comorbidity groups in terms of testicular volume or further hormonal or seminal parameters. Both continuously coded and categorized sperm concentrations were independent predictors of CCI ≥1. Patients with sperm concentration <45.6 million/mL (most informative cutoff value) had a 2.74-fold increased risk of having a CCI ≥1.
  
  
  CONCLUSIONS
  Decreased general health status appears to be associated with impaired male reproductive health, including lower sperm concentration, lower total testosterone levels, and higher follicle-stimulating hormone values.
authors.affiliation: Division of Experimental Oncology/Unit of Urology; URI, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Ventimiglia
authors.affiliation: Division of Experimental Oncology/Unit of Urology; URI, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Capogrosso
authors.affiliation: Division of Experimental Oncology/Unit of Urology; URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Boeri
authors.affiliation: Division of Experimental Oncology/Unit of Urology; URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Serino
authors.affiliation: Division of Experimental Oncology/Unit of Urology; URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Colicchia
authors.affiliation: Division of Experimental Oncology/Unit of Urology; URI, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Ippolito
authors.affiliation: Division of Experimental Oncology/Unit of Urology; URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Scano
authors.affiliation: Infertility Unit, Unit of Obstetrics/Gynecology, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Papaleo
authors.affiliation: Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Damiano
authors.affiliation: Division of Experimental Oncology/Unit of Urology; URI, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Division of Experimental Oncology/Unit of Urology; URI, IRCCS Ospedale San Raffaele, Milan, Italy; Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy. Electronic address: salonia.andrea@hsr.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D006304:Health Status; D006801:Humans; D007248:Infertility, Male / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D055101:Semen Analysis / Q000379:methods / Q000639:trends; D013076:Sperm Count / Q000379:methods / Q000639:trends*; D013081:Sperm Motility; D055815:Young Adult
keywords: Comorbidities; infertility; semen parameters; sperm concentration; testosterone