Male fertility potential alteration in rheumatic diseases: a systematic review.
BACKGROUND
Improved targeted therapies for rheumatic diseases were developed recently resulting in a better prognosis for affected patients. Nowadays, patients are living longer and with improved quality of life, including fertility potential. These patients are affected by impaired reproductive function and the causes are often multifactorial related to particularities of each disease. This review highlights how rheumatic diseases and their management affect testicular function and male fertility.


METHODS
A systematic review of literature of all published data after 1970 was conducted. Data was collected about fertility abnormalities in male patients with systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, ankylosing spondylitis, Behçet disease and gout. Two independent researchers carried out the search in online databases.


RESULTS
A total of 19 articles were included addressing the following diseases: 7 systemic lupus erythematosus, 6 Behçet disease, 4 ankylosing spondylitis, 2 rheumatoid arthritis, 2 dermatomyositis and one gout. Systemic lupus erythematosus clearly affects gonadal function impairing spermatogenesis mainly due to antisperm antibodies and cyclophosphamide therapy. Behçet disease, gout and ankylosing spondylitis patients, including those under anti-TNF therapy in the latter disease, do not seem to have reduced fertility whereas in dermatomyositis, the fertility potential is hampered by disease activity and by alkylating agents. Data regarding rheumatoid arthritis is scarce, gonadal dysfunction observed as consequence of disease activity and antisperm antibodies.


CONCLUSIONS
Reduced fertility potential is not uncommon. Its frequency and severity vary among the different rheumatic diseases. Permanent infertility is rare and often associated with alkylating agent therapy.
Departamento de Urologia da Faculdade de Medicina da Universidade de São Paulo, Brasil.
Bruno Camargo
BC
Tiseo
Departamento de Urologia da Faculdade de Medicina da Universidade de São Paulo, Brasil.
Marcello
M
Cocuzza
Divisão de Reumatologia da Faculdade de Medicina da Universidade de São Paulo, Brasil.
Eloisa
E
Bonfa
Departamento de Urologia da Faculdade de Medicina da Universidade de São Paulo, Brasil.
Miguel
M
Srougi
Divisão de Reumatologia da Faculdade de Medicina da Universidade de São Paulo, Brasil.|Unidade de Reumatologia Pediátrica do Departamento de Pediatria da Faculdade de Medicina da Universidade de São Paulo, Brasil.
Clovis A
CA
Silva
D000477:Alkylating Agents / Q000009:adverse effects; D001528:Behcet Syndrome / Q000150:complications; D003882:Dermatomyositis / Q000150:complications; D006073:Gout / Q000150:complications; D006801:Humans; D007248:Infertility, Male / Q000209:etiology* / Q000503:physiopathology; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D008297:Male; D012216:Rheumatic Diseases / Q000150:complications*; D013167:Spondylitis, Ankylosing / Q000150:complications
D000477:Alkylating Agents