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There is a high frequency of sperm abnormalities, small testicular volume, and a high level of sperm antibodies in men with systemic lupus erythematosus (SLE).
Investigators at the University of Sao Paolo, Brazil, reporting in the August issue of Arthritis and Rheumatism, trace the source of these abnormalities back to treatment of the disease with intravenous cyclophosphamide.
Dr. Pollyana Maria F. Soares and colleagues studied gonad function in 35 consecutive male patients with SLE. Their age range was 15-42 years, mean age was 28.9 years. The patients were compared with 35 healthy age-matched controls.
The investigators collected demographic and clinical data on the study group, including previous and current treatment for SLE. The subjects underwent urologic evaluation and Doppler ultrasound of the testes. An analysis of sperm morphology and sperm antibodies was conducted and a hormone profile was obtained.
Median testicular volume was lower bilaterally in patients than controls, as were median sperm count and motility. Mean sperm volume and the percentage of normally formed sperm were also lower in the study group than controls.
Eighteen of the 35 patients had teratozoospermia (group 1). Seventeen patients had azoospermia or teratozoospermia plus oligozoospermia or asthenozoospermia or both (group 2).
The frequency of treatment with IV cyclophosphamide was higher and median testicular volume was lower in group 2 than group 1. Follicle-stimulating hormone (FSH) levels were higher in group 2 than group 1.
A cumulative cyclophosphamide dose greater than 7.5 gm/m was associated with azoospermia.
Dr. Soares and colleagues note that "it is not possible to predict which patients will become infertile" after IV cyclophosphamide treatment.
They add that "the persistence of abnormal testicular function after approximately five years of IV cyclophosphamide treatment associated with elevated FSH levels and lower testicular volumes, as observed in the present study, supports the notion of an irreversible lesion and supports the need for sperm cryopreservation."
Arthritis Rheum 2007;56:2325-2361.
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