Questionnaire responses from 628 men treated at eight Dutch hospitals for rheumatoid arthritis and other types of inflammatory arthritis suggest that compared to diagnosis after age 40, diagnosis before and during the peak reproductive years is linked with more childlessness and fertility problems.
Still, there may be options for these men if they want to have bigger families, said study leader Dr. Louis Perez-Garcia of Erasmus Medical Center in Rotterdam, The Netherlands.
"From a biological perspective, early identification of fertility problems, for example, varicocele or hypogonadism and prompt intervention/referral can improve these men's chances of getting more children," Dr. Perez-Garcia said in an email. "Furthermore, although information on the topic is limited, rheumatologists should consider these men's sexual and reproductive health and adjust their pharmacological treatment in order to avoid drugs with known sexual and reproductive health side effects, such as sulfasalazine."
In a report in Annals of the Rheumatic Diseases, Dr. Perez-Garcia and his colleagues note that in the Netherlands, most men become fathers between ages 30 and 40. For the current study, they excluded men older than 40 who were still planning on having biological children in the future.
The mean number of children was highest, at 1.88, in men diagnosed at age 41 or older, dropping to 1.60 in men diagnosed between ages 31 and 40, and to 1.32 in men diagnosed at or before age 30 (p=0.0004).
Rates of involuntary childlessness and medical evaluations for infertility were 12.03% and 20.61%, respectively, in men diagnosed before age 31, and 10.34% and 20.69%, respectively, in men diagnosed at ages 31 to 40. Among men diagnosed at older ages, only 3.98% reported involuntary childlessness and 11.36% reported seeking medical help for infertility.
Dr. Perez-Garcia shared the story of a patient who might have been physically able to have more children but was concerned about how his disease would impact his relationships with them.
"Football (soccer in the U.S.) is quite popular in the Netherlands and it came as no surprise that several men with different personal and medical backgrounds expressed how arthritis and the pain associated with it limited the number of children they wanted to have because 'I was afraid of not being able to play football with my children,'" Dr. Perez-Garcia said. "Again, our participants are sending us a strong message and alerting us that impact of inflammatory arthritis on male fertility goes well beyond the biological factors."
"Further research will focus on identifying how disease activity, inflammation and pharmacological treatment impact male fertility," Dr. Perez-Garcia said. "On the other hand, while we tend to focus on the 'biological factors' of rheumatic diseases and infertility, the non-biological factors can be as important. The psychosocial impact of the diagnosis of inflammatory arthritis is different for a 14 year old boy than for a 34 year old men. We need to consider this and offer these men personalized advice sessions. In a few words, we need to talk about this topic with our male patients."
"While infertility is a couples issue that involves both partners, the impact of inflammatory arthritis on male reproductive health remains largely unestablished," Dr. Kathleen Hwang, director of UPMC's Men's Health Center, said in an email.
Dr. Hwang, who was not involved in the study, commented that while it "does not address the mechanistic drive for these findings, it certainly highlights an area that requires further investigation."
"For patients, the uncertainty of being diagnosed with inflammatory arthritis as well as the associated treatments and impact on fertility represents an area that is ripe for further investigation, education, and critical for male preconception counseling," Dr. Hwang said.
SOURCE: https://bit.ly/3iAPIG1 Annals of the Rheumatic Diseases, online August 9, 2021.
By Linda Carroll
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