Gonadal function in male patients with ankylosing spondylitis

Abstract

Objective: To assess reproductive function in male ankylosing spondylitis (AS) patients in comparison to healthy controls.

Methods: Twenty AS patients were compared to 24 healthy male subjects with regard to demographic data, urological examination, testicular ultrasound (US), semen analysis, anti-sperm antibodies, and hormone profile. Exclusion criteria were present use of sulfasalazine or methotrexate, and ever use of biological/cytotoxic agents. Disease activity of AS was evaluated by clinical and laboratory assessments.

Results: Demographic data were similar in AS and controls (p = 0.175). Varicocele was found significantly more frequently in AS patients than in controls (40% vs. 8%, p = 0.027). Semen analysis revealed no significant differences in sperm quality between AS patients and controls (p > 0.05). By contrast, the median of normal sperm forms was significantly lower in AS patients with vs. those without varicocele [13.5 (range 2–27) vs. 22 (range 10–32.5)%, p = 0.049] whereas no difference in sperm morphology was observed comparing AS patients and controls without varicocele (p = 0.670). Comparison of AS patients with and without varicocele showed that anti-sperm antibodies, hormones, inflammatory markers, and disease activity scores did not contribute to the impaired sperm morphology observed in AS patients with varicocele.

Conclusions: An increased frequency of varicocele was found in AS patients associated with sperm abnormalities but independent of therapy, anti-sperm antibodies, hormonal alterations, or disease parameters. Investigation for varicocele should be routine in AS patients with fertility problems.

Acknowledgements

This study was supported by the Foundation for Research Support of the State of São Paulo (FAPESP: 2009/51897-5 to EB), the National Council for Scientific and Technological Development (CNPQ: grant 301411/2009-3 to EB and 302724/2011-7 to CAS), and Federico Foundation Grants to EB and CAS. We thank Maribê Salan Marcos and Rosa Casemiro for technical support and Ulysses Dória Filho for the statistical analysis.