medwireNews: Men with inflammatory arthritis (IA) diagnosed before and around the time of peak reproductive age have lower fertility rates and are more likely to have reproductive problems than those diagnosed at a later age, researchers report.
For the iFAME-Fertility study, 628 men aged at least 40 years with spondyloarthritis (50.96%), rheumatoid arthritis (47.29%), or juvenile idiopathic arthritis (1.59%) who indicated that their family size was complete took part in a questionnaire on fertility rates, family planning, and fertility problems.
In all, participants who were diagnosed with IA before (≤30 years) or during (31–40 years) the peak reproductive age range in the Netherlands had significantly fewer biological children than those diagnosed after the age of 41 years, at an average of 1.32 and 1.56 versus 1.88 children, respectively.
After adjustment for a raft of confounding factors including diagnosis, age, and diagnosis of infertility in a partner, this difference in the number of biological children remained statistically significant for people diagnosed at age 30 years or younger, but not for those diagnosed between 31 and 40 years.
Men in the two younger age categories for diagnosis were also significantly more likely than those diagnosed after 41 years of age to report medical evaluations for fertility (20.61 and 20.69 vs 11.36%) and a diagnosis of low sperm quality (6.57 and 8.05 vs 3.51%).
In accordance with these results, the proportion of men without children was significantly greater among those diagnosed by 30 years or at 31–40 years compared with those diagnosed at 41 years and older, at 33.83% and 26.90% versus 17.25%, respectively.
Luis Fernando Perez-Garcia (Erasmus Medical Center, Rotterdam, the Netherlands) and team additionally found that “diagnosis of IA may have a major impact on family planning.”
A significantly higher proportion of men in the two younger versus older age categories for IA diagnoses said they felt unsatisfied with the final number of children they had (16.67 and 9.66 vs 5.50%), and around a third of these men said that their diagnosis or the treatment was “the main reason” for having fewer children than they desired.
In light of these findings, the researchers recommend that rheumatologists should talk to their patients about “the impact of IA on male fertility and if indicated, adjust treatment aiming at low disease activity with the safest treatment strategy possible.”
They conclude in the Annals of the Rheumatic Diseases: “Multiple biological and non-biological mechanisms can be responsible for this association and more research is urgently needed to improve the quality of care for men diagnosed with IA and a desire for parenthood.”
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