Semen Quality and Sperm DNA Integrity in Patients With Severe Active Inflammatory Bowel Disease and Effects of Tumour Necrosis Factor-alpha Inhibitors. 
The impact of severe inflammation on semen quality, including sperm DNA integrity, in men with inflammatory bowel disease [IBD] is unknown, as are the potential effects of anti-tumour necrosis factor-alpha [TNF-alpha] therapy.  We investigated the influence of severe active IBD and anti-TNF-alpha treatment on semen quality.  We prospectively included 20 patients admitted with severe active IBD.  Further, 19 patients who initiated and 17 who stopped anti-TNF-alpha therapy were included.  Semen samples were obtained during active disease, and on/off treatment.  For paired comparisons, samples were collected not less than 3 months after achieving remission, after treatment initiation, or after treatment cessation.  Sperm DNA Fragmentation Index [DFI], concentration, morphology, and motility were evaluated.  Sex hormones and seminal plasma anti-TNF-alpha drug levels were measured.  In patients with severe disease, progressive sperm motility was impaired and increased significantly [from 28.4% to 37.4%, p = 0.045] during remission.  There was no difference in DFI [12.5% versus 12.0%, p = 0.55], concentration [55.0 mill/ml versus 70.0 mill/ml, p = 0.39], or normal morphology [4.7% versus 5.1%, p = 0.51] in these patients.  During active disease, testosterone was decreased, and normalised after obtaining remission.  Patients who started anti-TNF-alpha therapy had a statistically significant, but clinically irrelevant, reduction in DFI after treatment initiation [12.8% versus 10.0%, p = 0.02].  All other semen parameters were unaffected by therapy.  Anti-TNF-alpha drugs were excreted in negligible amounts in semen.  Severe active IBD reduces progressive sperm motility and testosterone levels, but sperm DNA integrity is unaffected by active disease.  Anti-TNF-alpha therapy does not impair sperm quality.