SP0150 THE IMPACT OF RHEUMATIC DISEASES AND ANTI-RHEUMATIC DRUGS ON MALE FERTILITY IN ADULT AND YOUNG PEOPLE
Authors: Monika Østensen
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> The chronic, systemic inflammation in rheumatic diseases can impair male fertility by direct effects on the gonads or by affecting the hypothalamic-pituitary-gonadal (HPG) axis resulting in hypogonadism. Impaired gonadal function is reflected by reduced sperm quality and sometimes lowered testosterone levels. Drugs may impair fertility by impairing spermatogenesis or interfere with the HPG axis. <h3>Objectives:</h3> To summarize the knowledge on the impact of rheumatic disease and its therapy on fertility in adult and pediatric patients <h3>Methods:</h3> Search of the literature <h3>Results:</h3> No impairment of spermatogenesis has been shown for azathioprine, cyclosporine, and mycophenolate mofetil. Risk of permanent infertility is associated with cytotoxic drugs, particularly the alkylating agent cyclophosphamide. Effects of methotrexate (MTX) on male fertility are related to dose. There is no indication that low-dose MTX 5 – 25 mg/week impairs male fertility. Case reports of men with psoriasis treated with low-dose MTX have either found completely normal sperm quality or detected oligo- and azoospermia. Cyclophosphamide (CYC) is administered to adult and pediatric patients with systemic lupus erythematosus, other connective tissue disease and vasculitides. Gonadal damage by CYC is dose-dependent revealed by oligo-and azoospermia as well as low testosterone, low inhibin B and elevated FSH levels. Cumulative doses of &gt; 7.5g/m<sup>2</sup> carry a high risk of permanent infertility in adults. In survivors of childhood cancer treated with CYC recovery of spermatogenesis was sometimes seen after many years. Sulfasalazine (SZ) can induce transient infertility with oligospermia, abnormal morphology of sperm cells and reduced sperm motility in about 40-86% of treated men. Plasma levels of steroids and gonadotropins remain normal during SZ therapy. Recovery of normal sperm quality is observed one to three months after discontinuation of SZ. Studies comparing men treated with TNF inhibitors (TNFi) with disease-matched and/or healthy controls did not find impairment of sperm quality neither after short term or long-term treatment. Several studies found significantly better sperm quality in patients receiving long-term TNFi therapy than untreated disease matched controls. <h3>Conclusion:</h3> Rheumatic disease has an impact on male fertility both by the disease process and by therapy. Most antirheumatic drugs have no negative effect on reproduction, however, treatment with cyclophosphamide increases the risk of infertility both in adults and pediatric patients. Increasing awareness about reproduction issues and infertility risk is needed among adult and pediatric rheumatologists. Clinicians should actively involve themselves in counseling their patients. <h3>References:</h3> [1] Østensen M. Sexual and reproductive health in rheumatic disease. Nat Rev Rheumatol. 2017;13(8):485-493. [2] Micu MC &amp; Ostensen M, Villiger PM, Micu R, Ionescu R. Paternal exposure to antirheumatic drugs -– what physicians should know. Review of the literature. Semin Arthritis Rheum. 2018; 48(2):343-355. <h3>Disclosure of Interests:</h3> None declared