TY - JOUR
T1 - Fertility Related Quality of Life, Gonadal Function and Erectile Dysfunction in Male Partners of Couples with Unexplained Infertility
AU - Coward, R. Matthew
AU - Stetter, Christy
AU - Kunselman, Allen
AU - Trussell, J. C.
AU - Lindgren, Mark C.
AU - Alvero, Ruben R.
AU - Casson, Peter
AU - Christman, Gregory M.
AU - Coutifaris, Christos
AU - Diamond, Michael P.
AU - Hansen, Karl R.
AU - Krawetz, Stephen A.
AU - Legro, Richard S.
AU - Robinson, Randal D.
AU - Smith, James F.
AU - Steiner, Anne Z.
AU - Wild, Robert A.
AU - Zhang, Heping
AU - Santoro, Nanette
N1 - Funding Information:
Accepted for publication February 19, 2019. The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. Supported by the National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development Grants U10 HD077844, U10 HD077680, U10 HD39005, U10 HD38992, U10 HD27049, U10 HD38998, U10 HD055942, U10 HD055944, U10 HD055936 and U10 HD055925 (University of Virginia Center for Research in Reproduction Ligand Assay and Analysis Core of Specialized Cooperative Centers Program in Reproduction and Infertility Research, National Center for Research Resources), National Center for Advancing Translational Sciences Grant UL1 TR000127 (Pennsylvania State University), and the American Recovery and Reinvestment Act. Registered at ClinicalTrials.gov NCT01044862. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. * Correspondence: 2113 Physician's Office Building, CB#7235, 170 Manning Dr., Chapel Hill, North Carolina 27599 (telephone: 919-966-8217; FAX: 919-966-0098; e-mail: mcoward@med.unc.edu).
Publisher Copyright:
© 2019 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION AND RESEARCH, INC.
PY - 2019/8/1
Y1 - 2019/8/1
N2 - We sought to determine whether lower fertility related quality of life or depression in men of couples with unexplained infertility is associated with low total testosterone levels, abnormal semen quality or erectile dysfunction.Materials and Methods:This study is a secondary analysis of a large, multicenter, randomized controlled trial in couples with unexplained infertility. Male partners underwent baseline semen analysis with measurement of fasting total testosterone and gonadotropin. They also completed surveys, including the FertiQOL (Fertility Quality of Life), the PHQ-9 (Patient Health Questionnaire-9) and the IIEF (International Index of Erectile Function). The primary study outcomes were total testosterone with low total testosterone defined as less than 264 ng/dl, semen parameters and the IIEF score. We performed multivariable logistic regression analyses adjusted for patient age, race, body mass index, education, smoking, alcohol use, infertility duration and comorbidity.Results:A total of 708 men with a mean ± SD age of 34.2 ± 5.6 were included in study. Of the men 59 (8.3%) had a PHQ-9 score of 5 or greater, which was consistent with depression, 99 (14.0%) had low total testosterone and 63 (9.0%) had mild or worse erectile dysfunction. Neither the FertiQOL score nor depression was associated with total testosterone or any semen parameter. The FertiQOL score was inversely associated with erectile dysfunction (for every 5-point score decline AOR 1.30, 95% CI 1.16-1.46). Depressed men were significantly more likely to have erectile dysfunction than nondepressed men (AOR 6.31, 95% CI 3.12-12.77).Conclusions:In men in couples with unexplained infertility lower fertility related quality of life and depression are strongly associated with erectile dysfunction. However, neither is associated with spermatogenesis or testosterone levels. Erectile dysfunction in infertile men merits longitudinal investigation in future studies.
AB - We sought to determine whether lower fertility related quality of life or depression in men of couples with unexplained infertility is associated with low total testosterone levels, abnormal semen quality or erectile dysfunction.Materials and Methods:This study is a secondary analysis of a large, multicenter, randomized controlled trial in couples with unexplained infertility. Male partners underwent baseline semen analysis with measurement of fasting total testosterone and gonadotropin. They also completed surveys, including the FertiQOL (Fertility Quality of Life), the PHQ-9 (Patient Health Questionnaire-9) and the IIEF (International Index of Erectile Function). The primary study outcomes were total testosterone with low total testosterone defined as less than 264 ng/dl, semen parameters and the IIEF score. We performed multivariable logistic regression analyses adjusted for patient age, race, body mass index, education, smoking, alcohol use, infertility duration and comorbidity.Results:A total of 708 men with a mean ± SD age of 34.2 ± 5.6 were included in study. Of the men 59 (8.3%) had a PHQ-9 score of 5 or greater, which was consistent with depression, 99 (14.0%) had low total testosterone and 63 (9.0%) had mild or worse erectile dysfunction. Neither the FertiQOL score nor depression was associated with total testosterone or any semen parameter. The FertiQOL score was inversely associated with erectile dysfunction (for every 5-point score decline AOR 1.30, 95% CI 1.16-1.46). Depressed men were significantly more likely to have erectile dysfunction than nondepressed men (AOR 6.31, 95% CI 3.12-12.77).Conclusions:In men in couples with unexplained infertility lower fertility related quality of life and depression are strongly associated with erectile dysfunction. However, neither is associated with spermatogenesis or testosterone levels. Erectile dysfunction in infertile men merits longitudinal investigation in future studies.
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U2 - 10.1097/JU.0000000000000205
DO - 10.1097/JU.0000000000000205
M3 - Article
C2 - 30835629
AN - SCOPUS:85069297367
SN - 0022-5347
VL - 202
SP - 379
EP - 384
JO - Journal of Urology
JF - Journal of Urology
IS - 2
ER -
