We sought to determine whether lower fertility-related QOL or depression in men of couples with unexplained infertility is associated with low total testosterone (TT) levels, abnormal semen quality, or erectile dysfunction (ED).
This study is a secondary analysis of a large, multicentered, randomized controlled trial for couples with unexplained infertility. Male partners had a baseline semen analysis, fasting TT and gonadotropin levels, and completed the Fertility-Related QOL (FertiQOL), Patient Health Questionnaire 9 (PHQ-9), and International Index of Erectile Function (IIEF) surveys. The primary outcomes were TT (low TT defined as <264 ng/dL), semen parameters, and IIEF score. Multivariable logistic regression analyses adjusted for age, race, BMI, education, smoking, alcohol use, length of infertility, and comorbidity.
708 men (mean age 34.2 ± 5.6) were included. Fifty-nine (8.3%) men had a PHQ-9 score (≥5) consistent with depression, 99 (14.0%) had low TT, and 63 (9.0%) had mild ED or worse. Neither FertiQOL score nor depression was associated with TT or any semen parameter. FertiQOL was inversely associated with ED [adjusted odds ratio (AOR) 1.30; 95% confidence interval (CI): 1.16, 1.46, for every 5-point decline in score], and depressed men were significantly more likely to have ED than non-depressed men (AOR 6.31; 95% CI: 3.12, 12.77).
For men in couples with unexplained infertility, both lower fertility-related QOL and depression are strongly associated with ED, but neither is associated with spermatogenesis or testosterone levels. ED in infertile men merits longitudinal investigation in future studies.
The Journal of urology. 2019 Mar 05 [Epub ahead of print]
R Matthew Coward, Christy Stetter, Allen Kunselman, J C Trussell, Mark C Lindgren, Ruben R Alvero, Peter Casson, Gregory M Christman, Christos Coutifaris, Michael P Diamond, Karl R Hansen, Stephen A Krawetz, Richard S Legro, Randal D Robinson, James F Smith, Anne Z Steiner, Robert A Wild, Heping Zhang, Nanette Santoro, Reproductive Medicine Network
Department of Urology, University of North Carolina School of Medicine , Chapel Hill , NC., Department of Public Health Sciences, Penn State College of Medicine , Hershey , PA., Department of Urology, Upstate University Hospital , Syracuse , NY., Department of Urology, University of Oklahoma Health Sciences Center , Oklahoma City , OK., Department of Obstetrics and Gynecology, Warren Alpert School of Medicine at Brown University , Providence , RI., Northeastern Reproductive Medicine , Colchester , VT., Department of Obstetrics and Gynecology, University of Florida , Gainesville , FL., Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA., Department of Obstetrics and Gynecology, Augusta University , Augusta , GA., Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center , Oklahoma City , OK., Department of Obstetrics and Gynecology, Center for Molecular Medicine and Genetics, Wayne State University School of Medicine , Detroit , MI., Department of Obstetrics and Gynecology, Pennsylvania State University , Hershey , PA., Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio , San Antonio , TX., Department of Urology, University of California , San Francisco , San Francisco ,CA., Department of Obstetrics and Gynecology, Duke University , Durham , NC., Department of Biostatistics, Yale University School of Public Health , New Haven , CT., Department of Obstetrics and Gynecology, University of Colorado School of Medicine , Aurora , CO.