Acute Effects of Blood transfusion on Pituitary Gonadal Axis and Sperm Parameters in Adolescents and Young Menwith Thalassemia Major: A Pilot Study

Capsule:
This study suggests that in thalassemic men, blood transfusion is associated with significant acute enhancement of sperm parameters and increased concentrations of serum T, LH, FSH, and IGF-1.

Authors:
Ashraf Soliman, M.D., Ph.D., F.R.C.P., Mohamed Yasin, M.B.B.S., C.A.B.M., M.Sc., F.A.C.P., Ahmed El-Awwa, M.D., Mohamed Osman, M.D., Ph.D., Vincenzo De Sanctis, M.D.

Volume 98, Issue 3, Pages 638-643, September 2012

Abstract:

Objective:
To evaluate semen parameters and measure serum follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T) and insulin-like growth factor-I ( IGF-I ) concentrations before and 7 days after packed red cell transfusion (PCTx) in young adults with thalassemia major (TM).

Design:
Prospective study.

Setting:
Tertiary care hospital

Patients:
This study investigated 10 young adults with TM, aged from 17 to 32 years, with full pubertal development (Tanner’s stage 5) (euogonadal), and capacity to ejaculate. They were regularly transfused since early childhood and underwent chelation therapy using desferrioxamine, which was replaced by deferasirox for the last 4 -5 years. At the time of the study their serum ferritin levels ranged from 500 to 5922 ng/ml (mean2686 ng/ml). Basal serum concentrations of FSH, LH, T and IGF-I were evaluated before and 7 days after packed red cell transfusion (PCTx).

Interventions:
We studied the effect of PCTx on semen parameters and the endocrine functions in these 10
patients with TM.

Main Outcome Measures and Results:
After PCTx significant increase of Hb from 8.7 +/- 0.86 g/dl to 11.1 +/- 0.82 g/dl was associated with increased testosterone (from 16.5 +/- 8 nmol/L to 20 +/- 8.8 nmol/L, IGF-I (from 173 +/- 46ng/ml to 214 +/- 61ng/ml) and gonadotropins’ concentrations. Total sperm count increased significantly from 57.8 +/- 38.3 million/ml to 166 +/- 132 million/ml and rapid progressive sperm motility progressive motility increased from 20.6+/- 16.6 % to 79.7 +/- 67.4 %. After PCTx, LH concentrations were correlated significantly with T concentrations ( r = 0.434, p < 0.001) and sperm volume and count (r = 0.439 and r = 0.376 respectively , p: 0.01). The increase of IGF-I concentration was correlated significantly with Hb level after PCTx (r = 0.535, p < 0.001) and negatively with ferritin concentration (r = -0.458, p < 0.001). Significant correlation were found between serum T concentrations and semen parameters before and after PCTx including sperm count ( r = 0.658 and r = 0.73 respectively, p < 0.001)rapid progressive motility (r = 0.675 and r = 0.758 respectively p < 0.001), and the number of sperms with normal morphology (r = 0.752 and r = 0.834 respectively, p < 0.001) IGF-I levels and seminal parameters. No correlations were found between serum FSH and IGFI concentrations and seminal parameters.

Conclusion:
Our study suggests that in thalassemic males blood transfusion is associated with significant acute enhancement of sperm parameters and with an increased concentrations of serum testosterone, LH, FSH and IGF-I. These “acute” effects on spermiogenesis are reached with an unknown mechanism/s and suggest a number of pathways that need further human and/or experimental studies.

  • This is fascinating work. While none of the biology of this has been worked out in regards to male fertility and the male endocrine axis, there is a fairly robust literature on how transfusions during oncologic surgery are independently associated with worse cancer outcomes and also a literature on how transfusions up to 30 days after cardiothoracic surgery are also independently associated with worse outcomes. The effects are thought to be immune mediated, with transient suppression of the transfusion recipients immune system. It would be interesting to repeat the analysis in a subset of patients with irradiated or leukocyte reduced blood to see if this made a difference.

  • thanks a lot for your comments. Although blood transfusion was associated with increased testosterone level that may have contributed to improving semen parameters, however we believe that other unknown mechanism/s contribute to the effect of increased Hb level and O2 carrying capacity on sperm parameters in these patients. The second patient with low LH and testosterone level had sideosis of the pituitary gland (Low LH and FSH in presence of low testosterone secretion)

  • Carlos Balmori

    Congratulations to the authors for the article.
    I miss having not made the determination of estrogen. Infertility in a great number of chronic illness may be associated with an increase in the peripheral conversion of androgens to estrogens although most animal experimentation articles demonstrate that hypoxia is like an endocrine disruptor. T/E2 could be useful to know this

    • Thanks a lot for your comments. The T/E2 was not measured in our research but I agree that it may be investigated as a possible mechanism

  • Pravin Rao

    This was enjoyable to read — it definitely highlights some fascinating aspects of reproductive physiology. One theory presented is that correction of anemia that inhibits the ineffective erythropoiesis. Authors, any thoughts on erythropoeitin itself playing a role in feedback mechanisms on gonadotropins/T in this patient population?

    • Thanks a lot for your comments. There is no study to our knowledge that correlates Erythropoeitin level in these patients with sperm parameters. This is a good idea to study the association between variable levels of erythropoeitin and sperm parameters in different forms of chronic anemias and other chronic illnesses affecting hemopoiesis.

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