Infertility as a proxy of general male health Results of a cross sectional survey

Men with decreased general health status have lower sperm concentration, lower testosterone levels, and higher follicle-stimulating hormone values. Poorer health status appears associated with a malfunctioning male reproductive system.

Eugenio Ventimiglia, M.D., Paolo Capogrosso, M.D., Luca Boeri, M.D., Alessandro Serino, M.D., Michele Colicchia, M.D., Silvia Ippolito, M.D., Roberta Scano, B.S., Enrico Papaleo, M.D., Rocco Damiano, M.D., Francesco Montorsi, M.D., Andrea Salonia, M.D.

Volume 104, Issue 1, Pages 48–55


To evaluate the prevalence, and clinical and seminal impact of comorbidities in white European men presenting for couple infertility.

Cross-sectional study.

Academic reproductive medicine outpatient clinic.

Cohort of 2,100 consecutive infertile men (noninterracial infertile couples).

Obtaining complete demographic, clinical, and laboratory data from 2,100 consecutive infertile men with health-significant comorbidities scored via the Charlson comorbidity index (CCI; categorized 0 vs. 1 vs. ≥2) and semen analysis values assessed based on 2010 World Health Organization reference criteria.

Main Outcome Measure(s):
Assessment of the rate of comorbidities by means of CCI scores and possible associations between CCI, semen and hormonal parameters.

Descriptive statistics and regression models tested the associations among semen parameters, clinical characteristics, and CCI. When assessing general comorbidity prevalence, CCI 0, CCI 1, and CCI ≥2 was found in 1,921 (91.5%), 102 (4.9%), and 77 (3.6%) patients, respectively. Patient age and follicle-stimulating hormone levels increased as the general health status decreased. Conversely, the total testosterone levels and sperm concentration decreased as CCI scores increased. A higher rate of oligozoospermia and nonobstructive azoospermia was observed in patients with CCI ≥1. No differences were observed among the considered comorbidity groups in terms of testicular volume or further hormonal or seminal parameters. Both continuously coded and categorized sperm concentrations were independent predictors of CCI ≥1. Patients with sperm concentration

Decreased general health status appears to be associated with impaired male reproductive health, including lower sperm concentration, lower total testosterone levels, and higher follicle-stimulating hormone values.

  • msamplaski

    Were men who were s/p vasectomy excluded? These men were
    presumably generally fertile prior to their vasectomy and then finished with
    their families. In addition, why where only noninterracial couples included?

  • With the continued rising rates of obesity in children, we will see a continued increase in the rate of weight related medical problems and co-morbidities. We are seeing a lot more early onset DM2, HTN, CKD, cardiac problems, strokes, respiratory issues in our young men. I envision a continued increase in male factor infertility as these men reach reproductive age.

  • Ali Dabaja

    Good data and great work, Wondering if any of the environmental factors were looked at? For example smoking is a confounding factor for the majority of comorbidities that can also effect infertility.

  • ranjithrama

    The authors should be commended for continuing some of the work initiated by Mike Eisneberg. Was there a particular comorbidity associated in men with impaired sperm density such as HTN? DM?

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