Effects of medical comorbidity on male infertility and comorbidity treatment on spermatogenesis

Objective: To investigate the prevalence and effects of medical comorbidities on spermatogenesis and to determine whether the treatment of medical comorbidities effectively improves spermatogenesis. Design: Single-center case-control study. Setting: University hospital. Patient(s): A total of 3,328 infertile men and 452 men with normal results on semen examination, with mean age of 35 years. Intervention(s): Hormonal and spermatogenic parameters were compared between the men with and without medical comorbidities. For the men diagnosed with medical comorbidities during the infertility evaluation, semen parameters were compared between those who did and did not undergo treatment of the comorbidities. Main Outcome Measure(s): Rate of comorbidity, relationship between infertility and comorbidity, comorbidity treatment on total motile sperm count. Result(s): The prevalence of comorbidities was significantly higher in the infertile men (21.7%) than in the fertile men (9.1%), particularly for hypertension (17.8%), hyperlipidemia (5.9%), hyperuricemia (5.2%), and skin disease (3.0%). Among the infertile men, the reproductive functions were aberrant in the men with comorbidity compared with those without comorbidity. After treatment for comorbidities, a significant increase was observed in the total motile sperm count compared with both the baseline values and with the poorly controlled men. A multivariate analysis showed that varicocele and comorbidity treatments were independent predictors of an improved total motile sperm count, with odds ratios of 2.895 and 2.057, respectively. Conclusion(s): Medical comorbidities are associated with impaired sperm production. Male infertility evaluation offers not only specific therapy to improve semen parameters but also therapy for nonspecific medical comorbidities, which may benefit general health status and spermatogenesis restoration. (C) 2018 by American Society for Reproductive Medicine.