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What about Male Partners?

A recently published multicenter study of the association between total testosterone (TT) levels, semen analyses, and live birth rates in men with unexplained infertility, found that low TT (<264 ng/dl) in the male partner was associated with low sperm morphology (normal forms) and a lower live birth rate. The design of the investigation was a secondary analysis of the prospective, randomized clinical trial “Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation” (AMIGOS). Seven hundred eighty-one men with a median TT of 411 (318-520) ng/dl were included. There was no association between low TT and low semen volume (<1.5 ml), sperm concentration (< 15 million/ml), or motility (<40% moving) and among couples in which the male partner had low TT, 21 (18.8%) had a live birth, compared with 184 (27.5%) live births in couples where the male partner had TT>264 ng/dl.

Perhaps the larger question to be answered from this study is whether all men undergoing infertility investigations should have baseline endocrine testing. And is total testosterone sufficient? Should men be checked for other, perhaps more subtle endocrine disturbances such as thyroid disease, prolactin disorders, vitamin D insufficiency, estrogen excess and perhaps others? What if abnormalities are found? Shouldn’t men have a follow up consultation with the appropriate physician, e.g., reproductive endocrinologist, reproductive urologist, or medical endocrinologist? Isn’t time that men, like their partners, have more thorough reproductive evaluation than a simple semen analysis? Moreover, is a single semen analysis, ever enough?

This study certainly suggests a role for baseline blood screening of male partners as part of the initial fertility evaluation. Identified hormonal abnormalities may be then treated and may enable more couples to conceive naturally or to experience increased success with fertility treatments [intrauterine insemination (IUI) or in vitro fertilization (IVF)]. Such more in depth evaluations of the male may prove highly cost effective; however, more studies are needed to answer this and a number of the related questions above.

Reference:

Trussell JC, Coward R, Santoro N, Stetter C, et al: Association between testosterone, semen parameters, and live birth in men with unexplained infertility in an intrauterine population. FertilSteril 111:6, Jun 2019 https://doi.org/j.fertnstert.2019.01.034

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