Spotlight on Male Infertility: A Review of Recent Publications

Infertility remains a complex and challenging issue affecting couples worldwide, and recent research has shed light on the evolving landscape of infertility care and treatment in the United States. In this blog post, we will delve into three recent publications that provide valuable insights into the trends and advancements in addressing male infertility.

"Trends in Infertility Care and Treatment in the United States: Data from the National Survey for Family Growth" by Edouard Nicaise and Michael Eisenberg, published in the Journal of Urology on April 1, 2023

This study examined data from the National Survey for Family Growth (NSFG), a nationally representative sample of men aged 18-45 from 2002 to 2019, and highlighted intriguing trends in infertility diagnosis and treatment among men in the US. Notably, there has been a significant increase in the proportion of men seeking infertility testing, growing from 51.8% in 2002 to 68.5% by 2019 (p=0.011), indicating a growing awareness and adoption of fertility evaluations. Moreover, the study revealed a positive shift in the rate of successful biological births after infertility evaluations (p=0.013), implying improvements in treatment options. However, the research also uncovered disparities in access to care, with white men (OR 1.85, 95% CI: 1.38-2.47) and men with a college degree (OR 1.5, 95% CI: 1.23-2.21) more likely to undergo testing and father children following infertility visits. This publication calls for attention to these disparities and emphasizes the need for equitable access to infertility care for all individuals.

"Cessation of Chronic Delta-9-Tetrahydrocannabinol Use Partially Reverses Impacts on Male Fertility and the Sperm Epigenome in Rhesus Macaques" by Jason C Hedges et al., published in Fertility & Sterility in July 2023.

With the increasing prevalence of cannabis use, concerns have been raised about its potential impact on male fertility. This study focused on adult male rhesus macaques (n=6) and investigated the effects of daily recreational THC (delta-9-tetrahydrocannabinol) use on male reproductive parameters. The findings indicated significant testicular atrophy, increased gonadotropin levels, decreased serum sex steroid levels, changes in seminal fluid proteome, and increased DNA fragmentation. However, the study revealed that discontinuation of THC use led to a significant increase in the total serum testosterone level by 1.3 ng/mL and estradiol level by 2.9 pg/mL, while seminal fluid proteomics and sperm DNA methylation and fragmentation revealed only partial recovery. This research emphasizes the importance of understanding the effects of cannabis use on fertility and highlights the potential for reversal upon cessation.

"The Effect of Clomiphene Citrate on Patient Reported Outcome Measures" by Jessica Schardein, Kia Fendereski, Zane Randell, Soren Keihani, Joshua Horns, and James Hotaling, published in the Journal of Urology on April 1, 2023.

Clomiphene citrate (CC) has been a longstanding option for treating male infertility, and this retrospective study aimed to assess its impact on self-reported changes in androgen deficiency symptoms and erectile function are observed along with changes in hormone levels and semen parameters. This retrospective, single-institution study looked at all men from 2014-2018 who had hormone levels, semen parameters, SHIM scores, and ADMA scores assessed prior to and after use of CC (n=97). The research demonstrated that the use of CC significantly increased both mean total and bioavailable testosterone levels by 236.5 ng/dL and 115.6 ng/dL, respectively (p<0.05). In addition, concentration, total progressive motility and morphology all significantly improved (p<0.05). Clinical manifestations included a significant improvement in ADAM scores (p=0.025) and no change in SHIM scores (p=0.278). This suggests that CC remains a viable option for hypogonadal or subfertile men wishing to improve or preserve fertility while raising testosterone levels and improving symptoms.

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