Inflammatory arthritis connected to infertility in men under 30

LONDON — Young men dealing with arthritis have “significantly fewer” children than others from the same age group, a recent study reveals. Scientists believe that arthritis onset before the age of 30 may curb a man’s fertility.

According to researchers at the Erasmus Medical Center in the Netherlands, the debilitating condition that causes pain and inflammation in joints appears to have a connection to higher rates of male infertility, involuntary childlessness, and poor sperm quality.

Previous studies have found a link between inflammatory arthritis — which includes rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis, and ankylosing spondylitis (inflammation of the spine, joints, and tendon-bone joins) — and male infertility, erectile dysfunction, and insufficient testosterone or sperm production. Despite this, the impact of inflammatory arthritis on a man’s ability to father children has remained unclear.

Dramatic impact on family size

In this study, Dutch researchers compared the fertility rate among men with inflammatory arthritis based on their age at diagnosis; 30 or younger, between 31 and 40 – the peak reproductive years – and 41 or older. The team gathered participants from eight different hospitals across the Netherlands between September 2019 and January 2021.

A total of 628 men over the age of 40, who indicated that their family size was complete, completed a questionnaire on the medical and fertility issues they’ve experienced before and after their inflammatory arthritis diagnosis. The researchers also compared the total number of pregnancies for each man, desired family size, the proportion of childless men, and the results of medical assessments for fertility issues.

After adjusting for potentially influential factors, men with any type of inflammatory arthritis before the age of 30 had significantly fewer children than men in the other two age groups. Those men had an average of 1.32 children compared with 1.56 for those between 31 and 40, and 1.88 for those receiving an arthritis diagnosis after age 41. Men developing arthritis before age 30 also had fewer pregnancies (1.45) than those diagnosed between 31 and 40 (1.73) or the older men (1.98).

In the Netherlands, between 20 and 25 percent of men are childless. Among the participants, just over 22 percent had no children. Of this group, around two-thirds were voluntarily childless.

The percentage of childless men was “significantly higher” among those with arthritis before or at the age of 30 (45.3 percent) than among those dealing with the condition between 31 and 40 (39.2 percent).

Arthritis leads to different family decisions

Among the voluntarily childless, men with inflammatory arthritis at the youngest ages were more likely to agree with the statement “my disease reduced my desire to have children” than those in the older age groups. Significantly more men dealing with arthritis before age 30 (17%) and between 31 and 40 (10%) reported being “dissatisfied” with their final number of children than men receiving an arthritis diagnosis later in life (5.5%). Around a third of those men add that the main reasons they had fewer children include their arthritis diagnosis and the medical treatments to manage pain.

Compared with the older age group, significantly more of those with arthritis during their peak fertility years reported having to see a doctor for fertility problems. Physicians determined that the main issue among these patients was poor sperm quality.

“The difference between the desired and final number of children was significantly larger in men diagnosed before and during the reproductive [years], indicating that the lower fertility rates are primarily affected by reduced fertility potential and not by a reduced desire for parenthood,” says study author Dr. Luis Fernando Perez-Garcia and his team in a media release.

Study authors add that infertility rates were also higher among the partners of men with arthritis before or at the age of 30, although there are some plausible biological explanations for that link. The team says several inflammatory proteins that are part of the immune response and have a link to inflammatory arthritis, such as tumor necrosis factor, have key roles in regulating testicular stability and sperm production.

Arthritis medications may be hurting fertility too

The research team also suggests that drugs which treat arthritis may also play a role as frequent use of immunosuppressive agents appear to contribute to side-effects such as hypogonadism and poor sperm quality. Estimates show that among involuntarily childless men who go to infertility clinics, one in four take drugs that could affect sexual function while one in 10 take drugs which may impair fertility.

Dr. Perez-Garcia suggests that several psychosocial factors appearing after an arthritis diagnosis may also contribute to lower fertility rates.

“Due to problems or concerns associated with [the diagnosis] and its treatment and based on medical advice (or the lack of it), men with [inflammatory arthritis] and their partners decided to become voluntarily childless or to delay their plans to become parents. These psychosocial factors were of special importance for men diagnosed before the peak of reproductive age,” the study authors conclude.

These findings appear in the journal Annals of the Rheumatic Diseases.

South West News Service writer Stephen Beech contributed to this report.