Study suggests link between IV cyclophosphamide and reduced fertility in men with SLE

Recent findings identify intravenous cyclophosphamide as a major contributor to lower fertility in men with systemic lupus erythematosus (SLE). Dr Pollyana Soares (University of Sao Paolo, Brazil) and colleagues report that there is a high frequency of sperm abnormalities, small testicular volume, and a high level of sperm antibodies in men with SLE. The investigators compared 35 patients with SLE with age-matched healthy controls. Subjects underwent urologic evaluation, testicular Doppler ultrasound, hormone profiling and semen analysis. Soares group report that compared with controls, men with SLE had lower median testicular volumes, a lower median total sperm count, and a lower median total motile sperm count. The mean sperm volume and percentage of normally formed sperm were lower in SLE patients than in controls. Overall, 18 of the 35 SLE patients had teratozoospermia (group 1), 17 had azoospermia or teratozoospermia plus oligozoospermia or asthenozoospermia or both (group 2). The authors report that the frequency of treatment with IV cyclophosphamide was higher and median testicular volume was lower in group 2 than group 1. Follicle-stimulating hormone (FSH) levels were higher in group 2 than group 1 and a cumulative cyclophosphamide dose greater than 7.5 gm/m was associated with azoospermia. In discussing their findings Dr Soares’s team note that after IV cyclophosphamide therapy "it is not possible to predict which patients will become infertile." However, the authors write,"the persistence of abnormal testicular function after approximately five years of IV cyclophosphamide treatment associated with elevated FSH levels and lower testicular volumes, as observed in the present study, supports the notion of an irreversible lesion and supports the need for sperm cryopreservation." Reference...