Although commonly overlooked, male factor infertility may be identified in as many as 40% of couples that have been trying to conceive for over 1 year. For many men, this is a difficult diagnosis to receive. But aside from being a set back towards time to conception, male factor infertility can, in some cases, be a sign of an even more serious underlying medical condition. The diagnosis of male factor infertility should be an opportunity for open discussion and more thorough evaluation of a man’s cardiovascular risk factors and reproductive cancer risk.
Relationship Between Sperm Quality and Overall Health?
Research on the broader implications of male factor infertility is accumulating.
Several notable studies to this effect have been published, and the results may be surprising. Separate studies have demonstrated a higher rate of comorbidities in infertile men (1), a higher prevalence of reproductive cancers (2, 3), as well as a correlation between semen quality and overall life expectancy (4).
Semen Quality as a Predictor of Longevity
A large scale 2009 cohort study looked at over 40, 000 men and demonstrated a significant inverse relationship between sperm concentration and mortality. As the concentration of a man’s sperm increased, his chances of dying (from a wide range of diseases) decreased proportionately; and this relationship persisted up to a sperm concentration of 40 million/mL (4). In this study, having a higher sperm count was, in fact, associated with a 43% lower death rate, when compared to men with the lowest sperm counts (4). This study helped to establish a potential role for the use of semen quality as a biomarker of overall male health (4).
Also in 2009, a study was published which found that men diagnosed with male factor infertility had 3 times the rate of testicular cancer when compared to fertile men (3). A year later, a study by the same group of researchers demonstrated a 30% increase in prostate cancer in infertile men (2). The infertile men with prostate cancer were also 2.6 times more likely to be diagnosed with high-grade prostate cancer, even when age and other intervening factors were controlled for (2).
Erectile dysfunction (ED) is a common problem in men suffering from infertility. However, ED may not only be a fertility issue, but also a marker for impaired cardiovascular health. It is now well accepted that the presence of ED may predict the occurrence of a significant cardiovascular event 5-10 years later in life. In an otherwise healthy man, ED may be the only recognizable marker of undiagnosed cardiovascular disease or even diabetes (5). The link between ED and heart disease is the endothelial tissue – the layer of cells lining the inside of blood vessels – which is where plaques can form, leading to a process known as atherosclerosis. When these cells become dysfunctional, the result is not only more difficulty with erection, but plaques can be deposited in arteries anywhere in the body, including the heart. Thus, ED may be an early marker for systemic atherosclerosis, coronary artery disease and a future heart attack (5). The association is strong: in one study, the researchers noted that 42% of their male patients who had suffered a heart attack had also reported ED (6).
But it doesn’t end there.
In fact, a very recent study noted that men with ED had more than double the odds of having undiagnosed diabetes (7). For a man between the ages of 40-59, the probability of having undiagnosed diabetes rose from 1 in 50 to 1 in 10, in the presence of ED (7).
A Call to Action
The recognition of male factor infertility should no longer be regarded as primarily a fertility concern. An elevated risk of type 2 diabetes, coronary artery disease, prostate and testicular cancers, and even early death, have all been associated with this diagnosis. The diagnosis of male factor infertility should always be accompanied by a thorough evaluation of a man’s overall state of health and risk factors. The crucial risk factors for poor endothelial health include a lack of physical activity, exposure to cigarette smoke, elevated LDL cholesterol levels, elevated homocysteine levels, and poor blood sugar control (5, 8).
For some couples, uncovering and addressing the cause of male factor infertility will do much more than improve that couples’ chances of creating a family – it may actually become a crucial step in improving the health and extending the longevity of the male partner.
- Salonia A, Matloob R, Gallina A, Abdollah F, Saccà A, Briganti A, Suardi N, Colombo R, Rocchini L, Guazzoni G, Rigatti P, Montorsi F. Are infertile men less healthy than fertile men? Results of a prospective case-control survey. Eur Urol. 2009 Dec;56(6):1025-31.
- Walsh TJ, Schembri M, Turek PJ, Chan JM, Carroll PR, Smith JF, Eisenberg ML, Van Den Eeden SK, Croughan MS. Increased risk of high-grade prostate cancer among infertile men. Cancer. 2010 May 1;116(9):2140-7.
- Walsh TJ, Croughan MS, Schembri M, Chan JM, Turek PJ. Increased risk of testicular germ cell cancer among infertile men. Arch Intern Med. 2009 Feb 23;169(4):351-6.
- Jensen TK, Jacobsen R, Christensen K, Nielsen NC, Bostofte E. Good semen quality and life expectancy: a cohort study of 43,277 men. Am J Epidemiol. 2009 Sep 1;170(5):559-65.
- Schwartz BG, Kloner RA. How to save a life during a clinic visit for erectile dysfunction by modifying cardiovascular risk factors. Int J Impot Res. 2009 Nov-Dec;21(6):327-35.
- Dhabuwala CB, Kumar A, Pierce JM. Myocardial infarction and its influence on male sexual function. Arch Sex Behav. 1986;15:499–504.
- Skeldon SC, Detsky AS, Goldenberg SL, Law MR. Erectile Dysfunction and Undiagnosed Diabetes, Hypertension, and Hypercholesterolemia. Ann Fam Med. 2015 Jul;13(4):331-5.
- Stein RA. Endothelial Dysfunction, Erectile Dysfunction, and Coronary Heart Disease: The Pathophysiologic and Clinical Linkage. Rev Urol 2003; 5(Suppl 7):S21-S27.