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Fertil Steril. 2019 Jun;111(6):1129-1134. doi: 10.1016/j.fertnstert.2019.01.034. Epub 2019 Apr 12.

Association between testosterone, semen parameters, and live birth in men with unexplained infertility in an intrauterine insemination population.

Author information

1
Department of Urology, Upstate University Hospital, Syracuse, New York. Electronic address: jctrussell1@verizon.net.
2
Department of Urology, UNC School of Medicine, Chapel Hill, North Carolina; UNC Fertility, Raleigh, North Carolina.
3
Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado.
4
Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.
5
Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, Georgia.
6
Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
7
Department of Obstetrics and Gynecology and Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan.
8
Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.
9
Ligand Assay and Analysis Core, University of Virginia, Charlottesville, Virginia.
10
Department of Urology, University of California, San Francisco, San Francisco, California.
11
Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina.
12
Partner of Northeastern Reproductive Medicine, Colchester, Vermont.
13
Department of Obstetrics and Gynecology, University of Pennsylvania, Phildelphia, Pennsylvania.
14
Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, Rhode Island.
15
University of Texas Health Science Center, San Antonio, San Antonio, Texas.
16
Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida.
17
Yale Fertility Center, New Haven, Connecticut.
18
Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut.
19
Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.

Abstract

OBJECTIVE:

To determine whether men with unexplained infertility and low total T (TT) have abnormal spermatogenesis and lower fecundity.

DESIGN:

Secondary analysis of the prospective, randomized, multicenter clinical trial, Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS).

SETTING:

Infertility clinics.

PATIENT(S):

Nine hundred couples with unexplained infertility enrolled in AMIGOS. Semen analysis with an ejaculate of at least 5 million total motile sperm was required for enrollment. For inclusion in this secondary analysis, a fasting TT was required.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Logistic regression, adjusted for age and body mass index, assessed the association between low TT (defined as <264 ng/dL), semen parameters, and pregnancy outcome.

RESULT(S):

Seven hundred eighty-one men (mean age, 34.2 ± 5.7 years) with a median (interquartile range) TT of 411 (318-520) ng/dL were included. Men with TT <264 ng/dL were less likely to have normal (≥4% strict Kruger) morphology (unadjusted odds ratio [OR], 0.56; 95% confidence interval [CI], 0.34, 0.92; adjusted OR, 0.59; 95% CI, 0.35, 0.99). There was no association between low TT and semen volume < 1.5 mL, sperm concentration < 15 × 106/mL, or motility < 40%. Among couples whose male partner had low TT, 21 (18.8%) had a live birth, compared with 184 (27.5%) live births in couples with a male partner having TT > 264 ng/dL. The odds of live birth decreased by 40% in couples whose male partner had low TT (unadjusted OR, 0.60; 95% CI, 0.36, 1.00; adjusted OR, 0.65; 95% CI, 0.38, 1.12).

CONCLUSION(S):

In couples with unexplained infertility, low TT in the male partner was associated with abnormal sperm morphology and lower live birth rates.

CLINICAL TRIAL REGISTRATION NUMBER:

NCT01044862.

KEYWORDS:

Testosterone; infertility; live birth; male; semen analysis

PMID:
30982604
PMCID:
PMC6557574
[Available on 2020-06-01]
DOI:
10.1016/j.fertnstert.2019.01.034

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