Testosterone replacement therapy in men who conceived with intracytoplasmic sperm injection: nationwide register study.

Angel Elenkov,Yahia Al-Jebari,Yvonne Lundberg Giwercman,Aleksander Giwercman

doi:10.1530/eje-19-0734

Angel Elenkov, Yahia Al-Jebari + Show 2 more

Open Access

https://doi.org/10.1530/eje-19-0734

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Abstract

ObjectivesMale hypogonadism is associated with higher risk of co-morbidity and premature mortality. It is, therefore, of utmost importance to identify young men who are at the highest risk of testosterone deficiency and who may benefit from preventive measures. In this context, infertile men constitute a high-risk group. The extent of testosterone replacement therapy (TRT) among infertile men, defined as men who have to undergo assisted reproduction for fatherhood, is currently unknown. Therefore, we evaluated the pattern of prescription of TRT in the years following child conception among men who have fathered children with the help of intracytoplasmic sperm injection (ICSI) or in vitro fertilization (IVF).DesignBy sourcing data from national population registries, hazard ratio (HR) for subsequent TRT was assessed for IVF and ICSI-treated men and compared to those who conceived spontaneously with age Cox regression analysis adjusted for age, educational level and previous intake of medicines for metabolic diseases.ResultsICSI and IVF fathers had increased incidence of newly prescribed TRT compared to fathers conceiving spontaneously (ICSI: HR = 3.81, 95% CI = 3.09–4.69, P < 0.001; IVF: HR = 1.54, 95% CI = 1.15–2.05, P = 0.003). After adjustment for prescription of medication for one or more components of the MetS prior to TRT, the risk estimates attenuated but remained robust both for ICSI-treated (HR = 3.17 (95% CI: 2.56–3.9) and IVF-treated men (HR = 1.06 (95% CI: 1.05–1.07).ConclusionMen who have to utilise powerful techniques, such as ICSI for fathering children, may be at risk for testosterone deficiency. Routine endocrine evaluation of men seeking fertility treatment is hence warranted.

Highlights

Low serum testosterone in men has been associated with higher mortality and increased co-morbidity including cardiovascular disease, diabetes metabolic syndrome [1, 2, 3], low grade inflammation [4], lower insulin sensitivity [5] and accelerated atherosclerosis [6]
It is of utmost importance to identify young men who are at the highest risk of testosterone deficiency and who may benefit from preventive measures
By using the Swedish Prescription Drug Register (SPDR), we looked at the pattern of filled drug prescriptions for one or more components of the metabolic syndrome (MetS) – diabetes mellitus (DM), hypertension (HT) and dyslipidemia (DLE)

Summary

Introduction

Low serum testosterone in men (hypogonadism) has been associated with higher mortality and increased co-morbidity including cardiovascular disease, diabetes metabolic syndrome [1, 2, 3], low grade inflammation [4], lower insulin sensitivity [5] and accelerated atherosclerosis [6]. Patients on androgen deprivation therapy for prostate cancer are at an increased risk of coronary heart disease, diabetes and cardiovascular death [1], indicating a key role for testosterone in atheroprotection. The number of studies, in particular randomised controlled studies, is limited, and inclusion of elderly men with higher co-morbidity and often short follow-up result in available data being rather inconclusive [11, 12]. It is of utmost importance to identify young men who are at the highest risk of testosterone deficiency and who may benefit from preventive measures

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