Association between testosterone, semen parameters, and live birth in men with unexplained infertility in an intrauterine insemination population
J C Trussell, R Matthew Coward, Nanette Santoro, Christy Stetter, Allen Kunselman, Michael P Diamond, Karl R Hansen, Stephen A Krawetz, Richard S Legro, Dan Heisenleder, James Smith, Anne Steiner, Robert Wild, Peter Casson, Cristos Coutifaris, Reuben R Alvero, R B Robinson, Greg Christman, Pasquale Patrizio, Heping Zhang, Mark C Lindgren, Reproductive Medicine Network, J C Trussell, R Matthew Coward, Nanette Santoro, Christy Stetter, Allen Kunselman, Michael P Diamond, Karl R Hansen, Stephen A Krawetz, Richard S Legro, Dan Heisenleder, James Smith, Anne Steiner, Robert Wild, Peter Casson, Cristos Coutifaris, Reuben R Alvero, R B Robinson, Greg Christman, Pasquale Patrizio, Heping Zhang, Mark C Lindgren, Reproductive Medicine Network
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.
Published by Elsevier Inc.
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Source: PubMed