Fertility Related Quality of Life, Gonadal Function and Erectile Dysfunction in Male Partners of Couples with Unexplained Infertility

R. Matthew Coward, Christy Stetter, Allen Kunselman, J. C. Trussell, Mark C. Lindgren, Ruben R. Alvero, Peter Casson, Gregory M. Christman, Christos Coutifaris, Michael P. Diamond, Karl R. Hansen, Stephen A. Krawetz, Richard Legro, Randal D. Robinson, James F. Smith, Anne Z. Steiner, Robert A. Wild, Heping Zhang, Nanette Santoro

Research output: Contribution to journalArticle

Abstract

We sought to determine whether lower fertility related quality of life or depression in men of couples with unexplained infertility is associated with low total testosterone levels, abnormal semen quality or erectile dysfunction.Materials and Methods:This study is a secondary analysis of a large, multicenter, randomized controlled trial in couples with unexplained infertility. Male partners underwent baseline semen analysis with measurement of fasting total testosterone and gonadotropin. They also completed surveys, including the FertiQOL (Fertility Quality of Life), the PHQ-9 (Patient Health Questionnaire-9) and the IIEF (International Index of Erectile Function). The primary study outcomes were total testosterone with low total testosterone defined as less than 264 ng/dl, semen parameters and the IIEF score. We performed multivariable logistic regression analyses adjusted for patient age, race, body mass index, education, smoking, alcohol use, infertility duration and comorbidity.Results:A total of 708 men with a mean ± SD age of 34.2 ± 5.6 were included in study. Of the men 59 (8.3%) had a PHQ-9 score of 5 or greater, which was consistent with depression, 99 (14.0%) had low total testosterone and 63 (9.0%) had mild or worse erectile dysfunction. Neither the FertiQOL score nor depression was associated with total testosterone or any semen parameter. The FertiQOL score was inversely associated with erectile dysfunction (for every 5-point score decline AOR 1.30, 95% CI 1.16-1.46). Depressed men were significantly more likely to have erectile dysfunction than nondepressed men (AOR 6.31, 95% CI 3.12-12.77).Conclusions:In men in couples with unexplained infertility lower fertility related quality of life and depression are strongly associated with erectile dysfunction. However, neither is associated with spermatogenesis or testosterone levels. Erectile dysfunction in infertile men merits longitudinal investigation in future studies.

Original languageEnglish (US)
Pages (from-to)379-384
Number of pages6
JournalJournal of Urology
Volume202
Issue number2
DOIs
StatePublished - Aug 1 2019

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Erectile Dysfunction
Infertility
Fertility
Testosterone
Quality of Life
Depression
Semen Analysis
Semen
Health
Spermatogenesis
Gonadotropins
Comorbidity
Fasting
Body Mass Index
Randomized Controlled Trials
Logistic Models
Smoking
Regression Analysis
Alcohols
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Coward, R. Matthew ; Stetter, Christy ; Kunselman, Allen ; Trussell, J. C. ; Lindgren, Mark C. ; Alvero, Ruben R. ; Casson, Peter ; Christman, Gregory M. ; Coutifaris, Christos ; Diamond, Michael P. ; Hansen, Karl R. ; Krawetz, Stephen A. ; Legro, Richard ; Robinson, Randal D. ; Smith, James F. ; Steiner, Anne Z. ; Wild, Robert A. ; Zhang, Heping ; Santoro, Nanette. / Fertility Related Quality of Life, Gonadal Function and Erectile Dysfunction in Male Partners of Couples with Unexplained Infertility. In: Journal of Urology. 2019 ; Vol. 202, No. 2. pp. 379-384.
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abstract = "We sought to determine whether lower fertility related quality of life or depression in men of couples with unexplained infertility is associated with low total testosterone levels, abnormal semen quality or erectile dysfunction.Materials and Methods:This study is a secondary analysis of a large, multicenter, randomized controlled trial in couples with unexplained infertility. Male partners underwent baseline semen analysis with measurement of fasting total testosterone and gonadotropin. They also completed surveys, including the FertiQOL (Fertility Quality of Life), the PHQ-9 (Patient Health Questionnaire-9) and the IIEF (International Index of Erectile Function). The primary study outcomes were total testosterone with low total testosterone defined as less than 264 ng/dl, semen parameters and the IIEF score. We performed multivariable logistic regression analyses adjusted for patient age, race, body mass index, education, smoking, alcohol use, infertility duration and comorbidity.Results:A total of 708 men with a mean ± SD age of 34.2 ± 5.6 were included in study. Of the men 59 (8.3{\%}) had a PHQ-9 score of 5 or greater, which was consistent with depression, 99 (14.0{\%}) had low total testosterone and 63 (9.0{\%}) had mild or worse erectile dysfunction. Neither the FertiQOL score nor depression was associated with total testosterone or any semen parameter. The FertiQOL score was inversely associated with erectile dysfunction (for every 5-point score decline AOR 1.30, 95{\%} CI 1.16-1.46). Depressed men were significantly more likely to have erectile dysfunction than nondepressed men (AOR 6.31, 95{\%} CI 3.12-12.77).Conclusions:In men in couples with unexplained infertility lower fertility related quality of life and depression are strongly associated with erectile dysfunction. However, neither is associated with spermatogenesis or testosterone levels. Erectile dysfunction in infertile men merits longitudinal investigation in future studies.",
author = "Coward, {R. Matthew} and Christy Stetter and Allen Kunselman and Trussell, {J. C.} and Lindgren, {Mark C.} and Alvero, {Ruben R.} and Peter Casson and Christman, {Gregory M.} and Christos Coutifaris and Diamond, {Michael P.} and Hansen, {Karl R.} and Krawetz, {Stephen A.} and Richard Legro and Robinson, {Randal D.} and Smith, {James F.} and Steiner, {Anne Z.} and Wild, {Robert A.} and Heping Zhang and Nanette Santoro",
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Coward, RM, Stetter, C, Kunselman, A, Trussell, JC, Lindgren, MC, Alvero, RR, Casson, P, Christman, GM, Coutifaris, C, Diamond, MP, Hansen, KR, Krawetz, SA, Legro, R, Robinson, RD, Smith, JF, Steiner, AZ, Wild, RA, Zhang, H & Santoro, N 2019, 'Fertility Related Quality of Life, Gonadal Function and Erectile Dysfunction in Male Partners of Couples with Unexplained Infertility', Journal of Urology, vol. 202, no. 2, pp. 379-384. https://doi.org/10.1097/JU.0000000000000205

Fertility Related Quality of Life, Gonadal Function and Erectile Dysfunction in Male Partners of Couples with Unexplained Infertility. / Coward, R. Matthew; Stetter, Christy; Kunselman, Allen; Trussell, J. C.; Lindgren, Mark C.; Alvero, Ruben R.; Casson, Peter; Christman, Gregory M.; Coutifaris, Christos; Diamond, Michael P.; Hansen, Karl R.; Krawetz, Stephen A.; Legro, Richard; Robinson, Randal D.; Smith, James F.; Steiner, Anne Z.; Wild, Robert A.; Zhang, Heping; Santoro, Nanette.

In: Journal of Urology, Vol. 202, No. 2, 01.08.2019, p. 379-384.

Research output: Contribution to journalArticle

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T1 - Fertility Related Quality of Life, Gonadal Function and Erectile Dysfunction in Male Partners of Couples with Unexplained Infertility

AU - Coward, R. Matthew

AU - Stetter, Christy

AU - Kunselman, Allen

AU - Trussell, J. C.

AU - Lindgren, Mark C.

AU - Alvero, Ruben R.

AU - Casson, Peter

AU - Christman, Gregory M.

AU - Coutifaris, Christos

AU - Diamond, Michael P.

AU - Hansen, Karl R.

AU - Krawetz, Stephen A.

AU - Legro, Richard

AU - Robinson, Randal D.

AU - Smith, James F.

AU - Steiner, Anne Z.

AU - Wild, Robert A.

AU - Zhang, Heping

AU - Santoro, Nanette

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N2 - We sought to determine whether lower fertility related quality of life or depression in men of couples with unexplained infertility is associated with low total testosterone levels, abnormal semen quality or erectile dysfunction.Materials and Methods:This study is a secondary analysis of a large, multicenter, randomized controlled trial in couples with unexplained infertility. Male partners underwent baseline semen analysis with measurement of fasting total testosterone and gonadotropin. They also completed surveys, including the FertiQOL (Fertility Quality of Life), the PHQ-9 (Patient Health Questionnaire-9) and the IIEF (International Index of Erectile Function). The primary study outcomes were total testosterone with low total testosterone defined as less than 264 ng/dl, semen parameters and the IIEF score. We performed multivariable logistic regression analyses adjusted for patient age, race, body mass index, education, smoking, alcohol use, infertility duration and comorbidity.Results:A total of 708 men with a mean ± SD age of 34.2 ± 5.6 were included in study. Of the men 59 (8.3%) had a PHQ-9 score of 5 or greater, which was consistent with depression, 99 (14.0%) had low total testosterone and 63 (9.0%) had mild or worse erectile dysfunction. Neither the FertiQOL score nor depression was associated with total testosterone or any semen parameter. The FertiQOL score was inversely associated with erectile dysfunction (for every 5-point score decline AOR 1.30, 95% CI 1.16-1.46). Depressed men were significantly more likely to have erectile dysfunction than nondepressed men (AOR 6.31, 95% CI 3.12-12.77).Conclusions:In men in couples with unexplained infertility lower fertility related quality of life and depression are strongly associated with erectile dysfunction. However, neither is associated with spermatogenesis or testosterone levels. Erectile dysfunction in infertile men merits longitudinal investigation in future studies.

AB - We sought to determine whether lower fertility related quality of life or depression in men of couples with unexplained infertility is associated with low total testosterone levels, abnormal semen quality or erectile dysfunction.Materials and Methods:This study is a secondary analysis of a large, multicenter, randomized controlled trial in couples with unexplained infertility. Male partners underwent baseline semen analysis with measurement of fasting total testosterone and gonadotropin. They also completed surveys, including the FertiQOL (Fertility Quality of Life), the PHQ-9 (Patient Health Questionnaire-9) and the IIEF (International Index of Erectile Function). The primary study outcomes were total testosterone with low total testosterone defined as less than 264 ng/dl, semen parameters and the IIEF score. We performed multivariable logistic regression analyses adjusted for patient age, race, body mass index, education, smoking, alcohol use, infertility duration and comorbidity.Results:A total of 708 men with a mean ± SD age of 34.2 ± 5.6 were included in study. Of the men 59 (8.3%) had a PHQ-9 score of 5 or greater, which was consistent with depression, 99 (14.0%) had low total testosterone and 63 (9.0%) had mild or worse erectile dysfunction. Neither the FertiQOL score nor depression was associated with total testosterone or any semen parameter. The FertiQOL score was inversely associated with erectile dysfunction (for every 5-point score decline AOR 1.30, 95% CI 1.16-1.46). Depressed men were significantly more likely to have erectile dysfunction than nondepressed men (AOR 6.31, 95% CI 3.12-12.77).Conclusions:In men in couples with unexplained infertility lower fertility related quality of life and depression are strongly associated with erectile dysfunction. However, neither is associated with spermatogenesis or testosterone levels. Erectile dysfunction in infertile men merits longitudinal investigation in future studies.

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