Welcome to PracticeUpdate! We hope you are enjoying temporary access to this content.
Please register today for a free account and gain full access
to all of our expert-selected content.
Already Have An Account? Log in Now
Undiagnosed Prediabetes Is Highly Prevalent in Men With Primary Infertility
abstract
This abstract is available on the publisher's site.
Access this abstract nowOBJECTIVE
To study the prevalence and the risk associated with prediabetes (PreDM) in primary infertile men.
PATIENTS AND METHODS
Data from 744 infertile men were analysed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Serum hormones were measured in every man. Semen analysis was based on 2010 World Health Organization (WHO) reference criteria. PreDM was defined according to the clinical criteria detailed by the American Diabetes Association (Diabetes Care 2014; 37 (Suppl. 1): S81). Descriptive statistics and logistic regression analyses tested the association between PreDM status, hormonal milieu and seminal parameters. The predictive accuracy of all variables was evaluated using the area under the curve, and the clinical net benefit estimated by decision curve analysis (DCA).
RESULTS
Of the 744 men, PreDM was found in 114 (15.4%). Men with PreDM (+PreDM) were older, had higher CCI scores, lower total testosterone and sex hormone-binding globulin but higher follicle-stimulating hormone (FSH) and 17β-oestradiol values compared to those without PreDM (-PreDM) (all P ≤ 0.04). Higher sperm DNA fragmentation index (DFI; P = 0.014) and idiopathic non-obstructive azoospermia (iNOA; P < 0.001) were found more frequently in +PreDM men. At multivariable logistic regression analysis, older age, FSH and iNOA (all P ≤ 0.04) were significantly associated with +PreDM status. DCA demonstrated a clinical net benefit in discriminating men at higher risk of a +PreDM status.
CONCLUSIONS
About 15% of primary infertile men had criteria suggestive of undiagnosed PreDM. A PreDM status was associated with a greater risk of hypogonadism, higher DFI values and iNOA status. Age, FSH values and iNOA status could be considered as useful parameters to recognise men with PreDM and implement early preventive interventions in those men at risk of the consequences from poor glycaemic control.
Additional Info
Disclosure statements are available on the authors' profiles:
Undiagnosed Prediabetes Is Highly Prevalent in Primary Infertile Men – Results From a Cross-Sectional Study
BJU Int 2019 Jun 01;123(6)1070-1077, L Boeri, P Capogrosso, E Ventimiglia, F Pederzoli, N Frego, W Cazzaniga, F Chierigo, M Alfano, L Piemonti, P Viganò, M Pontillo, E Montanari, F Montorsi, A SaloniaFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Men with infertility are now understood to be at risk for a number of different medical conditions, including an increased risk of cancer, metabolic syndrome, and other issues. This is not surprising because there are common themes of obesity, increased oxidative stress, and genetic abnormalities that parallel those of Lynch syndrome in at least subsets of men with infertility. The biggest question is what should be done to follow an infertile male later in life. At present, there are no genetic tests routinely available, but avoidance of progressive obesity and routine medical follow-up seem most appropriate.