Severe active inflammatory bowel disease (IBD) is associated with impaired sperm motility and reduced testosterone levels, according to results from a tertiary IBD center in Denmark.

“Quite surprisingly, only progressive sperm motility and testosterone levels were affected by severe disease flare in patients with inflammatory bowel disease,” Dr. Ann Grosen from Aarhus University Hospital told Reuters Health by email. “We did not see an effect on sperm DNA integrity, sperm concentration, or the morphological appearance of sperm cells during severe disease. Fortunately, both sperm motility and testosterone levels (were) restored after remission in disease was obtained.”

Previous studies have found that men with recent IBD activity are more likely to experience difficulty conceiving than are men in sustained remission. But few studies have investigated the effects of IBD and its treatment on semen quality and sperm DNA integrity.

Dr. Grosen’s team investigated the effects of severe active IBD on semen quality, sperm DNA integrity and the hypothalamic-pituitary-gonadal axis, as well as the effects of infliximab and adalimumab, in 20 men with severe disease, 11 of whom achieved remission on high-dose steroids and nine of whom required additional infliximab therapy to achieve remission.

The team also included 19 outpatients who initiated anti-TNF-alpha therapy and 17 who discontinued anti-TNF-alpha treatment due to sustained remission, for an overall total of 38 men who received infliximab and seven who received adalimumab.

At the time of follow-up, all 20 men with severe disease and all 28 patients who initiated anti-TNF-alpha therapy were in remission and had been for at least three months. They had been treated for a median 5.4 months at the time of follow-up semen sampling.

Among men with severe active disease and those who started anti-TNF-alpha therapy, progressive motility values were abnormally low (mean, 28.4%), based on World Health Organization reference limits, and increased to normal levels (mean, 37.4%) after the patients achieved remission.

All other semen parameters were within the normal range and did not differ significantly between baseline and follow-up samples for any of the three subgroups.

DNA fragmentation index (DFI) decreased from a median 12.8 before initiation of anti-TNF-alpha therapy to a median 10.0 after the start of the anti-TNF-alpha therapy, the researchers reported in the Journal of Crohn’s and Colitis, online November 30.

Sperm DNA integrity did not differ between baseline and follow-up samples for any of the three subgroups, between men with ulcerative colitis and men with Crohn’s disease, or between infliximab- and adalimumab-treated patients.

Plasma testosterone levels were decreased in men with severe disease and in those who started anti-TNF-alpha therapy, but levels normalized after achieving remission.

Infliximab and adalimumab were detected in serum and seminal plasma collected while men were on maintenance treatment but were undetectable in the off-drug semen samples.

“The levels in semen corresponded to 1-2% of serum levels,” Dr. Grosen said. “Consequently, a potential female exposure through the ejaculate is negligible, and barrier methods are not necessary to use for men who are treated with anti-TNF-alpha drugs. This is especially relevant in case the female partner is pregnant.”

“Physicians should inform men with inflammatory bowel disease that we have seen no alarming effects on sperm quality, and pregnancy can be pursued without drug cessation,” she concluded. “Further, patients should not fear adverse effects on fertility despite disease flares.”