Association between testosterone, semen parameters, and live birth in men with unexplained infertility in an intrauterine insemination population
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J.C. Trussell, M.D., R. Matthew Coward, M.D., F.A.C.S., Nanette Santoro, M.D., Christy Stetter, B.S., Allen Kunselman, M.A., Michael P. Diamond, M.D., Karl R. Hansen, M.D., Ph.D., Stephen A. Krawetz, Ph.D., Richard S. Legro, M.D., Dan Heisenleder, Ph.D., James Smith, M.D., M.S., Anne Steiner, M.D., M.P.H., Robert Wild, M.D., Ph.D., Peter Casson, M.D., Cristos Coutifaris, M.D., Reuben R. Alvero, M.D., R.B. Robinson, M.D., Greg Christman, M.D., Pasquale Patrizio, M.D., M.B.E., Heping Zhang, Ph.D., Mark C. Lindgren, M.D. for the Reproductive Medicine Network
To determine whether men with unexplained infertility and low total T (TT) have abnormal spermatogenesis and lower fecundity.
Secondary analysis of the prospective, randomized, multicenter clinical trial, Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS).
Reproductive Medicine Network infertility clinics.
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.
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.
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).
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.