Soares et al evaluated factors affecting fertility in a male with systemic lupus erythematosus (SLE). Identifying the cause can help determine the appropriate course of action. The authors are from the University of Sao Paulo in Brazil.
Patient selection: systemic lupus erythematosus
Factors associated with decreased fertility:
(1) postpubertal intravenous cyclophosphamide therapy
(2) high titers of antisperm antibodies
Intravenous cyclophosphamide therapy was associated with impaired testicular function. The changes in sperm after low dose cyclophosphamide therapy may be temporary, but these may become permanent with higher doses.
Clinical findings:
(1) decrease in testicular size (small testes)
Laboratory findings:
(1) elevation of serum FSH and LH
(2) reduced serum testosterone (hypoandrogenism)
(3) reduced serum inhibin B levels
Changes in semen analysis:
(1) oligo or azoospermia
(2) sperm with abnormal morphology (teratozoospermia)
(3) impaired sperm motility
Suehiro et al suggested that the ratio of serum inhibin B to FSH may be a sensitive indicator of damage from intravenous cyclophosphamide therapy.
