Influence of TNF‐alpha inhibitors and fumaric acid esters on male fertility in psoriasis patients

AbstractObjectiveIs there any influence of a therapy with TNF‐alpha inhibitors or fumaric acid esters and of disease activity status on male fertility and sperm quality in patients with psoriasis?MethodsIn this monocentric, open‐label, prospective study, semen samples were collected from patients receiving either TNF‐alpha inhibitors or fumaric acid esters for moderate‐to‐severe plaque psoriasis. Semen was analysed at baseline before onset of the systemic therapy and monitored every 3 months under therapy. Sperm parameters were assessed according to the current WHO definitions.ResultsIn total, 101 semen specimens from 27 patients were obtained. Mean Psoriasis Area and Severity Index (PASI) score at baseline was 11.05. Only 14.8% of patients showed a normozoospermia without any other abnormal seminal values. 85.2% of patients had at least one sperm/seminal abnormality, including two patients showing an azoospermia. Interestingly, 48.1% showed sperm parameters indicative of genital tract inflammation. Therapy with TNF‐alpha inhibitors or fumaric acid esters did not have any negative effects on relevant sperm parameters such as mean total sperm number, sperm concentration, total and progressive motility. No major gonadal dysfunction was observed in any patient.ConclusionAt baseline, many patients with psoriasis showed abnormal semen/sperm parameters and remarkably elevated leukocytes and values of seminal polymorphonuclear elastase, indicating a genital tract inflammation. Thus, genital tract inflammation may represent an important comorbidity of psoriasis, little attention paid to so far. Regarding treatment with TNF‐alpha inhibitors or fumaric acid esters, no major negative (side‐) effects on sperm quality were observed.