Background: Recent evidence indicates that a systemic state of inflammation may impair fertility, but data about psoriatic males are scarce. Objectives: The aim of this study was to assess gonadal function in psoriatic males implementing our knowledge about fertility in these subjects. Methods: Male psoriatic patients, aged between 18 and 55 years, and a group of healthy subjects matched for age, BMI and geographic origin were enrolled. All subjects underwent a complete physical and andrological examination, standard semen analysis, complete microbiological analysis and ultrasound evaluation of sexual glands. Seminal levels of soluble urokinase-type plasminogen activator receptor (suPAR) and serum levels of testosterone, estradiol (E2), sex hormone-binding globulin (SHBG), luteinizing hormone and follicle-stimulating hormone were also assessed. Results: Fifty patients and 50 controls fulfilled the inclusion criteria and were enrolled in our study. Testosterone and SHBG were found to be significantly decreased in patients with psoriasis compared with the control group. Higher levels of E2 were also reported in psoriatic patients. Total sperm count, sperm motility and percent of spermatozoa with normal morphology were significantly reduced in patients compared to controls. suPAR levels were significantly increased in patients compared to controls and found to be above the reference limits. Ultrasound signs of inflammation of the accessory glands were observed in 35/50 patients with psoriasis and in none of the controls. Conclusion: Our study suggests that untreated psoriasis may impair male fertility. We also found that this might be due to an impact of systemic inflammation on the hormonal profile and on sexual accessory gland inflammation.

Keywords:
Psoriasis, Immune-mediated inflammatory disease, Inflammation, Males, Fertility
1.
Davidovici BB, Sattar N, Prinz J, et al: Psoriasis and systemic inflammatory diseases: potential mechanistic links between skin disease and co-morbid conditions. J Invest Dermatol 2010;130:1785-1796.
2.
Anderson DJ, Politch JA: Role of seminal plasma in human female reproductive failure: immunomodulation, inflammation, and infections. Adv Exp Med Biol 2015;868:159-169.
3.
Azenabor A, Ekun AO, Akinloye O: Impact of inflammation on male reproductive tract. J Reprod Infertil 2015;16:123-129.
4.
Pentikäinen V, Erkkilä K, Suomalainen L, et al: TNFalpha down-regulates the Fas ligand and inhibits germ cell apoptosis in the human testis. J Clin Endocrinol Metab 2001;86:4480-4488.
5.
Perdichizzi A, Nicoletti F, La Vignera S, et al: Effects of tumour necrosis factor alpha on human sperm motility and apoptosis. J Clin Immunol 2007;27:152-162.
6.
Said TM, Agarwal A, Falcone T, et al: Infliximab may reverse the toxic effects induced by tumor necrosis factor alpha in human spermatozoa: an in vitro model. Fertil Steril 2005;83:1665-1673.
7.
Estrada LS, Champion HC, Wang R, et al: Effect of tumour necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) on human sperm motility, viability and motion parameters. Int J Androl 1997;20:237-242.
8.
Cutolo M, Balleari E, Giusti M, Intra E, Accardo S: Androgen replacement therapy in male patients with rheumatoid arthritis. Arthritis Rheum 1991;34:1-5.
9.
Wallgren M, Kindahl H, Rodriguez-Martinez H: Alterations in testicular function after endotoxin injection in the boar. Int J Androl 1992;16:235-243.
10.
O'Bryan MK, Schlatt S, Gerdprasert O, et al: Inducible nitric oxide synthase in the rat testis: evidence for potential roles in both normal function and inflammation-mediated infertility. Biol Reprod 2000;63:1285-1293.
11.
Tomaszewska-Zaremba D, Herman A: The role of immunological system in the regulation of gonadoliberin and gonadotropin secretion. Reprod Biol 2009;9:11-23.
12.
Fredriksson T, Petterson U: Severe psoriasis - oral therapy with a new retinoid. Dermatologica 1978;157:238-244.
13.
La Vignera S, Calogero AE, Condorelli RA, et al: Ultrasonographic evaluation of patients with male accessory gland infection. Andrologia 2012;44:26-31.
14.
Dellabella M, Milanese G, Muzzonigro G: Correlation between ultrasound alterations of the preprostatic sphincter and symptoms in patients with chronic prostatitis-chronic pelvic pain syndrome. J Urol 2006;176:112-118.
15.
Cemil BC, Cengiz FP, Atas H, et al: Sex hormones in male psoriasis patients and their correlation with the Psoriasis Area and Severity Index. J Dermatol 2015;42:500-503.
16.
Herrmann M, Scholmerich J, Straub RH: Influence of cytokines and growth factors on distinct steroidogenic enzymes in vitro: a short tabular data collection. Ann NY Acad Sci 2002;966:166-186.
17.
Capellino S, Straub RH, Cutolo M: Aromatase and regulation of the estrogen-to-androgen ratio in synovial tissue inflammation: common pathway in both sexes. Ann NY Acad Sci 2014;1317:24-31.
18.
Tsilidis KK, Rohrmann S, McGlynn KA, et al: Association between endogenous sex steroid hormones and inflammatory biomarkers in US men. Andrology 2013;1:919-928.
19.
Tengstrand B, Carlstrom K, Fellander-Tsai L, et al: Abnormal levels of serum dehydroepiandrosterone, estrone, and estradiol in men with rheumatoid arthritis: high correlation between serum estradiol and current degree of inflammation. J Rheumatol 2003;30:2338-2343.
20.
Straub RH: The complex role of estrogens in inflammation. Endocr Rev 2007;28:521-574.
21.
Saad F, Haider A, Gooren L: Hypogonadal men with psoriasis benefit from long-term testosterone replacement therapy - a series of 15 case reports. Andrologia 2016;48:341-346.
22.
Tang WH, Zhuang XJ, Ma LL, et al: Correlation between body mass index and semen quality in male infertility patients. Turk J Med Sci 2015;45:1300-1305.
23.
Grunnet E, Nyfors A, Hansen KB: Studies of human semen in topical corticosteroid-treated and in methotrexate-treated psoriatics. Dermatologica 1977;154:78-84.
24.
Ramonda R, Foresta C, Ortolan A, et al: Influence of tumor necrosis factor α inhibitors on testicular function and semen in spondyloarthritis patients. Fertil Steril 2014;101:359-365.
25.
Kopa Z, Wenzel J, Papp G, Haidl G: Role of granulocyte elastase and interleukin-6 in the diagnosis of male genital tract inflammation. Andrologia 2005;37:188-194.
26.
Henkel R, Kierspel E, Stalf T, et al: Effect of reactive oxygen species produced by spermatozoa and leukocytes on sperm functions in nonleukocytospermic patients. Fertil Steril 2005;83:635-642.
27.
Motrich RD, Maccioni M, Molina R, et al: Reduced semen quality in chronic prostatitis patients that have cellular autoimmune response to prostate antigens. Hum Reprod 2005;20:2567-2572.
28.
Matalliotakis I, Cakmak H, Fragouli Y, et al: Increased IL-18 levels in seminal plasma of infertile men with genital tract infections. Am J Reprod Immunol 2006;55:428-433.
29.
Seshadri S, Bates M, Vince G, Jones D: Cytokine expression in the seminal plasma and its effects on fertilisation rates in an IVF cycle. Andrologia 2011;43:378-386.
30.
Autilio C, Morelli R, Milardi D, et al: Soluble urokinase-type plasminogen activator receptor as a putative marker of male accessory gland inflammation. Andrology 2015;3:1054-1061.
© 2017 S. Karger AG, Basel
2017
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