Fertility assessment in thalassemic men

Male infertility in β-thalassemia patients is typically considered to be the consequence of iron deposition in the endocrine glands. Adult male patients with β-thalassemia, on regular blood transfusions, are prone to developing acquired hypogonadism. The aim of this study was to evaluate the fertility indicators in male patients with β-thalassemia major and intermedia. In this study we evaluated testicular volume, semen parameters and serum FSH, LH, and Testosterone concentrations in 62 male patients in reproductive age, with major and intermedia thalassemia, at a tertiary care hospital in Tehran, Iran. The range of serum ferritin level in our patients was from 182 to 11053 ng/mL (mean 2067 ng/mL). The mean concentration of sperm was 61.04 million per milliliter. The mean volume of right and left testes was 11.4 cc and 11.7 cc, respectively. Those patients who had lower testicular volumes significantly had lower sperm concentration, lower percents of motile and also lower percents of normal morphologic sperms (P=0.04). The frequency of hypogonadism was significantly higher in patients whose testicular volume was lower (P=0.02). Hypogonadism and hypothyroidism were seen in 22.6% and 17.7% of patients, respectively. Patients with hypogonadism had significantly lower ejaculate volume, lower sperm concentration, lower percents of motile and progressively motile sperms and also lower percents of normal morphologic sperms (P=0.001). This study suggests that in thalassemic men, concentrations of serum testosterone, LH, FSH has significant correlation with sperm parameters and testicular volume. β地中海贫血患者中的男性不育症通常被认为是内分泌腺中铁沉积的结果。成年男性β地中海贫血患者在常规输血时易发生获得性性腺功能减退。本研究旨在评估男性重型和中间型β地中海贫血患者的生育指标。在本研究中，我们在伊朗德黑兰的一家三级保健医院对62名处于生育年龄的男性重型和中间型地中海贫血患者的睾丸体积、精液参数以及血清FSH、LH和睾酮浓度进行了评估。在我们的患者中，血清铁蛋白水平范围是182到11053ng/mL（平均2067ng/mL）。平均精子浓度为每毫升6104万。右侧和左侧睾丸的平均体积分别为11.4cc和11.7cc。睾丸体积较小的患者明显存在精子浓度低、活动精子比例低以及正常形态精子百分比低的情况（P=0.04）。睾丸体积较小的患者性腺机能减退的频率明显更高（P=0.02）。分别在22.6%和17.7%的患者中发现性腺功能减退和甲状腺功能减退。性腺功能减退症患者的射精量、精子浓度、活动精子比例和前向运动精子比例都明显偏低，正常形态精子的比例也存在同样的情况（P=0.001）。本研究表明，在男性地中海贫血患者中，血清睾酮、LH、FSH的浓度与精子参数和睾丸体积有显著的相关性。