Is systematic screening for thyroid disorders indicated in subfertile men?

Abstract

Context: Data on the prevalence of thyroid disorders in male subfertility remain scarce. Objective: To investigate the prevalence of thyroid dysfunction and thyroid autoimmunity in men with normal and abnormal semen characteristics. Setting: Tertiary referral center for reproductive medicine of the University Hospital AZ-VUB, Brussels, Belgium. Patients and design: Two hundred and ninety-two men were stratified according to the presence of normal (group 1; n = 39) or abnormal (group 2; n = 253) semen characteristics. Thyroid function was assessed by serum thyrotropin (TSH) and free thyroxine (FT4), and thyroid peroxidase antibodies (TPO-Ab) for thyroid autoimmunity (TAI or TPO-Ab > 34 kU/l); both were correlated with semen characteristics. Main outcome measures: Semen characteristics were determined by World Health Organisation criteria (rapid + slow motility ≥ 50% and concentration ≥ 20 × 106) and Kruger criteria (morphology ≥ 14% normal cells). Results: In group 1, the mean (± s.d.) age was 33 ± 4 years; serum TSH was 1.6 (0.3–29.6) mU/l (median (range)) and FT4 was 12.2 (8.8–15.6) ng/l. In group 2, the mean age was 33 ± 5 years, serum TSH was 1.3 (0.3–5.2) mU/l and FT4 was 12.5 (8.4–17.5) ng/l; (compared with group 1 P = 0.008 for TSH and P = 0.037 for FT4). In both groups, one patient had increased TSH (2.6% and 0.4%; P = not significant (ns)). In group 1, one patient had TAI and in group 2 twelve patients had TAI (2.6% compared with 4.7%; P = ns). FT4 was an independent determinant for semen characteristics. Conclusions: The prevalence of thyroid dysfunction and autoimmunity is comparable between men with normal and abnormal semen characteristics. On the basis of these data, we do not advise systematic screening for thyroid disorders in subfertile men consulting a tertiary referral center for reproductive medicine.