Systemic Lupus Erythematosus (SLE), commonly known as lupus, is a chronic autoimmune condition where the body’s immune system mistakenly attacks its own healthy tissues. While frequently associated with women, lupus can affect men as well, with about 10-12% of lupus patients being male. This complex disease can impact various organs, including the skin, joints, kidneys, and blood cells. For men with lupus who are considering fatherhood, several unique factors related to fertility, medication, and genetic considerations warrant careful attention.
Lupus and Male Fertility
Lupus can directly influence male fertility through its inflammatory and autoimmune processes. Disease activity may affect sperm quality and quantity, potentially leading to lower sperm counts, reduced motility, and an increased percentage of abnormally formed sperm. This impact can stem from inflammation damaging the testicles. Some studies have indicated that men with lupus may also have lower testicular volume.
Beyond direct sperm impact, lupus can sometimes lead to hormonal imbalances. Men with lupus have shown atypical levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), hormones that support testicular testosterone production. These imbalances can contribute to male infertility. Issues like erectile dysfunction may also arise due to vascular problems, nerve damage, or psychological stress associated with lupus or its treatments. About 40% of men with SLE experience autoimmune orchitis, characterized by anti-sperm antibodies, which can also contribute to infertility.
Managing Medications for Conception
Numerous medications used to manage lupus can impact male reproductive health, making careful planning with healthcare providers important. Cyclophosphamide (Cytoxan), a potent immunosuppressant often used for severe lupus, is known to impair spermatogenesis and can lead to permanent sperm damage. It can also reduce Leydig cell count and testosterone levels.
Methotrexate and sulfasalazine are other medications that can reduce sperm count and potentially cause infertility in men. While corticosteroids and NSAIDs are commonly used, their direct impact on male fertility is less severe than cytotoxic drugs like cyclophosphamide. Antimalarials, such as hydroxychloroquine, are not associated with male fertility issues. Consulting with a rheumatologist and a fertility specialist is recommended before conception to review current medications and discuss potential adjustments or alternatives, possibly including sperm freezing and storage before treatment.
Understanding Genetic Risks for the Child
Lupus is not inherited simply like single-gene disorders. Instead, it involves a genetic predisposition, where certain genes increase susceptibility. This involves a complex interplay of multiple genes and environmental factors. About 20% of individuals with lupus have a parent or sibling with the condition.
While the overall risk of a child developing lupus when the father has the condition is relatively low, it is higher than in the general population. Approximately 5% of children born to a parent with lupus will develop the disease. This highlights familial aggregation, where genetics and environmental factors play a role. Genetic counseling can provide a personalized risk assessment, helping prospective parents understand genetic risks and make informed decisions.
Navigating Pregnancy and Parenthood
When a man with lupus and his partner decide to conceive, a coordinated approach involving a multidisciplinary medical team is beneficial. This team typically includes a rheumatologist to manage the father’s lupus, a urologist or fertility specialist to address male reproductive health, and an obstetrician for the partner who will carry the pregnancy. Genetic counselors can also provide valuable insights regarding potential risks to the child.
Pre-conception planning is important to optimize lupus disease activity and ensure it has been stable for at least six months before attempting conception. The medical team can help navigate any necessary medication adjustments to ensure safety for conception and the subsequent pregnancy. Open communication among partners and with all healthcare providers is important for addressing concerns, coordinating care, and fostering a supportive environment throughout the process.