Reply to the comment 'Effect of Infliximab on Male Fertility' by Younis et al.

摘要

The case report presented by Younis et al. concerning the effect of infliximab treatment on male fertility is welcome [1]. Tumor necrosis factor a (TNF) inhibitors are a significant advantage for the treatment of spondyloarthritides (SpA) [2-4]. The majority of patients with SpA are men. Especially those patients with anky-losing spondylitis (AS) are affected during their peak reproductive years; thus, young men with SpA are concerned about fecundity. We have recently reported our experience in male patients with SpA who were treated with infliximab and had fathered healthy infants while they were on infliximab therapy [5,6]. However, in our reports, we did not study the effect of infliximab on hormonal status or on semen parameters before and during treatment with infliximab, since our studies were retrospective. Thus, we pointed out that our conclusions regarding male fertility are rather indirect. Indeed, we discussed appropriately all studies regarding the effect of anti-TNFa therapy on semen quality. The conclusions of these studies are still controversial. Mahadevan et al. evaluated the changes in semen quality in men receiving infliximab for inflammatory bowel disease. The authors concluded that infliximab might affect sperm morphology and mobility [7]. In addition, La Montagna et al. reported that infliximab caused asthenozoospermia and ter-atozoospermia [8]. On the other hand, it has been reported that infliximab had no effect on sperm quality [9].