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The sluggish fertility rate is a problem that plagues many countries.
It is not only related to policy, but also related to fertility and willingness to bear children
.
Today we will talk about the relationship between inflammatory arthritis (such as rheumatoid arthritis and ankylosing spondylitis) and male fertility and willingness to bear children
.
Recently, a research team led by Luis Fernando Perez-Garcia of the Erasmus Medical Center in the Netherlands published an article in the famous specialist journal "Ann Rheum Dis" (Ann Rheum Dis), pointing out that before/during the peak of male childbearing age (31-40 years old) Diagnosed inflammatory arthritis is related to lower fertility rate, higher involuntary childlessness rate and fertility problems [1]
.
Specifically, the average number of children diagnosed before the age of 31 and those diagnosed at the age of 31-40 were 1.
32 and 1.
56, respectively, significantly lower than those diagnosed after the age of 40 (1.
88)
.
Moreover, the proportion of involuntary infertility (12.
03% and 10.
34%) and the proportion of medical assessments (20.
61% and 20.
69%) for fertility problems are much higher than those diagnosed after the age of 40 (3.
98%, 11.
36%)
.
About one-third of the first two groups of patients in the screenshot of the paper's homepage said that inflammatory arthritis and/or related drugs were the main reason for their fewer children
.
The related physical factors (fertility) and/or psychological factors (worries about passing on the disease to the children, fearing that the drugs are harmful to the children) may make some families have to abandon their original birth plans
.
It's really hard to recite scriptures in every family.
.
.
but don't be too pessimistic.
Isn't the discovery that the problem is the beginning of solving the problem? Before finding a good solution, let’s take a look at how researchers discovered that inflammatory arthritis is related to male fertility..
Between September 2019 and January 2021, the Perez-Garcia team carried out this cross-sectional study called iFAME-Fertility in 8 hospitals in the Netherlands.
It asked 1841 people ≥40 years of age who had completed their childbirth plans and did not plan to Male patients with inflammatory arthritis who reproduced children issued an invitation to study, and a total of 628 (34.
1%) patients agreed to participate in the study
.
In order to protect the privacy of patients, the researchers attached the link of the electronic questionnaire to the "Informed Consent Form" and filled it out by themselves
.
The questionnaire contains the following content: general demographic information (age, place of birth, education level, etc.
); medical history (type of inflammatory arthritis-rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, etc.
, age of diagnosis , Complications-diabetes, ulcerative colitis, cardiovascular disease, etc.
, whether and where you have received guidance on fertility after the illness); family planning (the number of children expected, the number of existing children, whether you are satisfied with the status quo, etc.
) ; Fertility results (consultation experience and results of fertility issues of patients and partners, pregnancy history)
.
Researchers divided patients into 3 groups according to their age at diagnosis-before the peak of childbearing age (≤30 years old, 137 people), peak of childbearing age (31-40 years old, 149 people), and after the peak childbearing age (≥41 years old, 342 people) , To evaluate the relationship between inflammatory arthritis and fertility and willingness to give birth by comparing the expected number of children of each group of men, the actual number of children (fertility rate), the number of partner pregnancy times, the childless rate, the fertility consultation rate, and the duration of pregnancy
.
The results of the study show that the expected number of children of the above three groups is not much different (1.
75, 1.
86, 2.
03), but the actual number of children (1.
32, 1.
56) of those diagnosed before the age of 31 and those diagnosed at the age of 31-40 (1.
32, 1.
56) is significantly lower than the number of children diagnosed after the age of 40 The actual number of children (1.
88) is also lower than the average birth rate of all men of the same age in the Netherlands (1.
79)
.
After adjusting for the potential influence of factors such as partner infertility, the difference between the groups is still significant
.
This suggests that the low fertility rate of men diagnosed with inflammatory arthritis before/during the peak of childbearing age is mainly due to decreased fertility potential rather than weakened willingness to give birth
.
After the two comparisons, the difference between the expected number of children and the actual number of children in the three groups decreases successively, to 0.
41, 0.
29, and 0.
14, respectively
.
The difference between the expected number of children and the actual number of children in each group echoes this.
Among the three groups of men, 16.
67%, 9.
66% and 5.
50% are dissatisfied with their actual number of children
.
About one-third of patients in the first two groups said that inflammatory arthritis and/or related drugs were the main reason for their fewer children
.
In addition, the researchers also used the following 4 questions to quantitatively describe the impact of inflammatory arthritis and/or related drugs on the willingness to bear children (0 means "completely disagree", 10 means "completely agree"): I am worried about my child and I have the same disease; I am worried that the drugs used to treat inflammatory arthritis are harmful to children; my disease is too active to stop or reduce the medication; inflammatory arthritis makes me less want to have children
.
The results are not surprising.
Compared with those diagnosed after the age of 40, the willingness to reproduce before the age of 31 and those diagnosed at the age of 31-40 are more likely to be affected by inflammatory arthritis and/or related drugs
.
The effects of inflammatory arthritis and/or related drugs on the willingness to bear children are stratified according to the actual presence or absence of children, voluntary or involuntary infertility, and the results are similar
.
In order to more comprehensively assess the impact of inflammatory arthritis on male fertility, in addition to the above-mentioned outcome evaluation indicators that only consider live-born children, the researchers also compared the number of pregnancies of the three groups of partners (as long as the pregnancy test is positive)
.
The results showed that the number of pregnancy of the partners of those who were diagnosed before the age of 31 was 1.
45, which was also lower than those who were diagnosed at the age of 31-40 (1.
73) and those who were diagnosed after the age of 40 (1.
98)
.
After comparing the fertility conditions of each group, it is natural to compare the non-fertility conditions
.
Consistent with the childless rate of general men in the Netherlands (20%-25%), about 22.
27% of men in the study had no children, and 69.
23% of them were voluntary
.
The childless rates of those diagnosed before the age of 31 and those aged 31-40 were 33.
83% and 26.
90%, which were significantly higher than those diagnosed after the age of 40 (17.
25%)
.
The voluntary childlessness rates (24.
79%, 18.
32%, 14.
64%) and involuntary childlessness rates (12.
03%, 10.
34%, 3.
98%) of the three groups also conform to the same law
.
Among the 143 children without children, 35.
56%, 38.
46% and 22.
03% of the three groups originally wanted to have children
.
In addition, the study also found that the proportion of people diagnosed before the age of 31 and 31-40 years old who received fertility assessment (20.
61% and 20.
69%) was nearly twice as high as those diagnosed after the age of 40 (11.
36%)
.
Among them, the proportion of abnormal sperm quality (6.
77% and 8.
22%) was significantly higher than the general level (2%)
.
The fertility assessment results of the three groups had no significant difference in the pregnancy preparation time (5.
69 months, 6.
74 months, 4.
77 months)
.
In summary, the diagnosis of inflammatory arthritis before/during the peak of male childbearing age (31-40 years old) is related to impaired fertility and decreased willingness to bear children
.
As for the mechanism behind the association, the researchers put forward several conjectures: (1) Inflammatory arthritis is related to excessive immune response.
Under normal circumstances, the immune system only needs to fight against "foreign enemies" (bacteria, viruses, etc.
), but inflammatory arthritis The patient’s immune system may sometimes be indifferent to friend or foe, and to clean up together, accidentally injure the reproductive system[2, 3]; (2) The immunosuppressive drugs used to treat inflammatory arthritis have certain side effects, such as hypogonadism and decreased sperm quality[2, 3] 4, 5]; (3) Patients with inflammatory arthritis have a relatively high proportion of depression and anxiety, and they may choose not to have children if they worry about genetics or drugs that damage their children's health [6]
.
This is the first study to systematically explore the relationship between inflammatory arthritis and male fertility and willingness to reproduce.
There are many outcome evaluation indicators, but there are some limitations, such as the low response rate of questionnaires; people who are sick or taking medicine may be more concerned Own fertility, more willing to participate in relevant research; the methods and strategies for treating inflammatory arthritis during the peak childbearing age of the research subjects may be different from the current ones
.
The study reminds us that it is necessary for doctors to inform patients with inflammatory arthritis that the disease itself and/or related drugs may damage male fertility, and patients may need to discuss and adjust treatment strategies with doctors when preparing for pregnancy; more large samples are needed in the future Prospective cohort research and basic research further verify its association and explore its mechanism
.
In the new course of Singularity, we used a 10-lecture system to sort out the 20-year history of advanced lung cancer treatment
.
A detailed inventory of the latest developments in targeted therapy has also fully demonstrated the vitality of rare target research
.
Of course, immunotherapy is also a top priority.
We will take you once again to insight into the in-depth mechanism of immunotherapy, go deep into the forefront of immunotherapy, explore treatment options for the era of chemotherapy-free, and witness the achievements of adjuvant and neoadjuvant therapy.
.
In addition, we will also gaze with you on the complex biomarker research and explore the unlimited potential of new targets for immunotherapy
.
Of course, depth does not mean obscurity, and complexity does not mean complicated
.
We have tried our best to integrate these complex knowledge points into superb audio courses, so that you can listen easily, smoothly, and not too big, so that this knowledge can be quickly integrated into our cognitive system and become the soil for the next step
.
After talking for a long time, the original price of such a good course is only 39.
9 yuan, and the certified purchase only costs 9.
9 yuan, which is only half a cup of milk tea! Now that you see this, scan the QR code below immediately, and the purchase sounds like it! References [1] Perez-Garcia LF, Röder E, Goekoop RJ, et al.
Impaired fertility in men diagnosed with inflammatory arthritis: results of a large multicentre study (iFAME-Fertility) [published online ahead of print, 2021 Aug 9] Ann Rheum Dis.
2021;annrheumdis-2021-220709.
doi:10.
1136/annrheumdis-2021-220709[2] Fijak M, Pilatz A, Hedger MP, et al.
Infectious, inflammatory and'autoimmune' male factor infertility: how do rodent models inform clinical practice?.
Hum Reprod Update.
2018;24(4):416-441.
doi:10.
1093/humupd/dmy009[3] Agarwal A, Rana M, Qiu E, AlBunni H, Bui AD, Henkel R.
Role of oxidative stress, infection and inflammation in male infertility.
Andrologia.
2018;50(11):e13126.
doi:10.
1111/and.
13126[4] Sasaki JC, Chapin RE, Hall DG, et al.
It is not only related to policy, but also related to fertility and willingness to bear children
.
Today we will talk about the relationship between inflammatory arthritis (such as rheumatoid arthritis and ankylosing spondylitis) and male fertility and willingness to bear children
.
Recently, a research team led by Luis Fernando Perez-Garcia of the Erasmus Medical Center in the Netherlands published an article in the famous specialist journal "Ann Rheum Dis" (Ann Rheum Dis), pointing out that before/during the peak of male childbearing age (31-40 years old) Diagnosed inflammatory arthritis is related to lower fertility rate, higher involuntary childlessness rate and fertility problems [1]
.
Specifically, the average number of children diagnosed before the age of 31 and those diagnosed at the age of 31-40 were 1.
32 and 1.
56, respectively, significantly lower than those diagnosed after the age of 40 (1.
88)
.
Moreover, the proportion of involuntary infertility (12.
03% and 10.
34%) and the proportion of medical assessments (20.
61% and 20.
69%) for fertility problems are much higher than those diagnosed after the age of 40 (3.
98%, 11.
36%)
.
About one-third of the first two groups of patients in the screenshot of the paper's homepage said that inflammatory arthritis and/or related drugs were the main reason for their fewer children
.
The related physical factors (fertility) and/or psychological factors (worries about passing on the disease to the children, fearing that the drugs are harmful to the children) may make some families have to abandon their original birth plans
.
It's really hard to recite scriptures in every family.
.
.
but don't be too pessimistic.
Isn't the discovery that the problem is the beginning of solving the problem? Before finding a good solution, let’s take a look at how researchers discovered that inflammatory arthritis is related to male fertility..
Between September 2019 and January 2021, the Perez-Garcia team carried out this cross-sectional study called iFAME-Fertility in 8 hospitals in the Netherlands.
It asked 1841 people ≥40 years of age who had completed their childbirth plans and did not plan to Male patients with inflammatory arthritis who reproduced children issued an invitation to study, and a total of 628 (34.
1%) patients agreed to participate in the study
.
In order to protect the privacy of patients, the researchers attached the link of the electronic questionnaire to the "Informed Consent Form" and filled it out by themselves
.
The questionnaire contains the following content: general demographic information (age, place of birth, education level, etc.
); medical history (type of inflammatory arthritis-rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, etc.
, age of diagnosis , Complications-diabetes, ulcerative colitis, cardiovascular disease, etc.
, whether and where you have received guidance on fertility after the illness); family planning (the number of children expected, the number of existing children, whether you are satisfied with the status quo, etc.
) ; Fertility results (consultation experience and results of fertility issues of patients and partners, pregnancy history)
.
Researchers divided patients into 3 groups according to their age at diagnosis-before the peak of childbearing age (≤30 years old, 137 people), peak of childbearing age (31-40 years old, 149 people), and after the peak childbearing age (≥41 years old, 342 people) , To evaluate the relationship between inflammatory arthritis and fertility and willingness to give birth by comparing the expected number of children of each group of men, the actual number of children (fertility rate), the number of partner pregnancy times, the childless rate, the fertility consultation rate, and the duration of pregnancy
.
The results of the study show that the expected number of children of the above three groups is not much different (1.
75, 1.
86, 2.
03), but the actual number of children (1.
32, 1.
56) of those diagnosed before the age of 31 and those diagnosed at the age of 31-40 (1.
32, 1.
56) is significantly lower than the number of children diagnosed after the age of 40 The actual number of children (1.
88) is also lower than the average birth rate of all men of the same age in the Netherlands (1.
79)
.
After adjusting for the potential influence of factors such as partner infertility, the difference between the groups is still significant
.
This suggests that the low fertility rate of men diagnosed with inflammatory arthritis before/during the peak of childbearing age is mainly due to decreased fertility potential rather than weakened willingness to give birth
.
After the two comparisons, the difference between the expected number of children and the actual number of children in the three groups decreases successively, to 0.
41, 0.
29, and 0.
14, respectively
.
The difference between the expected number of children and the actual number of children in each group echoes this.
Among the three groups of men, 16.
67%, 9.
66% and 5.
50% are dissatisfied with their actual number of children
.
About one-third of patients in the first two groups said that inflammatory arthritis and/or related drugs were the main reason for their fewer children
.
In addition, the researchers also used the following 4 questions to quantitatively describe the impact of inflammatory arthritis and/or related drugs on the willingness to bear children (0 means "completely disagree", 10 means "completely agree"): I am worried about my child and I have the same disease; I am worried that the drugs used to treat inflammatory arthritis are harmful to children; my disease is too active to stop or reduce the medication; inflammatory arthritis makes me less want to have children
.
The results are not surprising.
Compared with those diagnosed after the age of 40, the willingness to reproduce before the age of 31 and those diagnosed at the age of 31-40 are more likely to be affected by inflammatory arthritis and/or related drugs
.
The effects of inflammatory arthritis and/or related drugs on the willingness to bear children are stratified according to the actual presence or absence of children, voluntary or involuntary infertility, and the results are similar
.
In order to more comprehensively assess the impact of inflammatory arthritis on male fertility, in addition to the above-mentioned outcome evaluation indicators that only consider live-born children, the researchers also compared the number of pregnancies of the three groups of partners (as long as the pregnancy test is positive)
.
The results showed that the number of pregnancy of the partners of those who were diagnosed before the age of 31 was 1.
45, which was also lower than those who were diagnosed at the age of 31-40 (1.
73) and those who were diagnosed after the age of 40 (1.
98)
.
After comparing the fertility conditions of each group, it is natural to compare the non-fertility conditions
.
Consistent with the childless rate of general men in the Netherlands (20%-25%), about 22.
27% of men in the study had no children, and 69.
23% of them were voluntary
.
The childless rates of those diagnosed before the age of 31 and those aged 31-40 were 33.
83% and 26.
90%, which were significantly higher than those diagnosed after the age of 40 (17.
25%)
.
The voluntary childlessness rates (24.
79%, 18.
32%, 14.
64%) and involuntary childlessness rates (12.
03%, 10.
34%, 3.
98%) of the three groups also conform to the same law
.
Among the 143 children without children, 35.
56%, 38.
46% and 22.
03% of the three groups originally wanted to have children
.
In addition, the study also found that the proportion of people diagnosed before the age of 31 and 31-40 years old who received fertility assessment (20.
61% and 20.
69%) was nearly twice as high as those diagnosed after the age of 40 (11.
36%)
.
Among them, the proportion of abnormal sperm quality (6.
77% and 8.
22%) was significantly higher than the general level (2%)
.
The fertility assessment results of the three groups had no significant difference in the pregnancy preparation time (5.
69 months, 6.
74 months, 4.
77 months)
.
In summary, the diagnosis of inflammatory arthritis before/during the peak of male childbearing age (31-40 years old) is related to impaired fertility and decreased willingness to bear children
.
As for the mechanism behind the association, the researchers put forward several conjectures: (1) Inflammatory arthritis is related to excessive immune response.
Under normal circumstances, the immune system only needs to fight against "foreign enemies" (bacteria, viruses, etc.
), but inflammatory arthritis The patient’s immune system may sometimes be indifferent to friend or foe, and to clean up together, accidentally injure the reproductive system[2, 3]; (2) The immunosuppressive drugs used to treat inflammatory arthritis have certain side effects, such as hypogonadism and decreased sperm quality[2, 3] 4, 5]; (3) Patients with inflammatory arthritis have a relatively high proportion of depression and anxiety, and they may choose not to have children if they worry about genetics or drugs that damage their children's health [6]
.
This is the first study to systematically explore the relationship between inflammatory arthritis and male fertility and willingness to reproduce.
There are many outcome evaluation indicators, but there are some limitations, such as the low response rate of questionnaires; people who are sick or taking medicine may be more concerned Own fertility, more willing to participate in relevant research; the methods and strategies for treating inflammatory arthritis during the peak childbearing age of the research subjects may be different from the current ones
.
The study reminds us that it is necessary for doctors to inform patients with inflammatory arthritis that the disease itself and/or related drugs may damage male fertility, and patients may need to discuss and adjust treatment strategies with doctors when preparing for pregnancy; more large samples are needed in the future Prospective cohort research and basic research further verify its association and explore its mechanism
.
In the new course of Singularity, we used a 10-lecture system to sort out the 20-year history of advanced lung cancer treatment
.
A detailed inventory of the latest developments in targeted therapy has also fully demonstrated the vitality of rare target research
.
Of course, immunotherapy is also a top priority.
We will take you once again to insight into the in-depth mechanism of immunotherapy, go deep into the forefront of immunotherapy, explore treatment options for the era of chemotherapy-free, and witness the achievements of adjuvant and neoadjuvant therapy.
.
In addition, we will also gaze with you on the complex biomarker research and explore the unlimited potential of new targets for immunotherapy
.
Of course, depth does not mean obscurity, and complexity does not mean complicated
.
We have tried our best to integrate these complex knowledge points into superb audio courses, so that you can listen easily, smoothly, and not too big, so that this knowledge can be quickly integrated into our cognitive system and become the soil for the next step
.
After talking for a long time, the original price of such a good course is only 39.
9 yuan, and the certified purchase only costs 9.
9 yuan, which is only half a cup of milk tea! Now that you see this, scan the QR code below immediately, and the purchase sounds like it! References [1] Perez-Garcia LF, Röder E, Goekoop RJ, et al.
Impaired fertility in men diagnosed with inflammatory arthritis: results of a large multicentre study (iFAME-Fertility) [published online ahead of print, 2021 Aug 9] Ann Rheum Dis.
2021;annrheumdis-2021-220709.
doi:10.
1136/annrheumdis-2021-220709[2] Fijak M, Pilatz A, Hedger MP, et al.
Infectious, inflammatory and'autoimmune' male factor infertility: how do rodent models inform clinical practice?.
Hum Reprod Update.
2018;24(4):416-441.
doi:10.
1093/humupd/dmy009[3] Agarwal A, Rana M, Qiu E, AlBunni H, Bui AD, Henkel R.
Role of oxidative stress, infection and inflammation in male infertility.
Andrologia.
2018;50(11):e13126.
doi:10.
1111/and.
13126[4] Sasaki JC, Chapin RE, Hall DG, et al.
