Effetto dei farmaci inibitori delTumor necrosisfactor alpha(TNFα) sui parametri del liquido seminale di pazienti affetti da malattie reumatiche

Tumor necrosisfactor-alpha (TNF) has a broad spectrum of biological actions. Among them a regulatory effect on gonadal function and semen quality, both positive and detrimental, has been demonstrated in in vitro models. On one hand, TNF seems promote germ cell survival inhibiting apoptosis, on the other hand it appears to impair steroidogenesis, spermatozoa functionality and genomic integrity. Therefore, the purpose of this study was to evaluate the impact of anti-TNF therapy on semen parameters in rheumatic patients.Firstly, we explored this issue with a cross-sectional study with predefined groups (cases: rheumatic patients treated with TNF-blockers; controls: patients receiving only NSAIDS and/or DMARDs). Twenty-seven patients with rheumatoid arthritis or psoriatic arthritis or ankylosing spondylitis who accepted to collect semen by masturbation after 3-5 days of abstinence were included in the study. Semen was evaluated according to the WHO 1999 criteria.There were no significant differences in sperm parameters between cases and controls with the exception of higher rate of asthenospermia in the controls (p =0.038).To validate this results a prospective study in patientseligible for anti-TNFαtreatment was carried out. Nineteen enrolled patients collected their semen at baseline and after at least 6 months of anti-TNFα therapy.Differently from cross-sectional study, results of prospective section did not show significant difference between number and motility of spermatozoa between baseline and post-therapy samples.Serum testosterone, follicle stimulating hormone and luteinizing hormone levels were tested in all patients both in cross-sectional and prospective studies and resulted in the range of normality. In conclusion, results of our study did not show a negative effectof anti-TNF therapyon seminal parameters.