Fertility status may be window into men's health

Houston-Fatherhood comes with burdens and travails, but one of the unanticipated benefits may be a lower risk of cardiovascular disease and death, results from a recent study suggest.

The review of data drawn from the National Institutes of Health-AARP found that married men who sired no children have a higher risk of dying from cardiovascular disease than those with two or more children. The finding is more than conversational trivia.

"Male fertility can be a window into a man's health. Men who are a member of an infertile couple should be evaluated by a reproductive expert and be informed that their risk of adverse health outcomes may be elevated. It may provide an opportunity to modify a number of other risk factors early in their lives," said first author Michael L. Eisenberg, MD, currently assistant professor of urology at Stanford University, Stanford, CA.

Finding could aid in preventive care

"This [finding] could allow us to identify men at greater risk early, when they are otherwise healthy, rather than wait until they present with symptoms such as erectile dysfunction or angina. It would give us a 30- to 40-year lead time to encourage risk reduction through behavior modification," said Dr. Eisenberg, who was a fellow in the division of male reproductive medicine and surgery in the department of urology at Baylor College of Medicine, Houston, at the time of the study, working with Larry I. Lipshultz, MD, and co-authors.

The authors, using data from the NIH-AARP Diet and Health Study, were able to follow 137,903 men aged 50 to 71 years for slightly longer than 10 years. ICD-9 codes were used to identify cause of death, and multivariable Cox proportional hazards modeling was used to estimate any associations between number of offspring and cardiovascular death. Socioeconomic and lifestyle characteristics such as age, race, body mass index, educational attainment, alcohol usage, and others were factored into the analysis.

Slightly more than 90% of the men in the study had fathered one child, half had fathered three or more, and 8.2% were identified as childless.

Compared to the men who had fathered children, childless men had a 17% increased risk of dying of cardiovascular disease (HR 1.17 [95% CI 1.03–1.32]). Men with one child also appeared to have a slightly elevated risk compared to men with two or more (HR 1.13 [95% CI 1.03–1.23]).

Interestingly, regardless of their childbearing status, between 57.3% and 63.6% of the men rated their health as very good to excellent.

Heart disease is not the only disease associated with infertility, said Dr. Eisenberg. He said there are data showing infertility to be associated with a greater risk of testis cancer and prostate cancer.

Results from the study were presented at the 2011 AUA annual meeting in Washington and subsequently published in Human Reproduction (2011; 26:3479-85).