Reproductive Issues in Males with SLE

Opinion statement Purpose of review Sexual function and fertility are neglected topics in men with systemic lupus erythematosus (SLE) in the literature. This review examines the impact of SLE and its treatment on fertility and erectile function. Recent findings Systemic illness, such as chronic kidney disease, and drugs used in SLE are associated with male infertility and sexual dysfunction through changes at the level of the hypothalamic-pituitary axis and direct testicular damage. In SLE patients, evidence shows a dose-dependent gonadotoxicity associated with intravenous (IV) cyclophosphamide (CYC). In contrast, recent observational studies evaluating disease-modifying anti-rheumatic drugs, non-steroidal anti-inflammatory drugs, and corticosteroids have found little evidence suggesting a significant impact of paternal exposure on fertility or pregnancy outcomes. In most patients, infertility management is focused on controlling SLE disease activity, minimizing the dose of gonadotoxic medications and cryopreserving sperm prior to treatment with IV CYC. Summary Reproductive issues are not uncommon in males with SLE. Understanding the impact of disease activity and drug effects on reproductive health may avert irreversible infertility and improve patient quality of life. However, additional studies are required to further explore the impact of SLE and its treatment on male fertility.