MANday: How obstructive sleep apnea may negatively affect male fertility.

Infertility is defined as the inability to achieve conception after 1 year of unprotected sex. Approximately 15% of couples have issues with infertility; 35% of the issues are associated with the female partner alone and another 30% are due to factors related to only the male. Approximately 20% are a combination of both and there are approximately 15% with an unknown reason. Specifically, in terms of male infertility, there are still many underlying conditions that are unknown and generally underdiagnosed and undertreated. 

In previous blogs we discussed some known causes for male infertility including hormone imbalance, infections, varicoceles, chromosomal abnormalities, testicular trauma, ejaculatory duct obstruction, history of chemo/radiation treatment, etc. Recently, emerging research has shown that obstructive sleep apnea (OSA) may also be a contributing cause of male infertility. 

We previously discussed the many ways OSA can affect our health. The lack of sufficient quality sleep over time can contribute to, for example, heart disease, diabetes, hypertension, obesity, weakened immunity, decreased cognitive function, etc. And many of these conditions can contribute to secondary disorders such as heart attacks, strokes, mental decline, abnormal hormone levels, etc. 

In terms of how OSA affects fertility, evidence from recent studies indicates that OSA and other sleep disorders can lead to increased oxidative stress which then contributes to increased DNA fragmentation. Increased levels of DNA fragmentation can cause infertility, recurrent pregnancy loss, or recurrent IVF failures. OSA can also cause systemic inflammation leading to increased levels of proinflammatory cytokines. And increased levels of proinflammatory cytokines are associated with decreased spermatogenesis, decrease sperm quality, and therefore decreased fertility. Recent studies have also revealed that the longer one is exposed to the negative effects of OSA, the more likely they are to become infertile; especially those with untreated OSA that are younger than 40 years old.

Investigating to discover any and all underlying disorders that may contribute to decrease fertility is sometimes a complicated and complex process. Decreased fertility in many cases is not simply due to one solitary condition, it is usually a combination of many underlying issues. And many of these issues have root causes that are correctable, and when corrected or improved, they can increase the chances of a successful conception. Determining if OSA is one of those root causes is an additional tool that we can examine and potentially help correct. And because sleep apnea is so common, it encourages additional research to further expose this impactful relationship.

If you have never been evaluated for obstructive sleep apnea, or if you have friends or family with any of the above conditions and would like to inquire about an easy take home FDA approved sleep study kit, give us a call and we will help you get started with your evaluation. 

References:

Jhuang Y, Chung C, Wang I, et al. Association of Obstructive Sleep Apnea with the Risk of Male Infertility in Taiwan. JAMA Netw Open. 2021;4(1):e2031846. doi:10.1001/jamanetworkopen.2020.31846

Palnitkar  G, Phillips  CL, Hoyos  CM, Marren  AJ, Bowman  MC, Yee  BJ.  Linking sleep disturbance to idiopathic male infertility. Sleep Med Rev. 2018;42:149-159. doi:10.1016/j.smrv.2018.07.006

Schlegel PN, Sigman M, Collura B, et al. Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I. J Urol. 2021 Jan;205(1):36-43.

Benancio Martinez Jr is a certified Family Nurse Practitioner and one of the newest integral parts of the Y Factor team. Benancio is the medical provider in charge of the Northpointe location and brings to the Y Factor 10 years of nursing experience obtained through the emergency departments of the VA and Kingwood medical centers, as well as clinical experience in family practice, hematology, and oncology.