The Association between Mortality and Male Infertility: Systematic Review and Meta-analysis.
Level 3 - non-randomized controlled study
Systematic review of observational retrospective cohort studies
PubMed 33819517 · doi:10.1016/j.urology.2021.02.041
What was done
A systematic review and meta-analysis following MOOSE guidelines to evaluate the association between male infertility, semen parameters, and early mortality. Five databases (PubMed, Web of Science, Embase, Cochrane Library, and Scopus) were searched through August 2020. Cohorts with male factor infertility were compared to fertile/normospermic controls or national mortality data to compute pooled Risk Ratios (RR), Risk Differences (Δr), Hazard Ratios (HR), and Standardized Mortality Ratios (SMR).
What was found
Six retrospective cohort studies were included: - Infertile vs. fertile men (3 studies; n = 202,456; 1,396 deaths): pooled HR for mortality was 1.26 (95% CI: 1.01–1.59). - Combined oligo- and azoospermic vs. normospermic men (4 studies; n = 59,291; 643 deaths): pooled RR of death was 1.67 (95% CI: 1.26–2.21) and pooled Δr was 0.37% (95% CI: 0.18–0.55%). - Azoospermic men comparisons: cumulative HR was 1.31 (95% CI: 1.11–1.54) comparing oligospermic to azoospermic men, and 2.17 (95% CI: 1.55–3.04) comparing normospermic to azoospermic men. - Infertile men vs. general population: pooled SMR was 0.38 (95% CI: 0.31–0.45).
Why it matters
Male reproductive impairment may serve as an indicator of broader somatic health and elevated long-term mortality risk relative to fertile controls. However, lower mortality relative to the general population highlights substantial selection and socioeconomic biases among men undergoing fertility workups.
Limits
All included studies were retrospective observational designs subject to residual confounding. The number of studies is small (six total), and the abstract does not report cause-specific mortality or adjustments for specific lifestyle confounders.
Cited by
- supports Lower sperm concentrations and poorer semen parameters are dose-dependently associated with higher all-cause mortality and younger age at death.