Vitamin D deficiency and low ionized calcium are linked with semen quality and sex steroid levels in infertile men

Martin Blomberg Jensen; Jacob Gerner Lawaetz; Anna-Maria Andersson; Jørgen Holm Petersen; Loa Nordkap; Anne Kirstine Bang; Pia Ekbom; Ulla Nordström Joensen; Lisbeth Prætorius; Peter Lundstrøm; Vibeke Hartvig Boujida; Beate Lanske; Anders Juul; Niels Jørgensen

doi:10.1093/humrep/dew152

Vitamin D deficiency and low ionized calcium are linked with semen quality and sex steroid levels in infertile men

Martin Blomberg Jensen, Jacob Gerner Lawaetz, Anna-Maria Andersson, Jørgen Holm Petersen, Loa Nordkap, Anne Kirstine Bang, Pia Ekbom, Ulla Nordström Joensen, Lisbeth Prætorius, Peter Lundstrøm, Vibeke Hartvig Boujida, Beate Lanske, Anders Juul, Niels Jørgensen

53 Citationer (Scopus)

Abstract

STUDY QUESTION Are low vitamin D levels linked with semen quality and sex steroids in infertile men? SUMMARY ANSWER Infertile men with vitamin D deficiency had lower sperm motility, total numbers of motile sperm, Inhibin B, sex-hormone-binding-globulin (SHBG) and testosterone/estradiol ratio, but higher levels of free sex steroids, than infertile men with normal vitamin D levels. WHAT IS KNOWN ALREADY Low vitamin D levels have been associated with decreased sperm motility in healthy men, but a relationship between vitamin D and calcium with semen quality and especially sex steroids has not been sufficiently described in infertile men. STUDY DESIGN, SIZE, DURATION This study comprises baseline characteristics of 1427 infertile men screened from 2011 to 2014 for inclusion in a randomized clinical trial, the Copenhagen-Bone-Gonadal Study. PARTICIPANTS/MATERIALS, SETTING, METHODS In total 1427 infertile men, consecutively referred to our tertiary andrological centre for fertility workup, underwent a physical examination and had semen quality assessed based on two samples and blood analysed for serum testosterone, SHBG, estradiol, inhibin B, luteinizing hormone, follicle-stimulating hormone (FSH), 25-hydroxyvitamin D (25-OHD), ionized calcium (Ca²⁺) and karyotype. There were 179 men excluded due to serious comorbidities or anabolic steroid usage, leaving 1248 patients for analyses. MAIN RESULTS AND THE ROLE OF CHANCE Men with 25-OHD >75 nmol/l had higher sperm motility and 66 and 111% higher total numbers of motile spermatozoa after 45 and 262 min, respectively, than men with 25-OHD <25 nmol/l (all P < 0.05). SHBG levels and testosterone/estradiol ratios were 15 and 14% lower, respectively, while free testosterone and estradiol ratios were 6 and 13% higher, respectively, in men with 25-OHD <25 nmol/l (all P < 0.05). Men with lower Ca²⁺ levels had higher progressive sperm motility and inhibin B/FSH ratio but lower testosterone/estradiol ratio (all P < 0.05). LIMITATIONS, REASONS FOR CAUTION All outcomes presented are predefined end-points but inferral of causality is compromised by the descriptive study design. It remains to be shown whether the links between vitamin D, calcium, semen quality and sex steroids in infertile men are causal. WIDER IMPLICATIONS OF THE FINDINGS The associations between vitamin D deficiency and low calcium with semen quality and sex steroids support the existence of a cross-link between regulators of calcium homeostasis and gonadal function in infertile men. STUDY FUNDING/COMPETING INTERESTS This study was supported by the Danish Agency for Science, Technology and Innovation, Hørslev Fonden, Danish Cancer Society and Novo Nordisk Foundation. There are no conflicts of interest.

Originalsprog	Engelsk
Tidsskrift	Human Reproduction
Vol/bind	31
Udgave nummer	8
Sider (fra-til)	1875-1885
Antal sider	11
ISSN	0268-1161
DOI	https://doi.org/10.1093/humrep/dew152
Status	Udgivet - 1 aug. 2016

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10.1093/humrep/dew152

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https://academic.oup.com/humrep/article-pdf/31/8/1875/17373414/dew152.pdf

Citationsformater

Jensen, M. B., Lawaetz, J. G., Andersson, A-M., Petersen, J. H., Nordkap, L., Bang, A. K., Ekbom, P., Joensen, U. N., Prætorius, L., Lundstrøm, P., Boujida, V. H., Lanske, B., Juul, A., & Jørgensen, N. (2016). Vitamin D deficiency and low ionized calcium are linked with semen quality and sex steroid levels in infertile men. Human Reproduction, 31(8), 1875-1885. https://doi.org/10.1093/humrep/dew152

Jensen, MB, Lawaetz, JG, Andersson, A-M, Petersen, JH, Nordkap, L, Bang, AK, Ekbom, P, Joensen, UN, Prætorius, L, Lundstrøm, P, Boujida, VH, Lanske, B, Juul, A & Jørgensen, N 2016, 'Vitamin D deficiency and low ionized calcium are linked with semen quality and sex steroid levels in infertile men', Human Reproduction, bind 31, nr. 8, s. 1875-1885. https://doi.org/10.1093/humrep/dew152

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title = "Vitamin D deficiency and low ionized calcium are linked with semen quality and sex steroid levels in infertile men",

abstract = "STUDY QUESTION Are low vitamin D levels linked with semen quality and sex steroids in infertile men? SUMMARY ANSWER Infertile men with vitamin D deficiency had lower sperm motility, total numbers of motile sperm, Inhibin B, sex-hormone-binding-globulin (SHBG) and testosterone/estradiol ratio, but higher levels of free sex steroids, than infertile men with normal vitamin D levels. WHAT IS KNOWN ALREADY Low vitamin D levels have been associated with decreased sperm motility in healthy men, but a relationship between vitamin D and calcium with semen quality and especially sex steroids has not been sufficiently described in infertile men. STUDY DESIGN, SIZE, DURATION This study comprises baseline characteristics of 1427 infertile men screened from 2011 to 2014 for inclusion in a randomized clinical trial, the Copenhagen-Bone-Gonadal Study. PARTICIPANTS/MATERIALS, SETTING, METHODS In total 1427 infertile men, consecutively referred to our tertiary andrological centre for fertility workup, underwent a physical examination and had semen quality assessed based on two samples and blood analysed for serum testosterone, SHBG, estradiol, inhibin B, luteinizing hormone, follicle-stimulating hormone (FSH), 25-hydroxyvitamin D (25-OHD), ionized calcium (Ca2+) and karyotype. There were 179 men excluded due to serious comorbidities or anabolic steroid usage, leaving 1248 patients for analyses. MAIN RESULTS AND THE ROLE OF CHANCE Men with 25-OHD >75 nmol/l had higher sperm motility and 66 and 111% higher total numbers of motile spermatozoa after 45 and 262 min, respectively, than men with 25-OHD <25 nmol/l (all P < 0.05). SHBG levels and testosterone/estradiol ratios were 15 and 14% lower, respectively, while free testosterone and estradiol ratios were 6 and 13% higher, respectively, in men with 25-OHD <25 nmol/l (all P < 0.05). Men with lower Ca2+ levels had higher progressive sperm motility and inhibin B/FSH ratio but lower testosterone/estradiol ratio (all P < 0.05). LIMITATIONS, REASONS FOR CAUTION All outcomes presented are predefined end-points but inferral of causality is compromised by the descriptive study design. It remains to be shown whether the links between vitamin D, calcium, semen quality and sex steroids in infertile men are causal. WIDER IMPLICATIONS OF THE FINDINGS The associations between vitamin D deficiency and low calcium with semen quality and sex steroids support the existence of a cross-link between regulators of calcium homeostasis and gonadal function in infertile men. STUDY FUNDING/COMPETING INTERESTS This study was supported by the Danish Agency for Science, Technology and Innovation, H{\o}rslev Fonden, Danish Cancer Society and Novo Nordisk Foundation. There are no conflicts of interest.",

keywords = "Journal Article",

author = "Jensen, {Martin Blomberg} and Lawaetz, {Jacob Gerner} and Anna-Maria Andersson and Petersen, {J{\o}rgen Holm} and Loa Nordkap and Bang, {Anne Kirstine} and Pia Ekbom and Joensen, {Ulla Nordstr{\"o}m} and Lisbeth Pr{\ae}torius and Peter Lundstr{\o}m and Boujida, {Vibeke Hartvig} and Beate Lanske and Anders Juul and Niels J{\o}rgensen",

note = "{\textcopyright} The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: [email protected].",

year = "2016",

month = aug,

day = "1",

doi = "10.1093/humrep/dew152",

language = "English",

volume = "31",

pages = "1875--1885",

journal = "Human Reproduction",

issn = "0268-1161",

publisher = "Oxford Academic",

number = "8",

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TY - JOUR

T1 - Vitamin D deficiency and low ionized calcium are linked with semen quality and sex steroid levels in infertile men

AU - Jensen, Martin Blomberg

AU - Lawaetz, Jacob Gerner

AU - Andersson, Anna-Maria

AU - Petersen, Jørgen Holm

AU - Nordkap, Loa

AU - Bang, Anne Kirstine

AU - Ekbom, Pia

AU - Joensen, Ulla Nordström

AU - Prætorius, Lisbeth

AU - Lundstrøm, Peter

AU - Boujida, Vibeke Hartvig

AU - Lanske, Beate

AU - Juul, Anders

AU - Jørgensen, Niels

N1 - © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: [email protected].

PY - 2016/8/1

Y1 - 2016/8/1

N2 - STUDY QUESTION Are low vitamin D levels linked with semen quality and sex steroids in infertile men? SUMMARY ANSWER Infertile men with vitamin D deficiency had lower sperm motility, total numbers of motile sperm, Inhibin B, sex-hormone-binding-globulin (SHBG) and testosterone/estradiol ratio, but higher levels of free sex steroids, than infertile men with normal vitamin D levels. WHAT IS KNOWN ALREADY Low vitamin D levels have been associated with decreased sperm motility in healthy men, but a relationship between vitamin D and calcium with semen quality and especially sex steroids has not been sufficiently described in infertile men. STUDY DESIGN, SIZE, DURATION This study comprises baseline characteristics of 1427 infertile men screened from 2011 to 2014 for inclusion in a randomized clinical trial, the Copenhagen-Bone-Gonadal Study. PARTICIPANTS/MATERIALS, SETTING, METHODS In total 1427 infertile men, consecutively referred to our tertiary andrological centre for fertility workup, underwent a physical examination and had semen quality assessed based on two samples and blood analysed for serum testosterone, SHBG, estradiol, inhibin B, luteinizing hormone, follicle-stimulating hormone (FSH), 25-hydroxyvitamin D (25-OHD), ionized calcium (Ca2+) and karyotype. There were 179 men excluded due to serious comorbidities or anabolic steroid usage, leaving 1248 patients for analyses. MAIN RESULTS AND THE ROLE OF CHANCE Men with 25-OHD >75 nmol/l had higher sperm motility and 66 and 111% higher total numbers of motile spermatozoa after 45 and 262 min, respectively, than men with 25-OHD <25 nmol/l (all P < 0.05). SHBG levels and testosterone/estradiol ratios were 15 and 14% lower, respectively, while free testosterone and estradiol ratios were 6 and 13% higher, respectively, in men with 25-OHD <25 nmol/l (all P < 0.05). Men with lower Ca2+ levels had higher progressive sperm motility and inhibin B/FSH ratio but lower testosterone/estradiol ratio (all P < 0.05). LIMITATIONS, REASONS FOR CAUTION All outcomes presented are predefined end-points but inferral of causality is compromised by the descriptive study design. It remains to be shown whether the links between vitamin D, calcium, semen quality and sex steroids in infertile men are causal. WIDER IMPLICATIONS OF THE FINDINGS The associations between vitamin D deficiency and low calcium with semen quality and sex steroids support the existence of a cross-link between regulators of calcium homeostasis and gonadal function in infertile men. STUDY FUNDING/COMPETING INTERESTS This study was supported by the Danish Agency for Science, Technology and Innovation, Hørslev Fonden, Danish Cancer Society and Novo Nordisk Foundation. There are no conflicts of interest.

AB - STUDY QUESTION Are low vitamin D levels linked with semen quality and sex steroids in infertile men? SUMMARY ANSWER Infertile men with vitamin D deficiency had lower sperm motility, total numbers of motile sperm, Inhibin B, sex-hormone-binding-globulin (SHBG) and testosterone/estradiol ratio, but higher levels of free sex steroids, than infertile men with normal vitamin D levels. WHAT IS KNOWN ALREADY Low vitamin D levels have been associated with decreased sperm motility in healthy men, but a relationship between vitamin D and calcium with semen quality and especially sex steroids has not been sufficiently described in infertile men. STUDY DESIGN, SIZE, DURATION This study comprises baseline characteristics of 1427 infertile men screened from 2011 to 2014 for inclusion in a randomized clinical trial, the Copenhagen-Bone-Gonadal Study. PARTICIPANTS/MATERIALS, SETTING, METHODS In total 1427 infertile men, consecutively referred to our tertiary andrological centre for fertility workup, underwent a physical examination and had semen quality assessed based on two samples and blood analysed for serum testosterone, SHBG, estradiol, inhibin B, luteinizing hormone, follicle-stimulating hormone (FSH), 25-hydroxyvitamin D (25-OHD), ionized calcium (Ca2+) and karyotype. There were 179 men excluded due to serious comorbidities or anabolic steroid usage, leaving 1248 patients for analyses. MAIN RESULTS AND THE ROLE OF CHANCE Men with 25-OHD >75 nmol/l had higher sperm motility and 66 and 111% higher total numbers of motile spermatozoa after 45 and 262 min, respectively, than men with 25-OHD <25 nmol/l (all P < 0.05). SHBG levels and testosterone/estradiol ratios were 15 and 14% lower, respectively, while free testosterone and estradiol ratios were 6 and 13% higher, respectively, in men with 25-OHD <25 nmol/l (all P < 0.05). Men with lower Ca2+ levels had higher progressive sperm motility and inhibin B/FSH ratio but lower testosterone/estradiol ratio (all P < 0.05). LIMITATIONS, REASONS FOR CAUTION All outcomes presented are predefined end-points but inferral of causality is compromised by the descriptive study design. It remains to be shown whether the links between vitamin D, calcium, semen quality and sex steroids in infertile men are causal. WIDER IMPLICATIONS OF THE FINDINGS The associations between vitamin D deficiency and low calcium with semen quality and sex steroids support the existence of a cross-link between regulators of calcium homeostasis and gonadal function in infertile men. STUDY FUNDING/COMPETING INTERESTS This study was supported by the Danish Agency for Science, Technology and Innovation, Hørslev Fonden, Danish Cancer Society and Novo Nordisk Foundation. There are no conflicts of interest.

KW - Journal Article

U2 - 10.1093/humrep/dew152

DO - 10.1093/humrep/dew152

M3 - Journal article

C2 - 27496946

SN - 0268-1161

VL - 31

SP - 1875

EP - 1885

JO - Human Reproduction

JF - Human Reproduction

IS - 8

ER -

Vitamin D deficiency and low ionized calcium are linked with semen quality and sex steroid levels in infertile men

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