Prostatitis and Infertility

The prostate gland only weighs 20 grams but has a significant role in a man’s health.

Is it true that prostate problems such as prostatitis can cause infertility? Keep reading to find out.

What is prostatitis?

Prostatitis is one of the most common problems found in the urology department. As opposed to benign prostatic hyperplasia, it commonly happens in young people

Males have a 14% chance of having prostatitis throughout their life, and most cases are diagnosed in men under 50 years of age (1).

It features inflammation of the prostate, which can be acute or chronic. It is usually caused by bacterial infection, but some patients develop prostatitis without any sign of infection. 

The most important symptoms of acute bacterial prostatitis are similar to urinary infections. They include dysuria (burning pain when urinating), nocturia (frequent urination at night), urinary urgency, difficulty to urinate, abdominal pain, or pain in the lower back. Some men may even report painful ejaculation and discomfort in their testicles or penis.

Besides prostatitis, there’s a similar diagnosis called Chronic Pelvic Pain Syndrome. They are chronic prostatitis patients without a traceable cause. The main symptom is intermittent pain which profoundly affects the quality of life of the patient.

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What is male infertility?

Infertility is a medical problem both men and women may display. In males, it is defined as the incapacity to get a woman pregnant after trying for 12 months or more. 

According to the World Health Organization, around 15% of couples cannot conceive, and there are many causes. Half of these cases are triggered by male factor infertility or have a male factor component (2).

The cause of male infertility is usually due to abnormal sperm production. Sperm delivery can also be blocked in obstructive azoospermia, preventing its release in ejaculation. 

Various illnesses can trigger sperm production and delivery problems, and varicocele is one of the most common. However, according to studies, genital tract infections may also cause this problem.

What’s the link between prostatitis and infertility?

Studies show that urinary tract infections and prostatitis can cause many cases of infertility. 

According to the evidence, 12% of cases of male infertility can be caused by an infection. Orchitis, epididymitis, and prostatitis are counted in. Doctors have found that sometimes solving these medical conditions can restore reproductive functions in infertile men (3).

Men with prostatitis can have sperm cell problems. Depending on the cause and comorbidities, prostatitis could affect sperm quality. 

Various studies show changes in sperm morphology, motility, and function in this group of patients. In contrast, other studies did not find any difference in semen parameters. Thus, the influence remains controversial, and it depends on the cause of prostatitis (4).

Other authors suggest that semen parameters change because of an autoimmune response. The immune system recognizes prostate antigens, attacking them and causing inflammation. This is one of the links between prostatitis and infertility. 

Other links include problems with ejaculation, oxidative stress, a secretory dysfunction of the prostate, inflammatory mediators, and the microbes that infect the gland.

Why can prostatitis lead to infertility?

Different mechanisms have been proposed to explain infertility in prostatitis. We have mentioned them above. Now let’s review each one in detail (5):

A dysfunction in the secretory function of the prostate

As mentioned above, prostatic fluid is vital for the mobility of sperm cells. In prostatitis, the volume of prostatic fluid decreases. 

Zinc, fructose, citric acid, and other components of the prostatic fluid are reduced. Sperm motility and enzyme activity are not the same, and this can impact male fertility. This alteration does not lead to infertility by itself, but it can be included as a multifactorial cause.

Antisperm antibodies

Auto-antibodies against the prostate tissue may also react against sperm cells. Antisperm antibodies are more common in nonbacterial prostatitis, especially when it has an autoimmune cause. 

Cytokines released in the inflammatory process can also affect sperm function and quality. An elevated level of such inflammatory mediators decreases sperm cell count and sperm motility, increasing damage through oxidative stress.

Free radical damage

Free radicals are unstable molecules that react against healthy tissues causing damage to their structures. In prostatitis, free radical damage aggravates the problem. 

It appears that such oxidative stress may also lead to male infertility through the formation of reactive oxygen species. They are produced by white blood cells in response to inflammation, and they impair sperm motility. They may even cause DNA damage in sperm cells.

Infertility caused by microorganisms

Different microorganisms in bacterial prostatitis are known to cause sperm quality changes. For example, Escherichia coli is known to reduce sperm motility. Semen infected with E. coli may also cause structural damage to the sperm cell tail, the midpiece, along with mitochondrial damage. 

The organism Chlamydia trachomatis may also cause a reduction in sperm motility. C. trachomatis also causes sperm cell death with a significant impact on sperm count. Other microorganisms that may contribute to infertility include enterococci, mycoplasma, and ureaplasma urealyticum.

Erectile dysfunction and ejaculatory problems

Males with chronic prostatitis sometimes live with pelvic pain and may have difficulties achieving an erection. They often have sexual dysfunction problems due to ejaculatory pain and premature ejaculation. These sexual symptoms may also influence intercourse and the capacity of a man to get a woman pregnant.

Can infertility caused by prostatitis be treated?

Prostatitis is often challenging to treat, especially in chronic cases. In most cases, doctors will recommend antibiotic treatment. 

Some infertile patients have increased their pregnancy rates after antibiotic therapy for three weeks (6). Thus, it is possible to treat infertility caused by prostatitis and reverse the problem. Moreover, it is reasonable to investigate asymptomatic inflammatory prostatitis in male patients with infertility.

Another treatment we can try in these cases is through antioxidants. Prostatitis sometimes responds to antioxidant therapy, but the treatment should be held for at least six months. Other alternative treatments include anti-inflammatory drugs and herbal therapies, with variable success rates (7).

In most cases, infertility is multifactorial. It responds to many causes instead of only one. If prostatitis is the leading cause of infertility, treatment may revert this problem. 

But when another issue is at hand, doctors should solve the main concern before any improvement is evident. In some cases, assisted reproductive techniques are required to achieve a successful pregnancy. 

However, even in these cases, it is recommended to solve prostatitis first because the presence of leukocytes in the sperm of prostatitis patients may affect fertility treatment outcomes (8).

Conclusion

Many causes can trigger male infertility. One of them is prostatitis, which is the third more common urologic diagnosis in young men. 

Prostatitis features inflammation, and it is often caused by male accessory gland infection. Oxidative stress, cytokines, sexual dysfunction, prostatic secretion changes, and other problems in prostatitis may lead to a reduction in fertility rates.

Thus, treating prostatitis may resolve the problem in many cases. However, it is also important to evaluate additional causes that may also affect fertility.

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Sources

  1. Mehik, A., Hellström, P., Lukkarinen, O., Sarpola, A., & Järvelin, M. R. (2000). Epidemiology of prostatitis in Finnish men: a population‐based cross‐sectional study. BJU international, 86(4), 443-448. https://pubmed.ncbi.nlm.nih.gov/10971269/
  2. Infertility, W. H. O. (1991). A tabulation of available data on prevalence of primary and secondary infertility. Programme on material and child health and family planning division of family health. Geneva: World Health Organization.
  3. Dohle, G. R. (2003). Inflammatory‐associated obstructions of the male reproductive tract. Andrologia, 35(5), 321-324. https://pubmed.ncbi.nlm.nih.gov/14535864/
  4. Marconi, M., Pilatz, A., Wagenlehner, F., Diemer, T., & Weidner, W. (2009). Impact of infection on the secretory capacity of the male accessory glands. International braz j urol, 35(3), 299-309. https://pubmed.ncbi.nlm.nih.gov/19538765/
  5. Alshahrani, S., McGill, J., & Agarwal, A. (2013). Prostatitis and male infertility. Journal of reproductive immunology, 100(1), 30-36. https://pubmed.ncbi.nlm.nih.gov/23938147/
  6. Hamada, A., Agarwal, A., Sharma, R., French, D. B., Ragheb, A., & Sabanegh Jr, E. S. (2011). Empirical treatment of low-level leukocytospermia with doxycycline in male infertility patients. Urology, 78(6), 1320-1325. https://pubmed.ncbi.nlm.nih.gov/22137697/
  7. Pasqualotto, F. F., Sharma, R. K., Potts, J. M., Nelson, D. R., Thomas Jr, A. J., & Agarwal, A. (2000). Seminal oxidative stress in patients with chronic prostatitis. Urology, 55(6), 881-885. https://pubmed.ncbi.nlm.nih.gov/10840100/
  8. Yilmaz, S., Koyuturk, M., Kilic, G., Alpak, O., & Aytoz, A. (2005). Effects of leucocytospermia on semen parameters and outcomes of intracytoplasmic sperm injection. international journal of andrology, 28(6), 337-342. https://pubmed.ncbi.nlm.nih.gov/16300665/

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