Anti-Depressant-Associated Changes In Semen Parameters

Editor's Choice
Main Category: Depression
Also Included In: Urology / Nephrology;  Fertility;  Psychology / Psychiatry
Article Date: 28 Nov 2008 - 1:00 PST

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SAN FRANCISCO, CA, USA (UroToday.com) - The authors previously reported an effect of antidepressants on semen parameters. The current study was designed to assess/confirm their prior report of the effects of an SSRI, paroxetine (Paxil), on semen parameters.

This was a prospective clinical trial involving 35 healthy male volunteers ages 18-65. SA were obtained prior and 2 weeks and 4 weeks after SSRI initiation. Paroxetine was given for 5weeks: 10mg QD week 1, 20mg QD week 2, 30mg QD weeks 3-4, and 20mg QD week 5. Standard WHO evaluation of semen parameters was assessed.

TUNEL assays were performed on baseline and week 4 semen samples to evaluate DNA fragmentation. Semen parameters and TUNEL assays for each individual were compared at each time point.

As opposed to prior report, semen parameters (volume, concentration, motility, morphology) were not significantly altered during SSRI treatment. However, mean DNA fragmentation TUNEL score was significantly higher on SSRI (30.3%) versus baseline (13.8%). Multivariate logistic regression, correcting for age and body mass index, confirmed that SSRI treatment was significantly correlated with increased DNA fragmentation Up to 35% of men noted significant changes in erectile function and up to 47% of subjects reported ejaculatory difficulties while on paroxetine.

Conclusions: In volunteer male subjects with normal semen parameters, paroxetine induced abnormal sperm DNA fragmentation in a significant proportion of patients. This effect occurred without a measurable effect on semen parameters. The fertility potential of a substantial proportion of men on paroxetine may be adversely affected by these changes in sperm DNA integrity.

Editorial Comment: This is an interesting study. The data refutes prior report by the same group indicating the effect on gross semen parameters and sperm transport mechanisms. None of these parameters were significantly different from baseline. However, this study noted an interesting and potentially significant change in DNA fragmentation. However, the mean DNA sperm fragmentation of 30.3% is at the upper limit of normal. The authors hypothesize that this may reflect delayed transport of sperm. The reported effect on sexual dysfunction is not surprising. Further studies are needed to assess the potential clinical significance of this interesting observation.

Presented by C. Tanrikut, et al., at the 64th Annual Meeting of the American Society for Reproductive Medicine - November 8 - 12, 2008 - San Francisco, California

Reported by UroToday.com Contributing Editor Harris M. Nagler, MD

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