Effects of antiretroviral therapy on semen quality.

Objective: To evaluate the effect of combination antiretroviral therapy (cART) on semen quality.

Design: A longitudinal cohort study.

Setting: The HIV outpatient clinic of the Academic Medical Centre in Amsterdam, the Netherlands.

Subjects: A cohort of 34 male patients with different estimated duration of HIV-1 infection, who were about to start various combinations of cART.

Intervention(s): Blood and semen analyses before the start of cART and 4, 12, 24, 36 and 48 weeks thereafter.

Main Outcome Measure(s): We examined the effect of cART on semen parameters by a repeated measurements procedure using a mixed-effects model.

Results: The median period of follow up was 48 weeks (interquartile range 33-52 weeks). Five patients used thymidine analogue-containing cART, 23 used tenofovir-based cART, six used other regimens. At all timepoints the percentage of progressively motile spermatozoa was low according to WHO criteria, and it decreased significantly from 28 to 17% during follow-up (P = 0.02). All other semen parameters were in the normal range and remained stable.

Conclusion: cART negatively affected the percentage of progressively motile spermatozoa. Whether this reduced motility affects the chances of fathering a child or leads to an increased need for artificial reproductive techniques is at present unknown.