September 25, 2019

expert reaction to study on men using assisted reproduction techniques and risk of prostate cancer

Research, published in The BMJ, reports that men who fathered children via assisted reproduction techniques had a higher risk of prostate cancer compared to men that conceived naturally. 

Prof Alastair Sutcliffe, Professor of General Paediatrics, UCL, said:

“It has been increasingly recognised that reproductive health (i.e. fertile or not) is an insight into somatic health. 15% of the male genome is involved in reproduction thus if there are issues with fertility this may reflect a broader problem. Yet due to the advance of the technique called ICSI (intracytoplasmic sperm injection) there has been an effective bypass of male infertility. There is a growing body of literature which is now starting to address the health of women and more recently men who are subfertile.

“This Swedish study which has the inevitable limitations of being a country that, whilst having good registries, is only small population wise, does attempt to ask a relatively simple question- did sub fertile men needing ART (assisted reproductive technologies) get a higher rate of prostate cancer (a common form of male reproductive cancer) and somewhat unsurprisingly the answer was yes. But as the authors cautiously say this is not cause and effect if anything it is more likely to be that the ART usage is confounding by indication. The men were on a life journey and one of the sentinels for future health risk was subfertility, and for some a higher risk of prostate cancer later in life. Again, the authors are cautious with respect to screening. They do not claim men with need for male factor treatment for ART, need screening for prostate cancer. Indeed, they are aware of such issues as lead time bias (earlier diagnosis without longer overall survival) and overdiagnosis. What are the implications for day to day practice? As yet, very little.”

Prof Allan Pacey, Professor of Andrology at the University of Sheffield, said:

“There have been a number of studies over the past few years suggesting that a diagnosis of male infertility, because of a low sperm count or poor sperm motility, might be a possible marker of future health conditions in men.

“As such, it has been proposed that male infertility might serve as a “canary in the coal mine” for men’s health that both men and their doctors should be better attuned to.

“This study is excellent, and adds further evidence to the “canary in the coal mine” theory by showing that Swedish men who became fathers using techniques of assisted reproduction (such as ICSI) are at increased risk of prostate cancer later in life.

“It is important to be clear that this is not because the techniques of assisted reproduction go on to cause prostate cancer, but probably because the two have a common cause in some way.

“The study is an exemplar of how we can use big data to answer fundamental questions in male reproductive health and it would be good to see more studies like this being conducted looking at other health conditions in men.

“The study should also serve to highlight that we may need to re-think the delivery of men’s health in some way, given that we know that men are reluctant to engage with healthcare services and they sometimes wait too long to go to the GP once medical symptoms develop.

“Perhaps all men who are diagnosed with a fertility problem in their 20’s and 30’s should be given a leaflet explaining what this might mean for them in their 50’s and 60’s so that they can be aware of possible future problems and be encouraged to visit their GP a bit quicker than they often do.”

Prof. Charles Kingsland, Clinical Director, CARE Fertility, said:

“This is a very interesting observational study which demonstrates a link between men fathering children through assisted conception and an increased risk of prostate cancer. Unfortunately it does not establish a link between men with reproductive problems who don’t go on to father children.  As one would expect, any organ in the human body which demonstrates disordered function is more liable to disease.  For example, infertility in females and increased risk of ovarian malignancy.  This current study elucidates an important principle; risk markers for potential disorders should be borne in mind when considering screening for disease.  Infertility due to male factor should therefore be an indicator for potential male pelvic disease”

‘Risk of prostate cancer for men fathering through assisted reproduction: nationwide population based register study’ by Yahia Al-Jebari et al. was published in The BMJ at 23:30 UK time on Wednesday 25th September. 

DOI: 10.1136/bmj.l5214

Declared interests

Prof Alastair Sutcliffe: Professor Sutcliffe has been given a Wellcome Individual Award in Science (June 2019 for 4 years) to study inter alia men (over 200,000) who are subfertile in the UK to look at multiple health outcomes including cancers.

Prof Allan Pacey: “Chairman of the advisory committee of the UK National External Quality Assurance Schemes in Andrology, Editor in Chief of Human Fertility and Trustee of the Progress Educational Trust (all unpaid).  Also, recent work for the World Health Organisation, British Broadcasting Corporation, Purple Orchid Pharma (paid consultancy with all monies going to University of Sheffield).  Co-applicant on a research grant from the Medical Research Council (ref: MR/M010473/1).”

Prof Charles Kingsland: No known conflicts of interest