Male Infertility Warning: High 17-OHP Levels Linked to Lower Motile Sperm Count

[madman]

Abstract​

INTRODUCTION AND OBJECTIVES:​

Early studies evaluating the role of 17-hydroxyprogesterone (17-OHP) in male reproduction were primarily conducted in fertile men receiving exogenous testosterone with varying doses of human chorionic gonadotropin (hCG). However, few studies have investigated 17-OHP within the context of true male infertility. Although higher 17-OHP levels might intuitively be expected to reflect greater steroidogenic activity, the only prior study in infertile men paradoxically found that elevated 17-OHP was associated with more severe infertility. In this study, we obtained comprehensive steroidogenesis profiles in men presenting for infertility evaluation to assess the relationship between steroidogenesis component and infertility.

METHODS:​

Men presenting to an academic andrology clinic for infertility evaluation were retrospectively reviewed. Subjects were stratified by the ratio of 17-hydroxypregnenolone to 17-hydroxyprogesterone (17OHPreg:17OHP) and divided into tertiles. Comparisons were made between men in the lowest and highest tertiles. All laboratory samples were obtained before 1:00 PM to minimize diurnal variation. Laboratory parameters were compared using the Mann–Whitney U test.

RESULTS:​

Forty-nine men completed steroidogenesis evaluation. The median 17OHPreg:17OHP ratio for the cohort was 1.88 (1.04–2.55). Men in the highest tertile demonstrated a median ratio of 2.50 (1.99–2.58), compared to 1.02 (0.75–1.23) in the lowest tertile. While men in the lowest tertile exhibited higher absolute 17-OHP levels, no other hormonal parameters differed significantly between groups. Importantly, men with a lower 17OHPreg:17OHP ratio had significantly lower total motile sperm counts, suggesting a negative association between elevated 17-OHP and spermatogenic output.

CONCLUSIONS:​

Among men presenting with infertility, higher 17-OHP levels were inversely associated with total motile sperm count. These findings indicate that elevated 17-OHP may reflect impaired steroidogenic efficiency or dysregulation within the 17-hydroxylase pathway. Further investigation is warranted to clarify the mechanistic and diagnostic role of 17-OHP in the evaluation of male infertility.