The association of hypertension and antihypertensive medications on semen parameters among men presenting for fertility evaluation

Background: Hypertension is a common medical condition and its prevalence increases with age. Therefore, more prospective fathers will present for fertility evaluation with this diagnosis. Objective: To determine if hypertension and antihypertensive medication use are associated with impaired semen parameters. Methods: We retrospectively reviewed men with and without hypertension at the time of their index semen analysis (SA) between 2002 and 2023. Demographics, medical comorbidities, and semen parameters were evaluated between cohorts. Univariable and multivariable regression analyses were also used to determine the association of hypertension, and number and class of antihypertensive medications, and abnormal total motile sperm count (TMSC < 20 million). Results: Among 14,009 men, 10.1% (n = 1410) had a diagnosis of hypertension. Hypertensive men had significantly lower ejaculate volume (2.8 mL [interquartile range {IQR} 1.8-3.8] vs. 2.9 mL [IQR 2.0-4.0], p < 0.001) and sperm motility (58% [IQR 50-66] vs. 60% [52-68], p < 0.001). Hypertension was also independently associated with abnormal TMSC (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.05-1.40, p = 0.008) on multivariable analysis. Among patients with hypertension, men with an active antihypertensive medication prescription at the time of index SA were older and had lower sperm motility (57% [IQR 47-64] vs. 59% [IQR 52-67], p = 0.006), sperm morphology (5% [IQR 2-7] vs. 6% [3-12], p < 0.001) and TMSC (48.9 M [IQR 16.1-94.9] vs. 68.4 M [25.0-124.9], p < 0.001) compared to patients with no prior antihypertensive medication exposure. Multivariable analysis demonstrated no significant increased risk of abnormal TMSC between unexposed patients and those taking an antihypertensive medication. Discussion: More than one in 10 men presenting for initial fertility evaluation had a diagnosis of hypertension. This diagnosis, as well as antihypertensive medication exposure, were associated with impaired semen parameters. Conclusion: Patients interested in future fertility should be counseled regarding lifestyle modifications to appropriately treat hypertension. Further studies are required to determine the impact of antihypertensive medications and adequate control of hypertension on semen quality.