Abstract
OBJECTIVE: To determine whether men with azoospermia are at an elevated risk of developing cancer in the years following an infertility evaluation. DESIGN: Cohort study. SETTING: United States andrology clinic. PATIENT(S): A total of 2,238 men with complete records were evaluated for infertility at a single andrology clinic in Texas from 1989 to 2009. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Cancer incidence was determined by linkage to the Texas Cancer Registry. RESULT(S): In all, 451 men had azoospermia, and 1,787 were not azoospermic, with a mean age at infertility evaluation of 35.7 years. Compared with the general population, infertile men had a higher risk of cancer, with 29 cases observed compared with 16.7 expected (standardized incidence rate [SIR] 1.7, 95% confidence interval [CI] 1.2-2.5). When stratifying by azoospermia status, azoospermic men had an elevated risk of cancer (SIR 2.9, 95% CI 1.4-5.4). Infertile men without azoospermia had a trend toward a higher rate of cancer (SIR 1.4, 95% CI 0.9-2.2). The Cox regression model revealed that azoospermic men had 2.2-fold higher cancer risk compared with nonazoospermic men (hazard ratio 2.2, 95% CI 1.0-4.8). CONCLUSION(S): Men with azoospermia have an increased risk of subsequently developing cancer, suggesting a possible common etiology between azoospermia and cancer development. Additional follow-up of azoospermic men after reproductive efforts end may be warranted.