The prevalence of erectile dysfunction in the infertile male population.

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Background:
Male factor infertility may be accompanied by erectile dysfunction (ED) and ejaculatory dysfunction. The goal of this study was to determine the prevalence of significant ED that interfered with intercourse in infertile couples actively trying to conceive.
Methods:
After IRB approval, the records of patients presenting for initial infertility evaluations from 1989 through 2008 were retrospectively reviewed. During the initial infertility assessment patients were asked two questions: (1) whether they were able to obtain an erection adequate for intercourse and (2) whether they were able to ejaculate with intercourse. Patients who responded affirmatively to question one were considered to have ED and those who answered affirmatively to question two were considered to have ejaculatory dysfunction. Patient age, partner age, BMI, marital status, length of marriage (if married), length of time trying to conceive, number of attempts at intercourse during ovulation, and diagnosis of primary or secondary infertility were analyzed for differences between those with and without ED.
Results:
Two hundred eleven (3.6 %) of a total of 5,802 patients were found to have ED and 200 (3.4 %) patients were found to have ejaculatory dysfunction. Ninety (1.5 %) patients were found to have combined erectile and ejaculatory dysfunction. Patients with ED and their partners had a higher mean age, 38.7 and 33.84 years old respectively, compared to those without, 35.1 years old and 32.3 years old (p < 0.001). Patients with ED had a higher mean BMI of 29.5 kg/m² compared to those without 27.8 kg/m² (p < 0.001). The number of attempts at intercourse during ovulation were fewer in patients with ED (1.9 attempts/week) than in those without ED (2.6 attempts/week), p < 0.001. Marital status was not associated with ED (p < 0.273). However, for those patients that were married, ED was associated with a greater length of marriage compared to those without, 6.0 years compared to 4.9 years (p < 0.001). Patients with ED were more likely have infertility for a shorter period of time, 2.5 years compared to 3.1 years (p < 0.02). There was no difference in ED between those men with primary and secondary infertility (p < 0.13).
Conclusions
Sexual dysfunction is not uncommon in the infertile male population. Both erectile and ejaculatory dysfunction occur with approximately equal frequency. Patients in this series were only considered to have ED if they were not able to have intercourse. This degree of ED is significant enough to contribute to the couple’s infertility as demonstrated by the lower frequency of attempts at intercourse per week during the ovulatory period. As expected increasing age is associated with an increased risk of ED. Patients with ED also have other age dependent risk factors including older partners and longer marriage length. Additionally, older patients may spend less time trying to conceive before seeking an infertility specialist. Patients with a higher BMI, suggestive of metabolic syndrome, were more likely to have ED. The clinician should question the infertile male about sexual function as part of the initial evaluation.

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