Division of Brain Medicine, Department of Psychiatry, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Soroka Clinical Research Center, Beer-Sheva, Israel.
Arch Gynecol Obstet. 2021 Aug;304(2):539-546. doi: 10.1007/s00404-020-05938-z. Epub 2021 Jan 12.
Methylphenidate (MPH) is the most widely prescribed therapy for attention deficit hyperactivity disorder. Animal studies have shown a potential adverse effect of MPH exposure on male fertility. We examined the impact of MPH on human male sperm parameters.
Sperm parameters of 9769 samples from patients 18 years of age or older, collected as part of the basic evaluation of couples referred to the Infertility Clinic were analyzed retrospectively. We divided the study population into three groups according to MPH purchasing information: MPH purchased ≤ 90 days prior to sperm analysis-current users (n = 83), MPH purchased > 90 days prior to sperm analysis-past users (n = 293), and MPH-naïve patients (n = 9393).
All sperm samples were analyzed by the same laboratory technician team for the following routine parameters: semen volume, sperm concentration, percentage of motile sperm, and percentage of normal morphology according to World Health Organization. The analysis of the samples was completed by evaluation of total sperm count, total sperm motility, and percentage of fast and slow motile cells. Sperm morphology was evaluated by a laboratory technician using methodological examination according to the strict Kruger-Tygerberg criteria.
Methylphenidate exposure did not affect sperm morphology but was associated with increased sperm concentration as well as increased total sperm count and total sperm motility among current and past users compared with MPH-naïve patients. In particular, progressive motility and total motile sperm count were significantly increased following MPH use. A multivariate analysis adjusting for age and current smoking was conducted, further supporting a positive correlation between current MPH use and increased values of total sperm count and total sperm motility.
Our study has several inherent weaknesses, foremost of which is its retrospective nature. Another notable weakness is that medication purchasing data may not accurately reflect MPH exposure in the study population. Patients may be purchasing MPH and not taking it as prescribed.
In the present study, we could not demonstrate a negative impact of methylphenidate treatment on sperm parameters in adults with ADHD. Hence, we may assume that methylphenidate does not negatively affect male fertility.
哌醋甲酯（MPH）是治疗注意力缺陷多动障碍最常用的药物。动物研究表明，MPH 暴露对男性生育力有潜在的不良影响。我们研究了 MPH 对人类男性精子参数的影响。
回顾性分析了作为不孕不育诊所就诊夫妇基本评估一部分收集的 9769 名年龄在 18 岁及以上患者的精子参数。我们根据 MPH 购买信息将研究人群分为三组：MPH 购买时间在精子分析前 90 天内的当前使用者（n=83），MPH 购买时间在精子分析前 90 天以上的既往使用者（n=293），和 MPH 无使用史的患者（n=9393）。
所有精子样本均由同一家实验室技术人员团队按照世界卫生组织的规定分析以下常规参数：精液量、精子浓度、精子活力百分比和正常形态百分比。通过评估总精子数、总精子活力以及快速和慢速运动细胞的百分比来分析样本。精子形态由实验室技术员按照严格的 Kruger-Tygerberg 标准进行方法学检查进行评估。
MPH 暴露并未影响精子形态，但与 MPH 无使用史的患者相比，当前和既往使用者的精子浓度以及总精子数和总精子活力增加。特别是，在使用 MPH 后，前向运动精子和总运动精子计数显著增加。进行了调整年龄和当前吸烟状况的多变量分析，进一步支持当前 MPH 使用与总精子数和总精子活力增加之间的正相关关系。
我们的研究存在一些固有缺陷，首先是其回顾性的性质。另一个显著的弱点是，药物购买数据可能无法准确反映研究人群中的 MPH 暴露情况。患者可能正在购买 MPH，但并未按规定服用。
在本研究中，我们无法证明哌醋甲酯治疗对 ADHD 成年患者精子参数有负面影响。因此，我们可以假设哌醋甲酯不会对男性生育力产生负面影响。
