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Sirolimus-Associated Infertility: Case Report and Literature Review of Possible Mechanisms

  1. M. A. Deutsch1,
  2. I. Kaczmarek2,*,
  3. S. Huber2,
  4. D. Schmauss1,
  5. A. Beiras-Fernandez1,
  6. M. Schmoeckel1,
  7. R. Ochsenkuehn3,
  8. B. Meiser1,
  9. J. Mueller-Hoecker4,
  10. B. Bruno Reichart1

Article first published online: 31 AUG 2007

DOI: 10.1111/j.1600-6143.2007.01929.x

Issue

American Journal of Transplantation

American Journal of Transplantation

Volume 7, Issue 10, pages 2414–2421, October 2007

Additional Information

How to Cite

Deutsch, M. A., Kaczmarek, I., Huber, S., Schmauss, D., Beiras-Fernandez, A., Schmoeckel, M., Ochsenkuehn, R., Meiser, B., Mueller-Hoecker, J. and Bruno Reichart, B. (2007), Sirolimus-Associated Infertility: Case Report and Literature Review of Possible Mechanisms. American Journal of Transplantation, 7: 2414–2421. doi: 10.1111/j.1600-6143.2007.01929.x

Author Information

  1. 1

    Department of Cardiac Surgery, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany

  2. 2

    Department of Surgery, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany

  3. 3

    Clinic and Polyclinic for Gynaecology and Obstetrics, Division of Gynaecological Endocrinology and Reproductive Medicine, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany

  4. 4

    Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany

* * Corresponding author: Ingo Kaczmarek, Ingo.Kaczmarek@med.uni-muenchen.de

Publication History

  1. Issue published online: 31 AUG 2007
  2. Article first published online: 31 AUG 2007
  3. Received 13 March 2007, revised 05 June 2007 and accepted for publication 28 June 2007
Corrected by:

Erratum

Vol. 8, Issue 2, 472–476, Article first published online: 7 JAN 2008

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Keywords:

  • Heart transplantation;
  • immunosuppression;
  • oligospermia;
  • sirolimus;
  • tertiality

The authors delineate a case of sirolimus-associated infertility and provide a detailed synopsis of potential molecular mechanisms by which the mTOR-inhibitor sirolimus may negatively influence spermatogenesis.

The mammalian-target-of-rapamycin/mTOR-inhibitor sirolimus as a component of the immunosuppressive strategy after solid organ transplantation is effective at preventing allograft rejection. However, recent reports indicate that sirolimus is associated with altered sex hormone levels and impaired sperm quality parameters.

Herein, we report on a case of sirolimus-associated infertility in a young male heart-lung transplant recipient and provide a detailed synopsis of potential mechanisms by which sirolimus may negatively influence spermatogenesis. Testicular immunohistochemistry, the course of sex hormone and sperm quality parameters of our patient support the hypothesis that mTOR might act as an important key regulator in the reproductive system. Fortunately, due to withdrawal of sirolimus as part of the maintenance, immunosuppression improved sperm quality and sex hormone parameters could be observed. Recently, these improvements even resulted in a spontaneous pregnancy of the patient's wife more than 1 year after the drug was withdrawn. In our view, oligospermia as a possible and at least partly reversible side-effect of mTOR inhibitors has to be taken into consideration, particularly, when administrated to young male patients.

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