Association Between Deviated Nasal Septum With Inferior Turbinate Hypertrophy and the Risk of Male Infertility

Objectives Obstructive sleep apnea is associated with an increased risk of male infertility, and one of its causes is deviated nasal septum with inferior turbinate hypertrophy (DNS/ITH). However, the risk of male infertility associated with DNS/ITH remains unclear. Methods Using the Taiwan Longitudinal Health Insurance Database, we conducted a retrospective matched cohort study to investigate the risk of infertility in male patients diagnosed with DNS/ITH (N = 61,761) from 2000 to 2015 in comparison with matched controls without DNS/ITH (N = 247,044). We further analyzed the effect of septoturbinoplasty (STP), including septoplasty and turbinoplasty, on the risk of male infertility in DNS/ITH patients. Results At the end of the follow-up period, 46 (0.07%, 46/61,761, incidence rate: 6.25 per 100,000 person-years) patients developed infertility in the DNS/ITH group versus 72 (0.03%, 72/247,044, incidence rate: 2.28 per 100,000 person-years) in the control group; the incidence rate was 2.740-fold higher in the DNS/ITH group (log-rank P < 0.001). Cox proportional hazards regression revealed that the risk of infertility increased in the DNS/ITH group [adjusted hazard ratio (HR): 1.080, 95% confidence interval (CI), 1.049–1.514, P = 0.001]. Compared with the control group, the risk of infertility was highest in the DNS/ITH group without STP (adjusted HR: 2.842, 95% CI, 1.715–4.082, P < 0.001), followed by the DNS/ITH group with STP (adjusted HR: 1.074, 95% CI, 1.035–1.488, P = 0.012). The intervention of STP reduced the risk of infertility in the DNS/ITH group by 45.1% compared with those without STP (P = 0.033). Conclusion Clinicians should be aware of the risk of infertility in male patients presenting with DNS/ITH. Improving the nasal airway by STP may decrease the risk of male infertility.