(735) Compensated Hypogonadism in Men with Sickle Cell Disease is Associated with Impaired Semen Quality Despite Noemal Testosterone

Introduction Male infertility in sickle cell disease (SCD) may persist even with ostensibly normal semen parameters. We assessed whether hormonal alterations and sperm DNA fragmentation (DFI) relate to semen quality and practical barriers to fertility evaluation Objective To examine associations among standard semen parameters, DFI, and gonadal hormones in adult men with SCD, and to describe barriers to semen collection. Methods Thirty-seven adults with SCD (median age 38 [29–44] years) underwent WHO semen analysis, flow-cytometric DFI, and serum testosterone (T), LH, FSH, and AMH. Structured interviews captured sociodemographic/clinical data (including hydroxyurea)-twenty-five (67.5%) completed semen analysis., 38 [29–44] years) underwent WHO semen analysis, flow cytometric DFI, and serum testosterone (T), LH, FSH, and AMH levels Results Median values were: concentration 23.4 million/mL (IQR 5.98–67.3), volume 2.75 mL (2.0–3.98), progressive (A+B) motility 40.0% (21.3–58.8), TMSC 36.6 million (4.67–86.8), vitality 73.5% (53.5–86.8), Kruger morphology 1.0% (0.0–1.75), and DFI 28.0% (12.0–49.0). All had T >300 ng/dL; median LH 6.9 mIU/mL and FSH 7.8 mIU/mL. Compensated hypogonadism (LH ≥9.4 mIU/mL) occurred in 11/37 (30%) and was associated with lower TMSC (3.45 vs 26.4 million) and higher DFI (49.5% vs 15%). DFI correlated negatively with TMSC (r = −0.393) and morphology (r = −0.375; both p < 0.001). Hydroxyurea use showed no significant differences in TMSC or DFI. Reported barriers included religious beliefs, severe erectile dysfunction, and procedural discomfort. Conclusions In SCD, elevated DFI is common and associates with poorer semen quality despite eugonadal T, while compensated hypogonadism identifies men with markedly reduced TMSC and higher DFI. Hydroxyurea showed no detectable impact on these outcomes. Findings support incorporating DFI and LH into routine fertility assessment and counseling for men with SCD Disclosure No