Does rosacea affect fertility?

There is currently no direct evidence that rosacea affects fertility in men or women. Although previous studies have reported that hormonal imbalances have been associated with an increased risk of rosacea, the impact of rosacea on hormone levels has not been demonstrated. However, other hypotheses about a potential indirect impact can be proposed. Indeed, rosacea has been potentially linked to the occurrence of various diseases.

• Metabolic Syndrome. Rosacea has been linked to the presence of metabolic syndromes, through the negative impact ofsystemic inflammation of rosacea on the lipid profile. Research has shown that women affected by these syndromes could be exposed to risks of infertility: an abnormal lipid metabolism would induce endothelial lesions leading to pre-eclampsia or premature birth. Alterations in carbohydrate metabolism related to insulin resistance and high carbohydrate intake can also hinder ovulation and have detrimental effects on the development and implantation of the endometrium.

  In men, male infertility and metabolic syndromes share risk factors (smoking, physical inactivity, etc.), leading to the production of reactive oxygen species (ROS) and an increase in oxidative stress, which results in endothelial dysfunction and a deterioration in sperm quality.

• Stress. Previously associated with rosacea through the common activation of the TRPV-1 receptor, stress leads to an increased secretion of hormones. The level of corticotropin-releasing hormone (CRH) increases, resulting in a large production of corticotropin (ACTH), which in turn leads to a high level of circulating glucocorticoids. When these exceed the essential levels for promoting fertility, they hinder reproduction in favour of survival. The risks of infertility then increase. Stress also affects the hypothalamic-pituitary-gonadal (HPG) axis by limiting the release of gonadotropin-releasing hormone (GnRH) and inhibiting the secretion of luteinising hormone (LH) and follicle-stimulating hormone (FSH), which are essential for the proper functioning of the female and male reproductive systems.

• Renal Pathologies. Rosacea has been linked to renal pathologies such as chronic kidney disease (CKD), through the inflammatory pathways and oxidative stress involved in both diseases. CKD has also been linked to a decrease in fertility: the kidney is an important modulator of sexual hormones. In women, there is a loss of pulsatile release of GnRH, which results in an alteration of the cyclicity of LH and FSH, leading to a decrease in oestrogen levels (hypoestrogenemia) and potentially anovulation.

  In men, the testosterone level is reduced. This results in a chronic elevation of serum gonadotropin levels (FSH and LH). The disruption of the cyclical release of GnRH and the loss of the pulsatile nature of LH release are also evident. This disturbance of the hypothalamic-pituitary-testicular axis and the reduction in testosterone production lead to an alteration in the stimulation of Sertoli cells and thus a significant reduction in spermatogenesis.

  Rosacea could therefore hypothetically cause, through underlying diseases, fertility problems. However, it must be remembered that these are only potential indirect effects, not automatic.