Effect of benzene exposure on fertility of male workers employed in bulk drug industries

Temporal trends in sperm count: a systematic review and meta-regression analysis of samples collected globally in the 20th and 21st centuries

BACKGROUND

Numerous studies have reported declines in semen quality and other markers of male reproductive health. Our previous meta-analysis reported a significant decrease in sperm concentration (SC) and total sperm count (TSC) among men from North America-Europe-Australia (NEA) based on studies published during 1981-2013. At that time, there were too few studies with data from South/Central America-Asia-Africa (SAA) to reliably estimate trends among men from these continents.

OBJECTIVE AND RATIONALE

The aim of this study was to examine trends in sperm count among men from all continents. The broader implications of a global decline in sperm count, the knowledge gaps left unfilled by our prior analysis and the controversies surrounding this issue warranted an up-to-date meta-analysis.

SEARCH METHODS

We searched PubMed/MEDLINE and EMBASE to identify studies of human SC and TSC published during 2014-2019. After review of 2936 abstracts and 868 full articles, 44 estimates of SC and TSC from 38 studies met the protocol criteria. Data were extracted on semen parameters (SC, TSC, semen volume), collection year and covariates. Combining these new data with data from our previous meta-analysis, the current meta-analysis includes results from 223 studies, yielding 288 estimates based on semen samples collected 1973-2018. Slopes of SC and TSC were estimated as functions of sample collection year using simple linear regression as well as weighted meta-regression. The latter models were adjusted for predetermined covariates and examined for modification by fertility status (unselected by fertility versus fertile), and by two groups of continents: NEA and SAA. These analyses were repeated for data collected post-2000. Multiple sensitivity analyses were conducted to examine assumptions, including linearity.

OUTCOMES

Overall, SC declined appreciably between 1973 and 2018 (slope in the simple linear model: -0.87 million/ml/year, 95% CI: -0.89 to -0.86; P < 0.001). In an adjusted meta-regression model, which included two interaction terms [time × fertility group (P = 0.012) and time × continents (P = 0.058)], declines were seen among unselected men from NEA (-1.27; -1.78 to -0.77; P < 0.001) and unselected men from SAA (-0.65; -1.29 to -0.01; P = 0.045) and fertile men from NEA (-0.50; -1.00 to -0.01; P = 0.046). Among unselected men from all continents, the mean SC declined by 51.6% between 1973 and 2018 (-1.17: -1.66 to -0.68; P < 0.001). The slope for SC among unselected men was steeper in a model restricted to post-2000 data (-1.73: -3.23 to -0.24; P = 0.024) and the percent decline per year doubled, increasing from 1.16% post-1972 to 2.64% post-2000. Results were similar for TSC, with a 62.3% overall decline among unselected men (-4.70 million/year; -6.56 to -2.83; P < 0.001) in the adjusted meta-regression model. All results changed only minimally in multiple sensitivity analyses.

WIDER IMPLICATIONS

This analysis is the first to report a decline in sperm count among unselected men from South/Central America-Asia-Africa, in contrast to our previous meta-analysis that was underpowered to examine those continents. Furthermore, data suggest that this world-wide decline is continuing in the 21st century at an accelerated pace. Research on the causes of this continuing decline and actions to prevent further disruption of male reproductive health are urgently needed.

Multi- and Transgenerational Effects of Environmental Toxicants on Mammalian Reproduction

Environmental toxicants (ETs) are an exogenous chemical group diffused in the environment that contaminate food, water, air and soil, and through the food chain, they bioaccumulate into the organisms. In mammals, the exposure to ETs can affect both male and female fertility and their reproductive health through complex alterations that impact both gametogeneses, among other processes. In humans, direct exposure to ETs concurs to the declining of fertility, and its transmission across generations has been recently proposed. However, multi- and transgenerational inheritances of ET reprotoxicity have only been demonstrated in animals. Here, we review recent studies performed on laboratory model animals investigating the effects of ETs, such as BPA, phthalates, pesticides and persistent contaminants, on the reproductive system transmitted through generations. This includes multigenerational effects, where exposure to the compounds cannot be excluded, and transgenerational effects in unexposed animals. Additionally, we report on epigenetic mechanisms, such as DNA methylation, histone tails and noncoding RNAs, which may play a mechanistic role in a nongenetic transmission of environmental information exposure through the germline across generations.

Solidified floating organic droplet microextraction coupled with HPLC for rapid determination of trans, trans muconic acid in benzene biomonitoring

Benzene is one of the carcinogenic compounds in the work environments. Exposure assessment of benzene through biological monitoring is an acceptable way to accurately measure the real exposure in order to conducting the health risk assessment, but it is always complicated, laborious, time consuming and costly process. A new sensitive, simple, fast and environmental friendly method was developed for the determination of urinary metabolite of benzene, trans trans muconic acid (t,t-MA) by dispersive liquid-liquid micro extraction based on solidification of floating organic droplet coupled with high-performance liquid chromatography with ultra violet detector. Central composite design methodology was utilized to evaluate the effective factors on the extraction output of the target metabolite. The calibration curve was plotted in the concentration ranges of 0.02-5 µg mL^-1. The precision and accuracy of the method were assayed via the relative standard deviation (RSD%) and relative recovery (RR%) using spiked samples with three replications. The RR% and RSD% of the optimized method were 86.9-91.3% and 4.3-6.3% respectively. The limit of detection (LOD) of the method was 0.006 µg mL^-1. The level of t,t-MA in real samples was ranged from 0.54 to 1.64 mg/g creatinine. We demonstrated that t,t-MA can be extracted and determined by an inexpensive, simple and fast method.

Infertility as inevitable: chronic lifestyles, temporal inevitability and the making of abnormal bodies in India

In seeking to explore the meaning of chronic and chronicity, the association with infertility is neither immediate nor evident. However, this paper explores this relationship by analyzing the idea of infertility in relation to chronicity. In the linkages that come forth the idea of chronic lifestyle emerging from certain ways of being and living, as well the imaginings associated with the chronic body become important nodes of exploring the relationship between infertility and chronicity. Most importantly, the role that time plays in marking the chronic state is seen to be especially potent in the practice of infertility treatment, and the narratives that emerge around its temporal inevitability. The rhetoric that marks the diagnosis and prescription of treatment is often based on the identification of the body as susceptible to reproductive decline and failure, due to the contingencies of modern living. This often translates into a more sustained involvement with ARTs, which may or may not fulfil the required desire for a child. In this paper I seek to analyse the ways in which practitioners of infertility medicine create an image of an affliction that borders on chronicity. In the process, I question the idea of both chronic diseases and chronicity by looking at how illness is imagined in narratives that IVF specialists create in public, and through the idea of a cure for infertility. By analysing data collected through ethnographic fieldwork, this paper aims to build on the idea of the chronic as inevitable within clinical discourse and practice.

Application of the comet assay for the evaluation of DNA damage in mature sperm

DNA integrity is considered an important parameter of semen quality and is of significant value as a predictor of male fertility. Currently, there are several methods that can assess sperm DNA integrity. One such assay is the comet assay, or single-cell gel electrophoresis, which is a simple, sensitive, reliable, quick and low-cost technique that is used for measuring DNA strand breaks and repair at the level of individual cells. Although the comet assay is usually performed with somatic cells from different organs, the assay has the ability to detect genotoxicity in germ cells at different stages of spermatogenesis. Since the ability of sperm to remove DNA damage differs between the stages, interpretation of the results is dependent on the cells used. In this paper we give an overview on the use and applications of the comet assay on mature sperm and its ability to detect sperm DNA damage in both animals and humans. Overall, it can be concluded that the presence in sperm of significantly damaged DNA, assessed by the comet assay, is related to male infertility and seems to reduce live births. Although there is some evidence that sperm DNA damage also has a long-term impact on offspring's health, this aspect of DNA damage in sperm is understudied and deserves further attention. In summary, the comet assay can be applied as a useful tool to study effects of genotoxic exposures on sperm DNA integrity in animals and humans.

Environmental and occupational exposures associated with male infertility

The upsurge in male infertility over the last two decades, possibly due to environmental exposure, has raised significant interest, particularly boosted by reports from fertility clinics, which showed that chronic diseases and hereditary or other medical conditions might only partially explain current incidence of male infertility. Both environmental and occupational settings may have a significant role in exposure to complex mixtures of endocrine disruptors (ED), which play a major role in fertility disorders. The aim of this review is to give an insight into the current knowledge on exposure settings which may be associated with male infertility. Our study relied on a systematic search of PubMed, Scopus, and Web of Science for articles published between January 2000 and September 2020. It showed that some well documented factors associated with male infertility include smoking, and physiological disturbances or chronic diseases such as obesity and diabetes, which in turn, may also reflect lifestyle choices and environmental exposures, especially to EDs such as phthalates, bisphenols, pesticides, and flame retardants. However, the number of studies on the aetiology of male infertility is still too low in comparison with the size of affected population. Occupational health follow-ups and medical surveillance do not collect any data on male infertility, even though ED chemicals are part of many technological processes.

Investigating the Potential Toxicity of Hydraulic Fracturing Flowback and Produced Water Spills to Aquatic Animals in Freshwater Environments: A North American Perspective

Unconventional methods of oil and natural gas extraction have been a growing part of North America's energy sector for the past 20-30 years. Technologies such as horizontal hydraulic fracturing have facilitated the exploitation of geologic reserves that were previously resistant to standard drilling approaches. However, the environmental risks associated with hydraulic fracturing are relatively understudied. One such hazard is the wastewater by-product of hydraulic fracturing processes: flowback and produced water (FPW). During FPW production, transport, and storage, there are many potential pathways for environmental exposure. In the current review, toxicological hazards associated with FPW surface water contamination events and potential effects on freshwater biota are assessed. This review contains an extensive survey of chemicals commonly associated with FPW samples from shale formations across North America and median 50% lethal concentration values (LC₅₀) of corresponding chemicals for many freshwater organisms. We identify the characteristics of FPW which may have the greatest potential to be drivers of toxicity to freshwater organisms. Notably, components associated with salinity, the organic fraction, and metal species are reviewed. Additionally, we examine the current state of FPW production in North America and identify the most significant obstacles impeding proper risk assessment development when environmental contamination events of this wastewater occur. Findings within this study will serve to catalyze further work on areas currently lacking in FPW research, including expanded whole effluent testing, repeated and chronic FPW exposure studies, and toxicity identification evaluations.

Analysis of semen quality of 38 905 infertile male patients during 2008-2016 in Wenzhou, China

This study analyzed the trend in semen quality of infertile male patients in Wenzhou, China, based on the data obtained from 38 905 patients during 2008–2016 in The First Affiliated Hospital of Wenzhou Medical University (Wenzhou, China). The results showed that only 24.9% of the patients had normal semen quality. For the semen quality of infertile male patients, that of the workers and 40-year-olds was significantly worse than the other occupational and age groups. For all the infertile patients, low semen volume, asthenozoospermia, and teratozoospermia accounted for 8.4%, 50.5%, and 54.1%, respectively. During 2008–2016, the annual mean percentage of fast forward motile spermatozoa, percentage of total forward motile spermatozoa, and percentage of spermatozoa with normal morphology decreased linearly with slopes of −2.11, −2.59, and −0.70, respectively. The proportion of patients with asthenozoospermia and multi-abnormal spermatozoa increased during 2008–2016 with slopes of 4.70 and 4.87, respectively, while for low semen volume, it decreased with a slope of −0.47 in the same time period. The proportion of patients with teratozoospermia increased from 2008 to 2011 and from 2011 to 2016 with slopes of 17.10 and 2.09, respectively. In general, the deteriorating trend of semen quality of infertile male patients in Wenzhou was obvious. Future efforts should be made to reveal the adverse influences on semen quality, such as occupational exposure, environmental quality, and living habits. Furthermore, more pervasive reproduction health education is necessary.

Derivation of an occupational exposure limit for benzene using epidemiological study quality assessment tools

This paper derives an occupational exposure limit for benzene using quality assessed data. Seventy-seven genotoxicity and 36 haematotoxicity studies in workers were scored for study quality with an adapted tool based on that of Vlaanderen et al., 2008 (Environ Health. Perspect. 116 1700-5). These endpoints were selected as they are the most sensitive and relevant to the proposed mode of action (MOA) and protecting against these will protect against benzene carcinogenicity. Lowest and No- Adverse Effect Concentrations (LOAECs and NOAECs) were derived from the highest quality studies (i.e. those ranked in the top tertile or top half) and further assessed as being "more certain" or "less certain". Several sensitivity analyses were conducted to assess whether alternative "high quality" constructs affected conclusions. The lowest haematotoxicity LOAECs showed effects near 2 ppm (8 h TWA), and no effects at 0.59 ppm. For genotoxicity, studies also showed effects near 2 ppm and showed no effects at about 0.69 ppm. Several sensitivity analyses supported these observations. These data define a benzene LOAEC of 2 ppm (8 h TWA) and a NOAEC of 0.5 ppm (8 h TWA). Allowing for possible subclinical effects in bone marrow not apparent in studies of peripheral blood endpoints, an OEL of 0.25 ppm (8 h TWA) is proposed.

Meta-Analysis Reveals the Association Between Male Occupational Exposure to Solvents and Impairment of Semen Parameters

OBJECTIVES

Solvent exposure is among the most common occupational exposures to chemical toxicants; data about the impact of such exposure on semen parameters are contradictory. We conducted the first meta-analysis to evaluate the risk of alteration in semen parameters related to occupational exposure to solvents.

METHODS

From the PubMed database, we selected studies analyzing the semen of subjects occupationally exposed to solvents, compared with unexposed controls. The meta-analysis was performed on the various semen parameters analyzed in both populations.

RESULTS

Seven studies were included in the study. The meta-analysis revealed a significant decrease in ejaculate volume [standardized mean difference (SMD) = -0.35 (-0.63 to -0.07)] and sperm concentration [SMD = -0.36 (-0.64 to -0.08)] in workers exposed to solvents compared with unexposed controls.

CONCLUSION

Our results highlight the importance of preventing reprotoxic risks to male fertility in the workplace.

Experimental exposure to gasohol impairs sperm quality with recognition of the classification pattern of exposure groups by machine learning algorithms

Contamination caused by leakage at gas stations leads to possible exposure of the general population when in contact with contaminated water and soil. The present study aimed to evaluate the reproductive effects of exposure of adult male rats to gasohol and evaluate the performance of machine learning (ML) algorithms for pattern recognition and classification of the exposure groups. Rats were orally exposed to 0 (control), 16 (EA), 160 (EB), or 800 mg kg^-1 bw day^-1 of gasohol (EC), for 30 consecutive days. Sperm quality of the groups exposed to two higher doses was reduced in comparison to the control group. The sperm parameters decreased were: daily sperm production, sperm number in the caput/corpus epididymis, progressive motility, mitochondrial activity, and acrosomal membrane integrity. Sperm transit time in the epididymis cauda and sperm isolated head were increased in EB and EC. Sertoli cells number was decreased in these groups, but their support capacity was maintained. ML methods were used to identify patterns between samples of control and exposure groups. The results obtained by ML methods were very promising, obtaining about 90% of accuracy. It was concluded that the exposure of rats to different doses of gasohol impair spermatogenesis and sperm quality, with a recognizable classification pattern of exposure groups at ML.

Temporal trends in sperm count: a systematic review and meta-regression analysis

BACKGROUND

Reported declines in sperm counts remain controversial today and recent trends are unknown. A definitive meta-analysis is critical given the predictive value of sperm count for fertility, morbidity and mortality.

OBJECTIVE AND RATIONALE

To provide a systematic review and meta-regression analysis of recent trends in sperm counts as measured by sperm concentration (SC) and total sperm count (TSC), and their modification by fertility and geographic group.

SEARCH METHODS

PubMed/MEDLINE and EMBASE were searched for English language studies of human SC published in 1981-2013. Following a predefined protocol 7518 abstracts were screened and 2510 full articles reporting primary data on SC were reviewed. A total of 244 estimates of SC and TSC from 185 studies of 42 935 men who provided semen samples in 1973-2011 were extracted for meta-regression analysis, as well as information on years of sample collection and covariates [fertility group ('Unselected by fertility' versus 'Fertile'), geographic group ('Western', including North America, Europe Australia and New Zealand versus 'Other', including South America, Asia and Africa), age, ejaculation abstinence time, semen collection method, method of measuring SC and semen volume, exclusion criteria and indicators of completeness of covariate data]. The slopes of SC and TSC were estimated as functions of sample collection year using both simple linear regression and weighted meta-regression models and the latter were adjusted for pre-determined covariates and modification by fertility and geographic group. Assumptions were examined using multiple sensitivity analyses and nonlinear models.

OUTCOMES

SC declined significantly between 1973 and 2011 (slope in unadjusted simple regression models -0.70 million/ml/year; 95% CI: -0.72 to -0.69; P < 0.001; slope in adjusted meta-regression models = -0.64; -1.06 to -0.22; P = 0.003). The slopes in the meta-regression model were modified by fertility (P for interaction = 0.064) and geographic group (P for interaction = 0.027). There was a significant decline in SC between 1973 and 2011 among Unselected Western (-1.38; -2.02 to -0.74; P < 0.001) and among Fertile Western (-0.68; -1.31 to -0.05; P = 0.033), while no significant trends were seen among Unselected Other and Fertile Other. Among Unselected Western studies, the mean SC declined, on average, 1.4% per year with an overall decline of 52.4% between 1973 and 2011. Trends for TSC and SC were similar, with a steep decline among Unselected Western (-5.33 million/year, -7.56 to -3.11; P < 0.001), corresponding to an average decline in mean TSC of 1.6% per year and overall decline of 59.3%. Results changed minimally in multiple sensitivity analyses, and there was no statistical support for the use of a nonlinear model. In a model restricted to data post-1995, the slope both for SC and TSC among Unselected Western was similar to that for the entire period (-2.06 million/ml, -3.38 to -0.74; P = 0.004 and -8.12 million, -13.73 to -2.51, P = 0.006, respectively).

WIDER IMPLICATIONS

This comprehensive meta-regression analysis reports a significant decline in sperm counts (as measured by SC and TSC) between 1973 and 2011, driven by a 50-60% decline among men unselected by fertility from North America, Europe, Australia and New Zealand. Because of the significant public health implications of these results, research on the causes of this continuing decline is urgently needed.

Benzeno: reflexos sobre a saúde pública, presença ambiental e indicadores biológicos utilizados para a determinação da exposição

O uso indiscriminado de um número cada vez maior de substâncias químicas vem aumentando e a contaminação ambiental associada tem trazido sérias consequências para o sistema público de saúde devido à elevação de danos para a saúde humana. Uma das substâncias que desperta grande interesse devido à contaminação contemporânea é o benzeno, composto aromático classificado pela International Agency for Research on Cancer como reconhecidamente carcinogênico para humanos. O objetivo do presente estudo foi elaborar e discutir um panorama sobre a contaminação por benzeno, seu metabolismo, consequências para a saúde e sua determinação ambiental e biológica a partir de informações existentes na literatura científica. O levantamento de dados possibilitou o acesso a mais de 200 artigos científicos tanto de âmbito nacional quanto internacional, demonstrando a atualidade do tema e a necessidade de minimização da exposição humana a essa substância. A maioria preocupa-se em explorar o metabolismo e investigar indicadores de exposição, muitos já amplamente estudados e com sérias limitações. Contudo, um crescente número de pesquisadores estão empenhados em elucidar fatores relacionados à suscetibilidade e à interferência da exposição no material genético e proteico. Indicadores de exposição inovadores têm sido propostos com o objetivo de complementar as lacunas de informações anteriormente obtidas, contribuindo para o delineamento da estrutura da biologia de sistemas orgânicos frente à exposição ao benzeno.

Current understandings and perspectives on non-cancer health effects of benzene: a global concern

OBJECTIVE

Benzene, as a volatile organic compound, is known as one of the main air pollutants in the environment. The aim of this review is to summarize all available evidences on non-cancerous health effects of benzene providing an overview of possible association of exposure to benzene with human chronic diseases, specially, in those regions of the world where benzene concentration is being poorly monitored.

METHODOLOGY

A bibliographic search of scientific databases including PubMed, Google Scholar, and Scirus was conducted with key words of "benzene toxic health effects", "environmental volatile organic compounds", "diabetes mellitus and environmental pollutants", "breast cancer and environmental pollution", "prevalence of lung cancer", and "diabetes prevalence". More than 300 peer reviewed papers were examined. Experimental and epidemiologic studies reporting health effects of benzene and volatile organic compounds were included in the study.

RESULTS

Epidemiologic and experimental studies suggest that benzene exposure can lead to numerous non-cancerous health effects associated with functional aberration of vital systems in the body like reproductive, immune, nervous, endocrine, cardiovascular, and respiratory.

CONCLUSION

Chronic diseases have become a health burden of global dimension with special emphasis in regions with poor monitoring over contents of benzene in petrochemicals. Benzene is a well known carcinogen of blood and its components, but the concern of benzene exposure is more than carcinogenicity of blood components and should be evaluated in both epidemiologic and experimental studies. Aspect of interactions and mechanism of toxicity in relation to human general health problems especially endocrine disturbances with particular reference to diabetes, breast and lung cancers should be followed up.

Occupational causes of male infertility

PURPOSE OF REVIEW

To highlight and discuss the new evidence on occupational and environmental risk to male reproductive function.

RECENT FINDINGS

Semen quality following occupational exposure to boron (an acknowledged experimental reproductive toxicant) and benzene, and new evidence on low-level environmental exposure to widespread xenobiotics with endocrine actions.

SUMMARY

The naturally occurring semimetal boron is an experimental reproductive toxicant, but now a Turkish semen study corroborates earlier evidence that high-level occupational exposure is not toxic to human spermatogenesis. It seems that human exposure levels are below the levels that cause reproductive toxicity in rodents. On the contrary, there is now ample evidence that the carcinogenic substance benzene may cause chromosomal aberrations in sperm at very low exposure levels. This includes chromosomal deletions that are known to cause infertility, mental retardation and congenital malformations. This research highlights the need to scrutinize the chemicals for possible male-mediated developmental toxicity. Several occupational studies are addressing adult testicular function in men exposed to chemicals that may interfere with endocrine signalling such as bisphenol A and phthalates, but findings are rather inconsistent and it remains to be established whether these widespread chemicals have any impact on male fertility.