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Virtanen HE, Rodprasert W, Toppari J. Deteriorating Semen Quality: The Role of the Environment. Semin Reprod Med 2023; 41:226-240. [PMID: 38499038 DOI: 10.1055/s-0044-1782151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Since the end of the last century, several reports have suggested that semen quality is declining, especially in Western countries. Furthermore, cross-sectional studies using similar protocols have suggested regional differences in semen quality of young and fertile men. Reasons for these regional differences and local adverse trends in semen quality are unknown, but environmental factors are suspected to have a role. Besides adulthood environmental exposures, those occurring during testicular development may also affect semen quality. Longitudinal follow-up studies and mixture risk analyses are needed to study the effect of fetal, childhood, and adult life environment on semen quality.
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Affiliation(s)
- Helena E Virtanen
- Research Centre for Integrative Physiology and Pharmacology and Centre for Population Health Research, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Wiwat Rodprasert
- Research Centre for Integrative Physiology and Pharmacology and Centre for Population Health Research, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Jorma Toppari
- Research Centre for Integrative Physiology and Pharmacology and Centre for Population Health Research, Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Pediatrics, Turku University Hospital, Turku, Finland
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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2
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Cipriani S, Ricci E, Chiaffarino F, Esposito G, Dalmartello M, La Vecchia C, Negri E, Parazzini F. Trend of change of sperm count and concentration over the last two decades: A systematic review and meta-regression analysis. Andrology 2023; 11:997-1008. [PMID: 36709405 DOI: 10.1111/andr.13396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 01/11/2023] [Accepted: 01/18/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Since the 1970s, several studies found that sperm concentration (SC) and total sperm count (TSC) constantly worsened over time, mainly in high-income countries. OBJECTIVES To evaluate whether the decreasing trend in sperm count is continuing in Western European countries and USA, we performed a systematic review and meta-regression analysis. MATERIALS AND METHODS Embase and Pubmed/Medline were searched papers published in English in the 2000-2020 period limiting the search to data collected in the USA and Western European countries. RESULTS We identified 62 articles and pooled information on 24,196 men (range 10-2,523), collected from 1993 to 2018. Considering all the studies, random-effects meta-regression analyses showed no significant trend for SC (slope per year -0.07 mil/mL, p-value = 0.86). Negative trends of SC were detected in Scandinavian countries (slope per year -1.11 mil/mL, 95% CI: -2.40 to +0.19; p-value = 0.09), but the findings were statistically not significant. No significant trends of SC were detected in Central Europe (slope per year +0.23, 95% CI -2.51 to +2.96; p-value = 0.87), the USA (slope per year +1.08, 95% CI -0.42 to +2.57; p-value = 0.16), and Southern Europe (slope per year +0.19, 95% CI -0.99 to +1.37; p-value = 0.75). We have analyzed separately findings from studies including sperm donors, fertile men, young unselected men (unselected men, study mean age < 25 years) and unselected men (unselected men, study mean age ≥ 25 years). No significant trends of SC were observed among sperm donors (slope per year -2.80, 95% CI -6.76 to +1.17; p-value 0.16), unselected men (slope per year -0.23, 95% CI -1.58 to +1.12; p-value 0.73), young unselected men (slope per year -0.49, 95% CI -1.76 to +0.79; p-value 0.45), fertile men (slope per year +0.29, 95% CI -1.09 to +1.67; p-value 0.68). DISCUSSION AND CONCLUSION The results of this analysis show no significant trends in SC, in USA, and selected Western European countries.
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Affiliation(s)
- Sonia Cipriani
- Gynaecology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elena Ricci
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Francesca Chiaffarino
- Gynaecology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Esposito
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Michela Dalmartello
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Eva Negri
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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3
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Levine H, Jørgensen N, Martino-Andrade A, Mendiola J, Weksler-Derri D, Jolles M, Pinotti R, Swan SH. Temporal trends in sperm count: a systematic review and meta-regression analysis of samples collected globally in the 20th and 21st centuries. Hum Reprod Update 2023; 29:157-176. [PMID: 36377604 DOI: 10.1093/humupd/dmac035] [Citation(s) in RCA: 118] [Impact Index Per Article: 118.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Hagai Levine
- Braun School of Public Health and Community Medicine, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Niels Jørgensen
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Jaime Mendiola
- Division of Preventive Medicine and Public Health, University of Murcia School of Medicine and Biomedical Research Institute of Murcia (IMIB-Arrixaca-UMU), Murcia, Spain
| | - Dan Weksler-Derri
- Clalit Health Services, Kiryat Ono, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Maya Jolles
- Braun School of Public Health and Community Medicine, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rachel Pinotti
- Gustave L. and Janet W. Levy Library, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shanna H Swan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Feferkorn I, Azani L, Kadour-Peero E, Hizkiyahu R, Shrem G, Salmon-Divon M, Dahan MH. Geographic variation in semen parameters from data used for the World Health Organization semen analysis reference ranges. Fertil Steril 2022; 118:475-482. [PMID: 35750517 DOI: 10.1016/j.fertnstert.2022.05.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To study geographic variations in sperm parameters using data from the trials that defined the reference ranges of the World Health Organization 2021 manual. DESIGN Retrospective evaluation of the data used to define the World Health Organization reference ranges. SETTING Not applicable. PATIENT(S) Data from 11 studies, including 3,484 participants across 5 continents. INTERVENTION(S) The data were divided according to geographic locations. MAIN OUTCOME MEASURE(S) Differences in sperm parameters. RESULT(S) The semen volume was significantly lower in samples from Asia and Africa than in other regions. The sperm concentration was the lowest in Africa and highest in Australia. The total motile sperm count (TMSC) and total motile progressive sperm count (TMPS) were significantly lower in Africa than in other regions. The TMSC and TMPS in Asia and the United States were significantly lower than in Europe and Australia. The 5th percentile of the sperm concentration was lowest in the United States (12.5 × 106/mL). The 5th percentile for the normal sperm morphology was lowest in the United States (3%) and highest in Asia (5%). The 5th percentile for the TMSC and TMPS were lowest in Africa (TMSC, 15.08 million; TMPS, 12.06 million) and the United States (TMSC, 18.05 million; TMPS, 16.86 million) and highest in Australia (TMSC, 29.61 million; TMPS, 25.80 million). CONCLUSION(S) Significant geographic differences in sperm parameters exist, and regional fertility societies should consider adding their own reference ranges on the basis of local experience and treatment outcomes.
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Affiliation(s)
- Ido Feferkorn
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, Québec, Canada.
| | - Liat Azani
- Department of Molecular Biology, Ariel University, Ariel, Israel
| | - Einav Kadour-Peero
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, Québec, Canada
| | - Ranit Hizkiyahu
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, Québec, Canada
| | - Guy Shrem
- IVF Unit, Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel
| | - Mali Salmon-Divon
- Department of Molecular Biology, Ariel University, Ariel, Israel; Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Michael H Dahan
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, Québec, Canada
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5
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Auger J, Eustache F, Chevrier C, Jégou B. Spatiotemporal trends in human semen quality. Nat Rev Urol 2022; 19:597-626. [PMID: 35978007 PMCID: PMC9383660 DOI: 10.1038/s41585-022-00626-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 11/09/2022]
Abstract
Over the past four decades, studies of various designs have reported spatial and temporal trends in human semen quality. Several standardized-methodology studies in homogeneous populations that compare specific cities within a country or a continent provide clear evidence of geographical differences in sperm production, even over short distances within the same country. Human sperm production is widely believed to be declining over time, but evidence from the scientific literature is less clear. Studies based on repeated cross-sectional data from a single centre have shown mixed results. Among the numerous retrospective studies conducted in a single centre, only some included homogeneous groups of men and appropriate methods, and most of them suggest a temporal decrease in human sperm production in the geographical areas considered. Conclusions reporting temporal trends in sperm production that came from existing retrospective multicentre studies based on individual semen data and those using means, medians or estimates of sperm production are questionable, owing to intrinsic limitations in the studies performed. Regardless of study design, studies on the percentage of motile or morphologically normal spermatozoa are still limited by the inherent variability in assessment. Overall, available data do not enable us to conclude that human semen quality is deteriorating worldwide or in the Western world, but that a trend is observed in some specific areas. To understand these trends and contrasts in sperm and semen quality, prospective studies should be encouraged and combined with assessment of the male exposome. Several studies over the past few decades have suggested that sperm quality varies by geographical region and might be subject to a temporal decline worldwide. However, the data supporting these conclusions have come from studies of various methodologies and heterogeneous populations, making them unreliable. In this in-depth Review, Chevrier and colleagues discuss the data surrounding discussion of spatiotemporal trends in semen parameters and consider how these trends and the factors promoting them interact. The vast literature on human semen quality trends is extremely heterogeneous in terms of the populations studied and study designs, and so these studies have been unable to draw firm conclusions. Understanding the data around spatiotemporal semen trends requires a focus on the methodological choices and application of criteria to filter findings from the studies with optimal design. Numerous appropriately designed studies suggest unambiguous geographical contrasts in human sperm production; however, evidence of a decline in sperm production is reliable only in specific populations and cities in which studies with a complete set of quality criteria have been conducted. By contrast, suggestions of a worldwide drop in human semen quality on the basis of retrospective multicentre studies cannot be substantiated, owing to intrinsic limitations in the studies performed. Many and varied factors of variation, in particular the diverse modalities of assessment, do not enable us to conclude that clear temporal trends of sperm motility and normal morphology are present. Progress in our understanding of the highlighted trends and their causal factors requires prospective studies that minimize all known biases combined with the assessment of men’s exposome.
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Affiliation(s)
- Jacques Auger
- INSERM U1016-Equipe "Génomique, Epigénétique et Physiologie de la Reproduction", Institut Cochin, Université Paris Descartes-Paris, Paris, France
| | - Florence Eustache
- INSERM U1016-Equipe "Génomique, Epigénétique et Physiologie de la Reproduction", Institut Cochin, Université Paris Descartes-Paris, Paris, France.,CECOS, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Jean Verdier and Service de Biologie de la Reproduction, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Bichat, Paris, France
| | - Cécile Chevrier
- Université Rennes, INSERM, EHESP, IRSET-UMR_S 1085, Rennes, France.
| | - Bernard Jégou
- Université Rennes, INSERM, EHESP, IRSET-UMR_S 1085, Rennes, France
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6
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Axelsson J, Lindh CH, Giwercman A. Exposure to polycyclic aromatic hydrocarbons and nicotine, and associations with sperm DNA fragmentation. Andrology 2022; 10:740-748. [PMID: 35234353 PMCID: PMC9310791 DOI: 10.1111/andr.13170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/16/2022] [Accepted: 02/28/2022] [Indexed: 12/03/2022]
Abstract
Background Tobacco smoking has been reported to cause DNA fragmentation and has been suggested to cause mutations in spermatozoa. These effects have been ascribed to the action of polycyclic aromatic hydrocarbons (PAH) present in the smoke. Simultaneously, DNA fragmentation has been associated with mutagenesis. Objective The aim of this study was to investigate whether levels of urinary biomarkers of PAH and nicotine exposure were associated with sperm DNA fragmentation. Methods In the urine of 381 men recruited from two cohorts of young men (17–21 years old) from the general Swedish population, the PAH metabolites 1‐hydroxypyrene and 2‐hydroxyphenanthrene, as well as the nicotine metabolite cotinine, were measured. The sperm DNA fragmentation index (DFI) was analysed using the sperm chromatin structure assay. Associations between the DFI, and PAH metabolite levels as continuous variables as well as in quartiles, were studied by general linear models adjusted for abstinence time. A similar analysis was carried out for cotinine levels, according to which the men were categorised as “non‐smoking” (n = 216) and “smoking” (n = 165). Results No association was found between levels of any of the three biomarkers and DFI, either as a continuous variable (p = 0.87–0.99), or when comparing the lowest and the highest quartiles (p = 0.11–0.61). The same was true for comparison of men categorised as non‐smoking or smoking (DFI 11.1% vs. 11.8%, p = 0.31). Discussion We found no evidence of PAH or nicotine exposure to be associated with DFI, which does not exclude that these exposures may have other effects on sperm DNA. Conclusion In these young men, levels of biomarkers of nicotine and PAH exposure were not associated with DFI.
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Affiliation(s)
- Jonatan Axelsson
- Reproductive Medicine Centre, Skåne University Hospital, and Molecular Reproductive Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden.,Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Sweden
| | - Christian H Lindh
- Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Sweden
| | - Aleksander Giwercman
- Reproductive Medicine Centre, Skåne University Hospital, and Molecular Reproductive Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
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7
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Catford SR, Halliday J, Lewis S, O'Bryan MK, Handelsman DJ, Hart RJ, McBain J, Rombauts L, Amor DJ, Saffery R, McLachlan RI. Reproductive function in men conceived with in vitro fertilization and intracytoplasmic sperm injection. Fertil Steril 2022; 117:727-737. [PMID: 35120745 DOI: 10.1016/j.fertnstert.2021.12.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the semen quality and reproductive hormones of men conceived by in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) compared with men conceived without assisted reproductive technology (ART). DESIGN Cohort study. SETTING IVF centers in Victoria and the Western Australian Raine Study. PATIENT(S) Men conceived with IVF/ICSI and men conceived without ART aged 18-25 years. INTERVENTION(S) Clinical review. MAIN OUTCOME MEASURE(S) The primary outcome was the prevalence of severe oligozoospermia (sperm concentration, <5 million/mL). The secondary outcomes were total sperm count, total and progressive motility, total motile count, normal morphology, and serum testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH). RESULTS There was no difference in the prevalence of severe oligozoospermia between 120 men conceived with IVF/ICSI and 356 men conceived without ART (9% vs. 5.3%). Men conceived with IVF/ICSI had similar sperm concentration, total sperm count, and total motile count but lower mean total (55.3% vs. 60.6%) and progressive (44.7% vs. 53.9%) sperm motility with higher mean normal morphology (8.5% vs. 5.4%). Differences in progressive motility (ß, -9.9; 95% confidence interval [CI], -16.7 - -3.0), normal morphology (ß, 4.3; 95% CI, 3.0-5.7), and proportion with abnormal morphology (adjusted odds ratios, 0.1; 95% CI, 0.04-0.5) remained significant after adjusting for confounders. Men conceived with IVF/ICSI had lower mean FSH (3.3 IU/L) and LH (3.9 IU/L) levels and higher mean testosterone levels (19.1 nmol/L) than controls (4.2 IU/L, 11.0 IU/L, and 16.8 nmol/L). CONCLUSION This study of men conceived with IVF/ICSI found similar sperm output to men conceived without ART. Overall, the results are reassuring.
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Affiliation(s)
- Sarah R Catford
- Hudson Institute of Medical Research, Melbourne, Australia; Department of Obstetrics and Gynecology, Monash University, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
| | - Jane Halliday
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Moira K O'Bryan
- The School of BioSciences, Faculty of Science, University of Melbourne, Melbourne, Australia
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney and Department of Andrology, Concord Hospital, Sydney, Australia
| | - Roger J Hart
- Division of Obstetrics and Gynecology, University of Western Australia, Perth, Australia; Fertility Specialists of Western Australia, Perth, Australia
| | - John McBain
- Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Australia; Melbourne IVF, East Melbourne, Australia; Department of Obstetrics and Gynecology, The Royal Women's Hospital, Melbourne, Australia
| | - Luk Rombauts
- Department of Obstetrics and Gynecology, Monash University, Melbourne, Australia; Monash IVF Group Pty Ltd, Melbourne, Australia
| | - David J Amor
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Robert I McLachlan
- Hudson Institute of Medical Research, Melbourne, Australia; Department of Obstetrics and Gynecology, Monash University, Melbourne, Australia; Monash IVF Group Pty Ltd, Melbourne, Australia
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8
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Priskorn L, Tøttenborg SS, Almstrup K, Andersson AM, Axelsson J, Bräuner EV, Elenkov A, Freiesleben NLC, Giwercman YL, Grøndahl ML, Hansen AH, Hansen LS, Henic E, Kitlinski ML, Landersoe SK, Lindh C, Løkkegaard EL, Malm J, Olsen KW, Petersen KU, Schmidt L, Stormlund S, Svendsen PF, Vassard D, Wang NF, Zedeler A, Bhasin S, Chavarro J, Eisenberg ML, Hauser R, Huhtaniemi I, Krawetz SA, Marko-Varga G, Salonia A, Toppari J, Juul A, Jørgensen N, Nielsen HS, Pinborg A, Rylander L, Giwercman A. RUBIC (ReproUnion Biobank and Infertility Cohort): A binational clinical foundation to study risk factors, life course, and treatment of infertility and infertility-related morbidity. Andrology 2021; 9:1828-1842. [PMID: 34114375 PMCID: PMC10015988 DOI: 10.1111/andr.13063] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Infertility affects 15%-25% of all couples during their reproductive life span. It is a significant societal and public health problem with potential psychological, social, and economic consequences. Furthermore, infertility has been linked to adverse long-term health outcomes. Despite the advanced diagnostic and therapeutic techniques available, approximately 30% of infertile couples do not obtain a live birth after fertility treatment. For these couples, there are no further options to increase their chances of a successful pregnancy and live birth. OBJECTIVES Three overall questions will be studied: (1) What are the risk factors and natural life courses of infertility, early embryonic loss, and adverse pregnancy outcomes? (2) Can we develop new diagnostic and prognostic biomarkers for fecundity and treatment success? And (3) what are the health characteristics of women and men in infertile couples at the time of fertility treatment and during long-term follow-up? MATERIAL AND METHODS ReproUnion Biobank and Infertility Cohort (RUBIC) is established as an add-on to the routine fertility management at Copenhagen University Hospital Departments in the Capital Region of Denmark and Reproductive Medicine Centre at Skåne University Hospital in Sweden. The aim is to include a total of 5000 couples equally distributed between Denmark and Sweden. The first patients were enrolled in June 2020. All eligible infertile couples are prospectively asked to participate in the project. Participants complete an extensive questionnaire and undergo a physical examination and collection of biospecimens (blood, urine, hair, saliva, rectal swabs, feces, semen, endometrial biopsies, and vaginal swabs). After the cohort is established, the couples will be linked to the Danish and Swedish national registers to obtain information on parental, perinatal, childhood, and adult life histories, including disease and medication history. This will enable us to understand the causes of infertility and identify novel therapeutic options for this important societal problem.
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Affiliation(s)
- Laerke Priskorn
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Sandra Søgaard Tøttenborg
- Department of Occupational and Environmental Health, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Kristian Almstrup
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Anna-Maria Andersson
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jonatan Axelsson
- Reproductive Medicine Center, Skåne University Hospital, Malmö, Sweden
| | - Elvira Vaclavik Bräuner
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Angel Elenkov
- Reproductive Medicine Center, Skåne University Hospital, Malmö, Sweden
| | - Nina la Cour Freiesleben
- The Fertility Clinic, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Marie Louise Grøndahl
- Fertility Clinic, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Ann Holm Hansen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Laura Smidt Hansen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Emir Henic
- Reproductive Medicine Center, Skåne University Hospital, Malmö, Sweden
| | | | - Selma Kloeve Landersoe
- Fertility Department, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Obstetrics and Gynecology, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Christian Lindh
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Ellen Leth Løkkegaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Obstetrics and Gynecology, Copenhagen University Hospital - North Zealand, Copenhagen, Denmark
| | - Johan Malm
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | | | - Kajsa Uglevig Petersen
- Department of Occupational and Environmental Health, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lone Schmidt
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sacha Stormlund
- Fertility Department, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Pernille Fog Svendsen
- Fertility Clinic, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Ditte Vassard
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nathalie Friis Wang
- Fertility Department, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Anne Zedeler
- Fertility Department, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Shalender Bhasin
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge Chavarro
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Michael L Eisenberg
- Department of Urology and Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - Russ Hauser
- Departments of Environmental Health and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ilpo Huhtaniemi
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Stephen A Krawetz
- Department of Obstetrics and Gynecology, Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan, USA
| | | | - Andrea Salonia
- Graduate School of Urology, University Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Jorma Toppari
- Institute of Biomedicine, Research Centre for Integrated Physiology and Pharmacology, University of Turku, Turku, Finland.,Centre for Population Health Research, University of Turku, Turku, Finland.,Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Niels Jørgensen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Henriette Svarre Nielsen
- The Fertility Clinic, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anja Pinborg
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Fertility Department, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Lars Rylander
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Aleksander Giwercman
- Reproductive Medicine Center, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Lund University, Malmö, Sweden
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9
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Anand-Ivell R, Tremellen K, Soyama H, Enki D, Ivell R. Male seminal parameters are not associated with Leydig cell functional capacity in men. Andrology 2021; 9:1126-1136. [PMID: 33715296 DOI: 10.1111/andr.13001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/01/2021] [Accepted: 03/10/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insulin-like peptide 3 (INSL3) is a constitutive, secreted peptide produced in the male uniquely by the Leydig cells of the testes. It is a biomarker for Leydig cell functional capacity, which is a measure of the numbers and differentiation status of these steroidogenic cells and lacks the biological and technical variance of the steroid testosterone. This retrospective study was carried out to examine the relationship between seminal parameters and the Leydig cell compartment, and secondarily to assess other factors responsible for determining Leydig cell functional capacity. METHODS INSL3 was assessed together with seminal, anthropometric, and hormonal parameters in a Swedish cohort of 18-year-old men, representing the average population, and in a smaller, more heterogeneous cohort of men visiting an Australian infertility clinic. RESULTS AND DISCUSSION Average INSL3 concentration at 18 years is greater than that reported at younger or older ages and indicated a large 10-fold variation. In neither cohort was there a relationship between INSL3 concentration and any semen parameter. For the larger, more uniform Swedish cohort of young men, there was a significant negative relationship between INSL3 and BMI, supporting the idea that adult Leydig cell functional capacity may be established during puberty. In both cohorts, there was a significant relationship between INSL3 and FSH, but not LH concentration. No relationship was found between INSL3 and androgen receptor trinucleotide repeat polymorphisms, reinforcing the notion that Leydig cell functional capacity is unlikely to be determined by androgen influence alone. Nor did INSL3 correlate with the T/LH ratio, an alternative measure of Leydig cell functional capacity, supporting the view that these are independent measures of Leydig cell function.
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Affiliation(s)
| | - Kelton Tremellen
- Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, Bedford Park, SA, Australia.,Repromed, Dulwich, SA, Australia
| | - Hiroaki Soyama
- School of Biosciences, University of Nottingham, Sutton Bonington, UK.,Department of Obstetrics and Gynecology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Doyo Enki
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, UK
| | - Richard Ivell
- School of Biosciences, University of Nottingham, Sutton Bonington, UK.,School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, UK
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10
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Rahban R, Nef S. Regional difference in semen quality of young men: a review on the implication of environmental and lifestyle factors during fetal life and adulthood. Basic Clin Androl 2020; 30:16. [PMID: 33072332 PMCID: PMC7559360 DOI: 10.1186/s12610-020-00114-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/14/2020] [Indexed: 02/08/2023] Open
Abstract
The prevalence of low semen quality and the incidence of testicular cancer have been steadily increasing over the past decades in different parts of the World. Although these conditions may have a genetic or epigenetic origin, there is growing evidence that multiple environmental and lifestyle factors can act alone or in combination to induce adverse effects. Exposure to these factors may occur as early as during fetal life, via the mother, and directly throughout adulthood after full spermatogenic capacity is reached. This review aims at providing an overview of past and current trends in semen quality and its relevance to fertility as well as a barometer of men’s general health. The focus will be on recent epidemiological studies of young men from the general population highlighting geographic variations in Europe. The impact of some lifestyle and environmental factors will be discussed with their role in both fetal life and adulthood. These factors include smoking, alcohol consumption, psychological stress, exposure to electromagnetic radiation, and Endocrine Disrupting Chemicals (EDCs). Finally, the challenges in investigating the influence of environmental factors on semen quality in a fast changing world are presented.
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Affiliation(s)
- Rita Rahban
- Swiss Centre for Applied Human Toxicology (SCAHT), Switzerland and Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206 Geneva, Switzerland
| | - Serge Nef
- Swiss Centre for Applied Human Toxicology (SCAHT), Switzerland and Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206 Geneva, Switzerland
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11
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Palani A, Sengupta P, Agarwal A, Henkel R. Geographical differences in semen characteristics: Comparing semen parameters of infertile men of the United States and Iraq. Andrologia 2020; 52:e13519. [DOI: 10.1111/and.13519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 12/03/2019] [Accepted: 12/18/2019] [Indexed: 12/28/2022] Open
Affiliation(s)
- Ayad Palani
- Department of Chemistry College of Science University of Garmian Kalar Iraq
| | - Pallav Sengupta
- Department of Physiology Faculty of Medicine MAHSA University Jenjarom Malaysia
| | - Ashok Agarwal
- American Center for Reproductive Medicine Cleveland Clinic Cleveland OH USA
| | - Ralf Henkel
- American Center for Reproductive Medicine Cleveland Clinic Cleveland OH USA
- Department of Medical Bioscience University of the Western Cape Bellville South Africa
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12
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Rahban R, Priskorn L, Senn A, Stettler E, Galli F, Vargas J, Van den Bergh M, Fusconi A, Garlantezec R, Jensen TK, Multigner L, Skakkebæk NE, Germond M, Jørgensen N, Nef S. Semen quality of young men in Switzerland: a nationwide cross-sectional population-based study. Andrology 2019; 7:818-826. [PMID: 31115178 PMCID: PMC6790593 DOI: 10.1111/andr.12645] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/11/2019] [Accepted: 04/10/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Sperm counts have been steadily decreasing over the past five decades with regional differences in the Western world. The reasons behind these trends are complex, but numerous insights indicate that environmental and lifestyle factors are important players. OBJECTIVE To evaluate semen quality and male reproductive health in Switzerland. MATERIALS AND METHODS A nationwide cross-sectional study was conducted on 2523 young men coming from all regions of Switzerland, recruited during military conscription. Semen volume, sperm concentration, motility, and morphology were analyzed. Anatomy of the genital area and testicular volume was recorded. Testicular cancer incidence rates in the general population were retrieved from Swiss regional registries. RESULTS Median sperm concentration adjusted for period of sexual abstinence was 48 million/mL. Comparing with the 5th percentile of the WHO reference values for fertile men, 17% of men had sperm concentration below 15 million/mL, 25% had less than 40% motile spermatozoa, and 43% had less than 4% normal forms. Disparities in semen quality among geographic regions, urbanization rates, and linguistic areas were limited. A larger proportion of men with poor semen quality had been exposed in utero to maternal smoking. Furthermore, testicular cancer incidence rates in the Swiss general population increased significantly between 1980 and 2014. DISCUSSION For the first time, a systematic sampling among young men has confirmed that semen quality is affected on a national level. The median sperm concentration measured is among the lowest observed in Europe. No specific geographical differences could be identified. Further studies are needed to determine to what extent the fertility of Swiss men is compromised and to evaluate the impact of environmental and lifestyle factors. CONCLUSION A significant proportion of Swiss young men display suboptimal semen quality with only 38% having sperm concentration, motility, and morphology values that met WHO semen reference criteria.
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Affiliation(s)
- R. Rahban
- Department of Genetic Medicine and DevelopmentUniversity of GenevaGenevaSwitzerland
| | - L. Priskorn
- Department of Growth and ReproductionRigshospitalet, University of CopenhagenCopenhagenDenmark
| | - A. Senn
- Department of Genetic Medicine and DevelopmentUniversity of GenevaGenevaSwitzerland
| | - E. Stettler
- Department of Genetic Medicine and DevelopmentUniversity of GenevaGenevaSwitzerland
- Swiss Armed Forces Joint StaffMedical ServicesIttigenSwitzerland
| | - F. Galli
- National Institute for Cancer Epidemiology and Registration (NICER)ZürichSwitzerland
| | - J. Vargas
- Centre de Procréation Médicalement Assistée SAFertas SA et Fondation FABERLausanneSwitzerland
| | | | - A. Fusconi
- Centro Cantonale di FertilitàOspedale di Locarno La CaritàLocarnoSwitzerland
| | - R. Garlantezec
- Inserm, EHESPIrset (Institut de recherche en santé, environnement et travail) – UMR_S 1085Université de RennesRennesFrance
| | - T. K. Jensen
- Department of Growth and ReproductionRigshospitalet, University of CopenhagenCopenhagenDenmark
| | - L. Multigner
- Inserm, EHESPIrset (Institut de recherche en santé, environnement et travail) – UMR_S 1085Université de RennesRennesFrance
| | - N. E. Skakkebæk
- Department of Growth and ReproductionRigshospitalet, University of CopenhagenCopenhagenDenmark
| | - M. Germond
- Centre de Procréation Médicalement Assistée SAFertas SA et Fondation FABERLausanneSwitzerland
| | - N. Jørgensen
- Department of Growth and ReproductionRigshospitalet, University of CopenhagenCopenhagenDenmark
| | - S. Nef
- Department of Genetic Medicine and DevelopmentUniversity of GenevaGenevaSwitzerland
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13
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Marsh C, McCracken M, Gray M, Nangia A, Gay J, Roby KF. Low total motile sperm in transgender women seeking hormone therapy. J Assist Reprod Genet 2019; 36:1639-1648. [PMID: 31250175 DOI: 10.1007/s10815-019-01504-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 06/11/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This study was undertaken to compare semen quality, hormonal status, and social factors in transgender women seeking fertility preservation with those of fertile cisgender men. Long-range goals are to establish standard practice measures ensuring optimum semen quality for cryopreservation and fertility preservation in transgender women. METHODS This is a case-control study carried out at an academic medical center. Cases are transgender women seeking fertility preservation prior to initiation of hormone therapy. Controls are cisgender men recently fathering a child. All participants completed the Depression Anxiety Stress Scales 21 survey and additional survey questions related to personal behaviors. Complete semen analysis was carried out in a clinical andrology laboratory according to WHO guidelines, 5th edition. Serum follicle stimulating hormone, estradiol, and testosterone were measured at the time of semen analysis. RESULTS Sperm concentration, total sperm per ejaculate, total motile sperm, volume, and normal sperm morphology were significantly lower in transgender females compared with fertile cisgender men. Other measures of semen parameters and hormone concentrations were not different between groups. Survey results indicated transgender women were more likely to have symptoms of depression, anxiety, and stress and utilize tucking and tight undergarments, compared with controls; however, both groups reported similar numbers of ejaculations per week. CONCLUSIONS Although semen parameters were low, cryopreservation of sperm prior to hormone therapy is a viable fertility preservation option for most transgender women. The etiology of the differences in semen parameters is not known. Enhanced education related to personal behaviors or treatment to reduce effects of stressors prior to cryopreservation may improve future fertility potential.
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Affiliation(s)
- Courtney Marsh
- Department of Obstetrics & Gynecology, University of Kansas Medical Center, Kansas City, KS, 66160, USA.
- Center for Advanced Reproductive Medicine, University of Kansas Medical Center, Overland Park, KS, 66211, USA.
- Institute for Reproduction and Perinatal Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA.
| | - Megan McCracken
- Department of Obstetrics & Gynecology, University of Kansas Medical Center, Kansas City, KS, 66160, USA
- Center for Advanced Reproductive Medicine, University of Kansas Medical Center, Overland Park, KS, 66211, USA
| | - Meredith Gray
- Department of Obstetrics & Gynecology, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Ajay Nangia
- Institute for Reproduction and Perinatal Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA
- Department of Urology, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Judy Gay
- Department of Obstetrics & Gynecology, University of Kansas Medical Center, Kansas City, KS, 66160, USA
- Center for Advanced Reproductive Medicine, University of Kansas Medical Center, Overland Park, KS, 66211, USA
| | - Katherine F Roby
- Department of Obstetrics & Gynecology, University of Kansas Medical Center, Kansas City, KS, 66160, USA.
- Center for Advanced Reproductive Medicine, University of Kansas Medical Center, Overland Park, KS, 66211, USA.
- Institute for Reproduction and Perinatal Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA.
- Department of Anatomy & Cell Biology, University of Kansas Medical Center, Kansas City, KS, 66160, USA.
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14
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Rodprasert W, Virtanen HE, Sadov S, Perheentupa A, Skakkebaek NE, Jørgensen N, Toppari J. An update on semen quality among young Finnish men and comparison with Danish data. Andrology 2018; 7:15-23. [PMID: 30251363 PMCID: PMC6519379 DOI: 10.1111/andr.12550] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 01/18/2023]
Abstract
Background Finnish men used to have higher semen quality than Danish men. However, recent studies showed that semen quality in Finland has declined, but it has been relatively stable in Denmark. Objective This study aimed to compare new data on semen quality of the young Finnish men to that of Danish men. Materials and methods In this cross‐sectional study, 18‐ to 19‐year‐old men residing in Turku, Finland and Copenhagen, Denmark, were invited to participate in 2008–2011. Each man filled in a questionnaire, provided one semen sample and underwent andrological examination. Semen samples were analyzed according to WHO. Multiway ANOVA was used to adjust semen variables for duration of sexual abstinence and age (and time from ejaculation to the start of semen analysis for sperm motility). Results Altogether 287 Finnish men and 873 Danish men participated in the study. The adjusted median sperm concentrations were 49 and 47 million/mL for Finnish and Danish men, respectively (p = 0.48). The adjusted median total sperm counts were 148 million in Finland and 146 million in Denmark (p = 0.87). The adjusted median percentages of morphologically normal spermatozoa were 6.9% in Finland and 6.5% in Denmark, p = 0.27. Finnish men had higher adjusted median percentages of motile spermatozoa (A+B+C) than Danish men (80% vs. 69%, p < 0.001). The proportion of men who had low semen quality (sperm concentration, percentage of morphologically normal spermatozoa or percentage of progressively motile spermatozoa below WHO reference limits) was lower in Finland (25.4%) than in Denmark (34.6%), p = 0.004. Discussion Considerable percentage of men in both countries had low semen quality. The deteriorating semen quality in Finland may result in decreasing fecundity, which is a cause of concern. Conclusion The formerly high semen quality in Finland has converged to the lower Danish levels. Our findings demonstrate the importance of continuing surveillance of semen quality.
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Affiliation(s)
- W Rodprasert
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - H E Virtanen
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - S Sadov
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - A Perheentupa
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland.,Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, Turku, Finland
| | - N E Skakkebaek
- University Department of Growth and Reproduction and EDMaRC, Rigshospitalet, Copenhagen, Denmark
| | - N Jørgensen
- University Department of Growth and Reproduction and EDMaRC, Rigshospitalet, Copenhagen, Denmark
| | - J Toppari
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland.,University Department of Growth and Reproduction and EDMaRC, Rigshospitalet, Copenhagen, Denmark.,Department of Pediatrics, Turku University Hospital, Turku, Finland
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15
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Levine H, Jørgensen N, Martino-Andrade A, Mendiola J, Weksler-Derri D, Mindlis I, Pinotti R, Swan SH. Temporal trends in sperm count: a systematic review and meta-regression analysis. Hum Reprod Update 2018; 23:646-659. [PMID: 28981654 DOI: 10.1093/humupd/dmx022] [Citation(s) in RCA: 705] [Impact Index Per Article: 117.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 06/28/2017] [Indexed: 12/11/2022] Open
Abstract
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.
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Affiliation(s)
- Hagai Levine
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, the Hebrew University Center of Excellence in Agriculture and Environmental Health, Ein Kerem Campus, PO BOX 12272, Jerusalem 9110202, Israel.,Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Niels Jørgensen
- University Department of Growth and Reproduction, University of Copenhagen, Rigshospitalet, CopenhagenDK-2100, Denmark
| | - Anderson Martino-Andrade
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.,Department of Physiology, Federal University of Parana, Curitiba 81531-980, Brazil
| | - Jaime Mendiola
- Division of Preventive Medicine and Public Health, University of Murcia School of Medicine and Biomedical Research Institute of Murcia (IMIB-Arrixaca-UMU), Murcia30100, Spain
| | - Dan Weksler-Derri
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva6676814, Israel
| | - Irina Mindlis
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY10029, USA
| | - Rachel Pinotti
- Gustave L. and Janet W. Levy Library, Icahn School of Medicine at Mount Sinai, New York, NY10029, USA
| | - Shanna H Swan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY10029, USA
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16
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Erenpreiss J, Punab M, Zilaitiene B, Hlevicka S, Zayakin P, Matulevicius V, Tomas Preiksa R, Jørgensen N. Semen quality of young men from the general population in Baltic countries. Hum Reprod 2018; 32:1334-1340. [PMID: 28383690 DOI: 10.1093/humrep/dex062] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/14/2017] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What are the parameters of semen quality in Baltic men? SUMMARY ANSWER Combined parameters of sperm concentration, motility and morphology revealed that 11-15% of men had low semen quality, 37-50% intermediate and 38-52% high semen quality. WHAT IS KNOWN ALREADY Previous studies have revealed regional differences in semen parameters, and semen quality of Baltic men has been suggested to be better than that of other European men. STUDY DESIGN, SIZE, DURATION This was a cross-sectional study of 1165 men aged 16-29 years from Estonia (N = 573), Latvia (N = 278) and Lithuania (N = 314) conducted in 2003-2004. PARTICIPANTS/MATERIALS SETTING METHODS Men from the general population, median age 19.8 years, provided one semen sample each, had blood samples taken, had testis size determined, and provided information on lifestyle. Based on combined data of sperm concentration, sperm motility and morphology the cohort was classified into three categories: low, intermediate or high semen quality. Comparisons between groups (including subgroups of Estonian men of Russian versus Estonian ethnicity) were tested, adjusting for ejaculation abstinence and age. MAIN RESULTS AND THE ROLE OF CHANCE The median sperm concentration of the Estonian, Latvian and Lithuanian populations of Baltic men was 63 mill/ml. Low semen quality was detected in 11-15% of the men, intermediate in 37-50% and high in 38-52%. No crucial differences between national subgroups were detected, except that a higher percentage (9.6%) of the subgroup of Russian Estonians reported having had cryptorchidism compared to the other men (2.5-3.6%, P < 0.001). Smoking had an adverse impact on both sperm concentration and total sperm counts (P < 0.001). LIMITATIONS REASONS FOR CAUTION The semen quality data were collected >10 years ago. Thus, a recent change in semen quality cannot be excluded. Owing to the study design, it is assumed, but unproven, that the men were representative of the general populations. Some men were very young (16 years), however, this was also the case for other European studies of similar populations. Assessment of sperm motility is associated with inter-observer variation, and no quality control was undertaken for sperm motility assessment to account for that. Thus, estimates of sperm motility should be interpreted with caution. WIDER IMPLICATIONS OF THE FINDINGS Analysis of the semen variables separately did not identify that a considerable percentage of Baltic men had low semen quality. The combined analysis, however, showed that more than one out of nine men had semen quality at a level indicating reduced fertility chances. We suggest that future studies of semen quality should be carried out reporting both results of single semen parameters and estimates that combine the most frequently assessed variables. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the EU fifth framework project Number QLK4-1999-01422 'Envir.Repro.Health' extension to Baltic countries Number QLRT-2001-02911; Estonian Science Foundation, grant numbers 2991 and PUT181. There are no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Juris Erenpreiss
- Latvian Biomedical Research and Study Center, Riga LV-1067, Latvia
| | - Margus Punab
- Andrology Center, Tartu University Hospital, 50406 Tartu, Estonia
| | - Birute Zilaitiene
- Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas LT-50009, Lithuania
| | | | - Pawel Zayakin
- Latvian Biomedical Research and Study Center, Riga LV-1067, Latvia
| | - Valentinas Matulevicius
- Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas LT-50009, Lithuania
| | - Romualdas Tomas Preiksa
- Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas LT-50009, Lithuania
| | - Niels Jørgensen
- Department of Growth and Reproduction, GR-5064, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), GR-5064, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
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17
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López-Espín JJ, Pérez-Palazón C, Maldonado-Cárceles AB, Román-Arias JD, Mendiola J, Torres-Cantero AM. Anogenital distance and variability in semen parameters. Syst Biol Reprod Med 2017; 64:71-79. [PMID: 29172721 DOI: 10.1080/19396368.2017.1401682] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to analyze whether the anogenital distance (AGD) was associated with variability in semen parameters. Semen parameters analyzed following the WHO guidelines and sperm DNA fragmentation were evaluated in 160 semen samples obtained over a period of a year from 16 healthy male volunteers. Two types of AGD measurements from the anus to the rear base of the scrotum (AGDAS) and to the cephalic insertion of the penis (AGDAP) were taken in each individual. The association between AGDs and semen parameters were studied using three statistical tools: a) general coefficient of variation (CV) and intra-individual coefficient of variation (CVi), b) general linear models for repeated measures, and c) mixed model fixed effects panel data. Men with shortened AGDAP have significantly greater intra-individual variability in sperm concentration, total sperm count, and normal sperm morphology. Conversely, greater total sperm motility was observed in men with long AGDAS. Shortened AGDAS was associated with less intra-individual variability of total sperm motility (progressive and non-progressive). AGD measurements were associated with the variability in semen parameters. AGD may be useful to determine intra-individual variability in semen parameters. ABBREVIATIONS AGD: anogenital distance; AGDAP: anogenital distance from the anus to the cephalic insertion of the penis; AGDAS: anogenital distance from the anus to the rear base of the scrotum; AIC: Akaike information criteria; BMI: body mass index; CV: general coefficient of variation; CVi: intra-individual coefficient of variation; GLM: generalized linear model; PR+NP: total sperm motility.
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Affiliation(s)
- José J López-Espín
- a Center of Operations Research , Miguel Hernandez University, Elche Campus , Elche , Spain
| | - Consuelo Pérez-Palazón
- b Gynaecological Center of Reproduction and Genetics , Murcia , Spain.,c Division of Preventive Medicine and Public Health , University of Murcia School of Medicine , IMIB-Arrixaca, Espinardo ( Murcia ), Spain
| | - Ana B Maldonado-Cárceles
- c Division of Preventive Medicine and Public Health , University of Murcia School of Medicine , IMIB-Arrixaca, Espinardo ( Murcia ), Spain.,d Department of Preventive Medicine , Reina Sofia University General Hospital , Murcia , Spain
| | | | - Jaime Mendiola
- c Division of Preventive Medicine and Public Health , University of Murcia School of Medicine , IMIB-Arrixaca, Espinardo ( Murcia ), Spain.,e CIBER of Epidemiology and Public Health (CIBERESP) , ISCIII, Madrid , Spain
| | - Alberto M Torres-Cantero
- c Division of Preventive Medicine and Public Health , University of Murcia School of Medicine , IMIB-Arrixaca, Espinardo ( Murcia ), Spain.,d Department of Preventive Medicine , Reina Sofia University General Hospital , Murcia , Spain.,e CIBER of Epidemiology and Public Health (CIBERESP) , ISCIII, Madrid , Spain.,f Regional Campus of Excellence Mare Nostrum , University of Murcia , Murcia , Spain
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Weihe P, Debes F, Halling J, Petersen MS, Muckle G, Odland JØ, Dudarev A, Ayotte P, Dewailly É, Grandjean P, Bonefeld-Jørgensen E. Health effects associated with measured levels of contaminants in the Arctic. Int J Circumpolar Health 2016; 75:33805. [PMID: 27974137 PMCID: PMC5156856 DOI: 10.3402/ijch.v75.33805] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The Human Health Assessment Group has over the past decade recommended that effect studies be conducted in the circumpolar area. Such studies examine the association between contaminant exposure in the Arctic populations and health effects. Because foetuses and young children are the most vulnerable, effect studies are often prospective child cohort studies. The emphasis in this article is on a description of the effects associated with contaminant exposure in the Arctic. The main topics addressed are neurobehavioural, immunological, reproductive, cardiovascular, endocrine and carcinogenic effect. For each topic, the association between exposure and effects is described, and some results are reported for similar studies outside the Arctic.
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Affiliation(s)
- Pál Weihe
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Torshavn, Faroe Islands;
| | - Fróði Debes
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Torshavn, Faroe Islands
| | - Jónrit Halling
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Torshavn, Faroe Islands
| | - Maria Skaalum Petersen
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Torshavn, Faroe Islands
| | - Gina Muckle
- École de psychologie, Université Laval and Centre de recherche du CHU de Québec, Québec, City, QC, Canada
| | - Jon Øyvind Odland
- Department of Community Medicine, UiT The Arctic University of Norway, Tromso, Norway
| | - Alexey Dudarev
- Northwest Public Health Research Center, St. Petersburg, Russia
| | | | | | - Philippe Grandjean
- Department of Environmental Medicine, Univerisity of Southern Denmark, Odense, Denmark
| | - Eva Bonefeld-Jørgensen
- Centre for Arctic Health, Department of Public Health, Aarhus University, Aarhus, Denmark
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Priskorn L, Jensen TK, Bang AK, Nordkap L, Joensen UN, Lassen TH, Olesen IA, Swan SH, Skakkebaek NE, Jørgensen N. Is Sedentary Lifestyle Associated With Testicular Function? A Cross-Sectional Study of 1,210 Men. Am J Epidemiol 2016; 184:284-94. [PMID: 27501721 DOI: 10.1093/aje/kwv338] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 12/02/2015] [Indexed: 11/12/2022] Open
Abstract
Based on cross-sectional data on 1,210 healthy young Danish men, we investigated whether sedentary lifestyle was associated with testicular function (semen quality and reproductive hormones) independent of physical activity. The men were invited to participate in the study between 2008 and 2012, when they attended a compulsory medical examination to determine their fitness for military service. Information on sedentary behavior (television watching and computer time) and physical activity was obtained by questionnaire. The men had a physical examination, delivered a semen sample, and had a blood sample drawn. Time spent watching television, but not time sitting in front of a computer, was associated with lower sperm counts. Men who watched television more than 5 hours/day had an adjusted sperm concentration of 37 million/mL (95% confidence interval (CI): 30, 44) versus 52 million/mL (95% CI: 43, 62) among men who did not watch television; total sperm counts in those 2 groups were 104 million (95% CI: 84, 126) and 158 million (95% CI: 130, 189), respectively. Furthermore, an increase in follicle-stimulating hormone and decreases in testosterone and the testosterone/luteinizing hormone ratio were detected in men watching many hours of television. Self-rated physical fitness, but not time spent on physical activity, was positively associated with sperm counts.
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21
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Matulevicius V, Zilaitiene B, Preiksa RT, Banisauskaite I, Jurevičiūtė J, Abramavicius S, Matuleviciute I, Kurakovas T, Ostrauskas R, Verkauskiene R, Urbanavicius V. APPROACHES TO THE 26-36-YEAR-OLD LITHUANIAN MEN'S SEXUAL FUNCTION. ACTA ENDOCRINOLOGICA-BUCHAREST 2016; 12:168-176. [PMID: 31149083 DOI: 10.4183/aeb.2016.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Context In the year 2003-2004 a circumstantial investigation of young men reproductive health parameters was performed in Nordic and Baltic countries, but sexuality remained undetermined. Objective To determine the suitability of the European Male Ageing Study - Sexual Function Questionnaire (EMAS - SFQ) for investigation of sexuality of 26-36 year aged general population and to investigate sexuality of Kaunas participants in the project "The reproductive function of Estonian, Latvian and Lithuanian Young men (2003-2004)" (KELLY), using EMAS - SFQ. Design Sixty one 26-36 year aged KELLY men were recaptured from the list of participants in a 2003-2004 study and completed EMAS - SFQ. Their anthropometric characteristics, scores of sexuality (22 parameters from EMAS - SFQ, 3 calculated parameters and 2 parameters consisting from answers to the only question - masturbation and erectile function-for each participant) were analysed, in conjunction with anthropometric, sperm quality and hormone levels of 2003-2004 18-25 year old general population. Results Overall sexual functioning and masturbation were higher as compared to all the published data for different age men and different testosterone concentration groups of EMAS study. Conclusions KELLY sexuality results, obtained using EMAS - SFQ, would be considered as referral values for young men in countries with generally good reproductive health.
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Affiliation(s)
- V Matulevicius
- Lithuanian University of Health Sciences, Institute of Endocrinology, Kaunas, Lithuania
| | - B Zilaitiene
- Lithuanian University of Health Sciences, Institute of Endocrinology, Kaunas, Lithuania
| | - R T Preiksa
- Lithuanian University of Health Sciences, Institute of Endocrinology, Kaunas, Lithuania
| | - I Banisauskaite
- Lithuanian University of Health Sciences, Institute of Endocrinology, Kaunas, Lithuania
| | - J Jurevičiūtė
- Lithuanian University of Health Sciences, Institute of Endocrinology, Kaunas, Lithuania
| | - S Abramavicius
- Lithuanian University of Health Sciences, Institute of Endocrinology, Kaunas, Lithuania
| | - I Matuleviciute
- Lithuanian University of Health Sciences, Institute of Endocrinology, Kaunas, Lithuania
| | - T Kurakovas
- Lithuanian University of Health Sciences, Institute of Endocrinology, Kaunas, Lithuania
| | - R Ostrauskas
- Lithuanian University of Health Sciences, Institute of Endocrinology, Kaunas, Lithuania
| | - R Verkauskiene
- Lithuanian University of Health Sciences, Institute of Endocrinology, Kaunas, Lithuania
| | - V Urbanavicius
- Vilnius University, Faculty of Medicine, Vilnius, Lithuania
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Hart RJ, Doherty DA, McLachlan RI, Walls ML, Keelan JA, Dickinson JE, Skakkebaek NE, Norman RJ, Handelsman DJ. Testicular function in a birth cohort of young men. Hum Reprod 2015; 30:2713-24. [PMID: 26409015 DOI: 10.1093/humrep/dev244] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 09/08/2015] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION By investigating a birth cohort with a high ongoing participation rate to derive an unbiased population, what are the parameters and influences upon testicular function for a population not selected with regard to fertility? SUMMARY ANSWER While varicocele, cryptorchidism and obesity may impact on human testicular function, most common drug exposures and the presence of epididymal cysts appear to have no or minimal adverse impact. WHAT IS KNOWN ALREADY The majority of previous attempts to develop valid reference populations for spermatogenesis have relied on potentially biased sources such as recruits from infertility clinics, self-selected volunteer sperm donors for research or artificial insemination or once-fertile men seeking vasectomy. It is well known that studies requiring semen analysis have low recruitment rates which consequently question their validity. However, there has been some concern that a surprisingly high proportion of young men may have semen variables that do not meet all the WHO reference range criteria for fertile men, with some studies reporting that up to one half of participants have not meet the reference range for fertile men. Reported median sperm concentrations have ranged from 40 to 60 million sperm/ml. STUDY DESIGN, SIZE AND DURATION The Western Australian Pregnancy Cohort (Raine) was established in 1989. At 20-22 years of age, members of the cohort were contacted to attend for a general follow-up, with 753 participating out of the 913 contactable men. Of these, 423 men (56% of participants in the 20-22 years cohort study, 46% of contactable men) participated in a testicular function study. Of the 423 men, 404 had a testicular ultrasound, 365 provided at least one semen sample, 287 provided a second semen sample and 384 provided a blood sample. PARTICIPANTS/MATERIALS, SETTING, METHODS Testicular ultrasound examinations were performed at King Edward Memorial Hospital, Subiaco, Perth, for testicular volume and presence of epididymal cysts and varicoceles. Semen samples were provided and analysed by standard semen assessment and a sperm chromatin structural assay (SCSA) at Fertility Specialists of Western Australia, Claremont, Perth. Serum blood samples were provided at the University of Western Australia, Crawley, Perth and were analysed for serum luteinizing hormone (LH), follicular stimulating hormone (FSH), inhibin B, testosterone, dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), estradiol, estrone and the primary metabolites of DHT: 5α-androstane-3α,17β-diol (3α-diol) and 5-α androstane-3-β-17-beta-diol (3β-diol). Serum steroids were measured by liquid chromatography, mass spectrometry and LH, FSH and inhibin B were measured by ELISA assays. MAIN RESULTS AND THE ROLE OF CHANCE Cryptorchidism was associated with a significant reduction in testicular (P = 0.047) and semen (P = 0.027) volume, sperm concentration (P = 0.007) and sperm output (P = 0.003). Varicocele was associated with smaller testis volume (P < 0.001), lower sperm concentration (P = 0.012) and total sperm output (P = 0.030) and lower serum inhibin B levels (P = 0.046). Smoking, alcohol intake, herniorrhaphy, an epididymal cyst, medication and illicit drugs were not associated with any significant semen variables, testicular volume or circulating reproductive hormones. BMI had a significantly negative correlation with semen volume (r = -0.12, P = 0.048), sperm output (r = -0.13, P = 0.02), serum LH (r = -0.16, P = 0.002), inhibin B (r = -0.16, P < 0.001), testosterone (r = -0.23, P < 0.001) and DHT (r = -0.22, P < 0.001) and a positive correlation with 3αD (r = 0.13, P = 0.041) and DHEA (r = 0.11, P = 0.03). Second semen samples compared with the first semen samples in the 287 participants who provided two samples, with no significant bias by Bland-Altman analysis. Testis volume was significantly correlated positively with sperm concentration (r = 0.25, P < 0.001) and sperm output (r = 0.29, P < 0.001) and inhibin B (r = 0.42, P < 0.001), and negatively correlated with serum LH (r = -0.24, P < 0.001) and FSH (r = -0.32, P < 0.001). SCSA was inversely correlated with sperm motility (r = -0.20, P < 0.001) and morphology (r = -0.16, P = 0.005). WHO semen reference criteria were all met by only 52 men (14.4%). Some criteria were not met at first analysis in 15-20% of men, including semen volume (<1.5 ml, 14.8%), total sperm output (<39 million, 18.9%), sperm concentration (<15 million/ml, 17.5%), progressive motility (<32%, 14.4%) and morphologically normal sperm (<4%, 26.4%), while all five WHO criteria were not met in four participants (1.1%). LIMITATIONS AND REASONS FOR CAUTION This was a large cohort study; however, potential for recruitment bias still exists. Men who did not participate in the testicular evaluation study (n = 282) did not differ from those who did (n = 423) with regard to age, weight, BMI, smoking or circulating reproductive hormones (LH, FSH, inhibin B, T, DHT, E2, E1, DHEA, 3α-diol, 3β-diol), but were significantly shorter (178 versus 180 cm, P = 0.008) and had lower alcohol consumption (P = 0.019) than those who did participate. WIDER IMPLICATIONS OF THE FINDINGS This study demonstrated the feasibility of establishing a birth cohort to provide a relatively unbiased insight into population-representative sperm output and function and of investigating its determinants from common exposures. While varicocele, cryptorchidism and obesity may impact on human testicular function, most common drug exposures and the presence of epididymal cysts appear to have little adverse impact, and this study suggests that discrepancies from the WHO reference ranges are expected, due to its derivation from non-population-representative fertile populations.
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Affiliation(s)
- R J Hart
- School of Women's and Infants' Health, University of Western Australia, Perth, WA 6008, Australia Fertility Specialists of Western Australia, Bethesda Hospital, 25 Queenslea Drive, Claremont, WA 6010, Australia
| | - D A Doherty
- School of Women's and Infants' Health, University of Western Australia, Perth, WA 6008, Australia Women and Infants Research Foundation, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Perth, WA, Australia
| | - R I McLachlan
- Hudson Institute of Medical Research, Monash Medical Centre, Melbourne, Australia
| | - M L Walls
- School of Women's and Infants' Health, University of Western Australia, Perth, WA 6008, Australia Fertility Specialists of Western Australia, Bethesda Hospital, 25 Queenslea Drive, Claremont, WA 6010, Australia
| | - J A Keelan
- School of Women's and Infants' Health, University of Western Australia, Perth, WA 6008, Australia Women and Infants Research Foundation, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Perth, WA, Australia
| | - J E Dickinson
- School of Women's and Infants' Health, University of Western Australia, Perth, WA 6008, Australia Women and Infants Research Foundation, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Perth, WA, Australia
| | - N E Skakkebaek
- Department of Growth and Reproduction, University Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark
| | - R J Norman
- Robinson Institute, University of Adelaide, FertilitySA, Adelaide, Australia
| | - D J Handelsman
- ANZAC Research Institute, University of Sydney, Concord Hospital, Sydney, Australia
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Bandel I, Bungum M, Richtoff J, Malm J, Axelsson J, Pedersen HS, Ludwicki JK, Czaja K, Hernik A, Toft G, Bonde JP, Spano M, Malm G, Haugen TB, Giwercman A. No association between body mass index and sperm DNA integrity. Hum Reprod 2015; 30:1704-13. [DOI: 10.1093/humrep/dev111] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/24/2015] [Indexed: 01/03/2023] Open
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Vested A, Ramlau-Hansen CH, Olsen SF, Bonde JP, Støvring H, Kristensen SL, Halldorsson TI, Rantakokko P, Kiviranta H, Ernst EH, Toft G. In utero exposure to persistent organochlorine pollutants and reproductive health in the human male. Reproduction 2014; 148:635-46. [PMID: 25190505 PMCID: PMC4241711 DOI: 10.1530/rep-13-0488] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Persistent organochlorine pollutants (POPs) are ubiquitous, bioaccumulative compounds with potential endocrine-disrupting effects. They cross the placental barrier thereby resulting in in utero exposure of the developing fetus. The objective of this study was to investigate whether maternal serum concentrations of polychlorinated biphenyls (PCBs) and p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE) during pregnancy are associated with son's semen quality and reproductive hormone levels. During 2008-2009, we recruited 176 male offspring from a Danish cohort of pregnant women who participated in a study in 1988-1989. Each provided semen and blood samples that were analyzed for sperm concentration, total sperm count, motility, and morphology, and reproductive hormone levels, respectively. The maternal blood samples were collected in pregnancy week 30 and were analyzed for the concentrations of six PCBs (PCB-118, -138, -153, -156, -170, and -180) and p,p'-DDE. The potential associations between in utero exposure to ΣPCBs (pmol/ml), Σdioxin like-(DL) PCBs (PCB-118 and -156) (pmol/ml), and p,p'-DDE and semen quality and reproductive hormone levels were investigated using multiple regression. Maternal median (range) exposure levels of ΣPCB, ΣDL-PCB, and p,p'-DDE were 10.0 (2.1-35.0) pmol/ml, 0.8 (0.2-2.7) pmol/ml, and 8.0 (0.7-55.3) pmol/ml, respectively, reflecting typical background exposure levels in the late 1980s in Denmark. Results suggested that in utero exposure to ΣPCB, ΣDL-PCB, and p,p'-DDE was not statistically significantly associated with semen quality measures or reproductive hormone levels. Thus, results based on maternal PCB and p,p'-DDE concentrations alone are not indicative of long-term consequences for male reproductive health; however, we cannot exclude that these POPs in concert with other endocrine-modulating compounds may have adverse effects.
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Affiliation(s)
- Anne Vested
- Department of Occupational MedicineDanish Ramazzini Centre, Aarhus University Hospital, Noerrebrogade 44 Building 2C, DK-8000 Aarhus C, DenmarkSection for EpidemiologyDepartment of Public Health, University of Aarhus, Bartholins Allé 2 Building 1260, DK-8000 Aarhus C, DenmarkStatens Serum InstitutCentre for Fetal Programming, Artellerivej 5, DK-2300 Copenhagen S, DenmarkDepartment of Occupational and Environmental MedicineBispebjerg Hospital of Copenhagen University, Bispebjerg Bakke 23 Building 33 1st floor, DK-2400 Copenhagen NV, DenmarkDepartment of Public HealthBiostatistics, Bartholins Allé 2 Building 1261, DK-8000 Aarhus C, DenmarkFaculty of Food Science and NutritionUniversity of Iceland, Eiríksgata 29, 101 Reykjavík, IcelandDepartment of Environmental HealthNational Institute for Health and Welfare (THL), PO Box 95, FI-70701 Kuopio, FinlandSection WestInstitute for Biomedicine, Aarhus University, Ole Worms Allé 2, build. 1170, 8000 Aarhus C, Denmark
| | - Cecilia H Ramlau-Hansen
- Department of Occupational MedicineDanish Ramazzini Centre, Aarhus University Hospital, Noerrebrogade 44 Building 2C, DK-8000 Aarhus C, DenmarkSection for EpidemiologyDepartment of Public Health, University of Aarhus, Bartholins Allé 2 Building 1260, DK-8000 Aarhus C, DenmarkStatens Serum InstitutCentre for Fetal Programming, Artellerivej 5, DK-2300 Copenhagen S, DenmarkDepartment of Occupational and Environmental MedicineBispebjerg Hospital of Copenhagen University, Bispebjerg Bakke 23 Building 33 1st floor, DK-2400 Copenhagen NV, DenmarkDepartment of Public HealthBiostatistics, Bartholins Allé 2 Building 1261, DK-8000 Aarhus C, DenmarkFaculty of Food Science and NutritionUniversity of Iceland, Eiríksgata 29, 101 Reykjavík, IcelandDepartment of Environmental HealthNational Institute for Health and Welfare (THL), PO Box 95, FI-70701 Kuopio, FinlandSection WestInstitute for Biomedicine, Aarhus University, Ole Worms Allé 2, build. 1170, 8000 Aarhus C, Denmark Department of Occupational MedicineDanish Ramazzini Centre, Aarhus University Hospital, Noerrebrogade 44 Building 2C, DK-8000 Aarhus C, DenmarkSection for EpidemiologyDepartment of Public Health, University of Aarhus, Bartholins Allé 2 Building 1260, DK-8000 Aarhus C, DenmarkStatens Serum InstitutCentre for Fetal Programming, Artellerivej 5, DK-2300 Copenhagen S, DenmarkDepartment of Occupational and Environmental MedicineBispebjerg Hospital of Copenhagen University, Bispebjerg Bakke 23 Building 33 1st floor, DK-2400 Copenhagen NV, DenmarkDepartment of Public HealthBiostatistics, Bartholins Allé 2 Building 1261, DK-8000 Aarhus C, DenmarkFaculty of Food Science and NutritionUniversity of Iceland, Eiríksgata 29, 101 Reykjavík, IcelandDepartment of Environmental HealthNational Institute for Health and Welfare (THL), PO Box 95, FI-70701 Kuopio, FinlandSection WestInstitute for Biomedicine, Aarhus University, Ole Worms Allé 2, build. 1170, 8000 Aarhus C, Denmark
| | - Sjurdur F Olsen
- Department of Occupational MedicineDanish Ramazzini Centre, Aarhus University Hospital, Noerrebrogade 44 Building 2C, DK-8000 Aarhus C, DenmarkSection for EpidemiologyDepartment of Public Health, University of Aarhus, Bartholins Allé 2 Building 1260, DK-8000 Aarhus C, DenmarkStatens Serum InstitutCentre for Fetal Programming, Artellerivej 5, DK-2300 Copenhagen S, DenmarkDepartment of Occupational and Environmental MedicineBispebjerg Hospital of Copenhagen University, Bispebjerg Bakke 23 Building 33 1st floor, DK-2400 Copenhagen NV, DenmarkDepartment of Public HealthBiostatistics, Bartholins Allé 2 Building 1261, DK-8000 Aarhus C, DenmarkFaculty of Food Science and NutritionUniversity of Iceland, Eiríksgata 29, 101 Reykjavík, IcelandDepartment of Environmental HealthNational Institute for Health and Welfare (THL), PO Box 95, FI-70701 Kuopio, FinlandSection WestInstitute for Biomedicine, Aarhus University, Ole Worms Allé 2, build. 1170, 8000 Aarhus C, Denmark
| | - Jens Peter Bonde
- Department of Occupational MedicineDanish Ramazzini Centre, Aarhus University Hospital, Noerrebrogade 44 Building 2C, DK-8000 Aarhus C, DenmarkSection for EpidemiologyDepartment of Public Health, University of Aarhus, Bartholins Allé 2 Building 1260, DK-8000 Aarhus C, DenmarkStatens Serum InstitutCentre for Fetal Programming, Artellerivej 5, DK-2300 Copenhagen S, DenmarkDepartment of Occupational and Environmental MedicineBispebjerg Hospital of Copenhagen University, Bispebjerg Bakke 23 Building 33 1st floor, DK-2400 Copenhagen NV, DenmarkDepartment of Public HealthBiostatistics, Bartholins Allé 2 Building 1261, DK-8000 Aarhus C, DenmarkFaculty of Food Science and NutritionUniversity of Iceland, Eiríksgata 29, 101 Reykjavík, IcelandDepartment of Environmental HealthNational Institute for Health and Welfare (THL), PO Box 95, FI-70701 Kuopio, FinlandSection WestInstitute for Biomedicine, Aarhus University, Ole Worms Allé 2, build. 1170, 8000 Aarhus C, Denmark
| | - Henrik Støvring
- Department of Occupational MedicineDanish Ramazzini Centre, Aarhus University Hospital, Noerrebrogade 44 Building 2C, DK-8000 Aarhus C, DenmarkSection for EpidemiologyDepartment of Public Health, University of Aarhus, Bartholins Allé 2 Building 1260, DK-8000 Aarhus C, DenmarkStatens Serum InstitutCentre for Fetal Programming, Artellerivej 5, DK-2300 Copenhagen S, DenmarkDepartment of Occupational and Environmental MedicineBispebjerg Hospital of Copenhagen University, Bispebjerg Bakke 23 Building 33 1st floor, DK-2400 Copenhagen NV, DenmarkDepartment of Public HealthBiostatistics, Bartholins Allé 2 Building 1261, DK-8000 Aarhus C, DenmarkFaculty of Food Science and NutritionUniversity of Iceland, Eiríksgata 29, 101 Reykjavík, IcelandDepartment of Environmental HealthNational Institute for Health and Welfare (THL), PO Box 95, FI-70701 Kuopio, FinlandSection WestInstitute for Biomedicine, Aarhus University, Ole Worms Allé 2, build. 1170, 8000 Aarhus C, Denmark
| | - Susanne L Kristensen
- Department of Occupational MedicineDanish Ramazzini Centre, Aarhus University Hospital, Noerrebrogade 44 Building 2C, DK-8000 Aarhus C, DenmarkSection for EpidemiologyDepartment of Public Health, University of Aarhus, Bartholins Allé 2 Building 1260, DK-8000 Aarhus C, DenmarkStatens Serum InstitutCentre for Fetal Programming, Artellerivej 5, DK-2300 Copenhagen S, DenmarkDepartment of Occupational and Environmental MedicineBispebjerg Hospital of Copenhagen University, Bispebjerg Bakke 23 Building 33 1st floor, DK-2400 Copenhagen NV, DenmarkDepartment of Public HealthBiostatistics, Bartholins Allé 2 Building 1261, DK-8000 Aarhus C, DenmarkFaculty of Food Science and NutritionUniversity of Iceland, Eiríksgata 29, 101 Reykjavík, IcelandDepartment of Environmental HealthNational Institute for Health and Welfare (THL), PO Box 95, FI-70701 Kuopio, FinlandSection WestInstitute for Biomedicine, Aarhus University, Ole Worms Allé 2, build. 1170, 8000 Aarhus C, Denmark
| | - Thorhallur I Halldorsson
- Department of Occupational MedicineDanish Ramazzini Centre, Aarhus University Hospital, Noerrebrogade 44 Building 2C, DK-8000 Aarhus C, DenmarkSection for EpidemiologyDepartment of Public Health, University of Aarhus, Bartholins Allé 2 Building 1260, DK-8000 Aarhus C, DenmarkStatens Serum InstitutCentre for Fetal Programming, Artellerivej 5, DK-2300 Copenhagen S, DenmarkDepartment of Occupational and Environmental MedicineBispebjerg Hospital of Copenhagen University, Bispebjerg Bakke 23 Building 33 1st floor, DK-2400 Copenhagen NV, DenmarkDepartment of Public HealthBiostatistics, Bartholins Allé 2 Building 1261, DK-8000 Aarhus C, DenmarkFaculty of Food Science and NutritionUniversity of Iceland, Eiríksgata 29, 101 Reykjavík, IcelandDepartment of Environmental HealthNational Institute for Health and Welfare (THL), PO Box 95, FI-70701 Kuopio, FinlandSection WestInstitute for Biomedicine, Aarhus University, Ole Worms Allé 2, build. 1170, 8000 Aarhus C, Denmark Department of Occupational MedicineDanish Ramazzini Centre, Aarhus University Hospital, Noerrebrogade 44 Building 2C, DK-8000 Aarhus C, DenmarkSection for EpidemiologyDepartment of Public Health, University of Aarhus, Bartholins Allé 2 Building 1260, DK-8000 Aarhus C, DenmarkStatens Serum InstitutCentre for Fetal Programming, Artellerivej 5, DK-2300 Copenhagen S, DenmarkDepartment of Occupational and Environmental MedicineBispebjerg Hospital of Copenhagen University, Bispebjerg Bakke 23 Building 33 1st floor, DK-2400 Copenhagen NV, DenmarkDepartment of Public HealthBiostatistics, Bartholins Allé 2 Building 1261, DK-8000 Aarhus C, DenmarkFaculty of Food Science and NutritionUniversity of Iceland, Eiríksgata 29, 101 Reykjavík, IcelandDepartment of Environmental HealthNational Institute for Health and Welfare (THL), PO Box 95, FI-70701 Kuopio, FinlandSection WestInstitute for Biomedicine, Aarhus University, Ole Worms Allé 2, build. 1170, 8000 Aarhus C, Denmark
| | - Panu Rantakokko
- Department of Occupational MedicineDanish Ramazzini Centre, Aarhus University Hospital, Noerrebrogade 44 Building 2C, DK-8000 Aarhus C, DenmarkSection for EpidemiologyDepartment of Public Health, University of Aarhus, Bartholins Allé 2 Building 1260, DK-8000 Aarhus C, DenmarkStatens Serum InstitutCentre for Fetal Programming, Artellerivej 5, DK-2300 Copenhagen S, DenmarkDepartment of Occupational and Environmental MedicineBispebjerg Hospital of Copenhagen University, Bispebjerg Bakke 23 Building 33 1st floor, DK-2400 Copenhagen NV, DenmarkDepartment of Public HealthBiostatistics, Bartholins Allé 2 Building 1261, DK-8000 Aarhus C, DenmarkFaculty of Food Science and NutritionUniversity of Iceland, Eiríksgata 29, 101 Reykjavík, IcelandDepartment of Environmental HealthNational Institute for Health and Welfare (THL), PO Box 95, FI-70701 Kuopio, FinlandSection WestInstitute for Biomedicine, Aarhus University, Ole Worms Allé 2, build. 1170, 8000 Aarhus C, Denmark
| | - Hannu Kiviranta
- Department of Occupational MedicineDanish Ramazzini Centre, Aarhus University Hospital, Noerrebrogade 44 Building 2C, DK-8000 Aarhus C, DenmarkSection for EpidemiologyDepartment of Public Health, University of Aarhus, Bartholins Allé 2 Building 1260, DK-8000 Aarhus C, DenmarkStatens Serum InstitutCentre for Fetal Programming, Artellerivej 5, DK-2300 Copenhagen S, DenmarkDepartment of Occupational and Environmental MedicineBispebjerg Hospital of Copenhagen University, Bispebjerg Bakke 23 Building 33 1st floor, DK-2400 Copenhagen NV, DenmarkDepartment of Public HealthBiostatistics, Bartholins Allé 2 Building 1261, DK-8000 Aarhus C, DenmarkFaculty of Food Science and NutritionUniversity of Iceland, Eiríksgata 29, 101 Reykjavík, IcelandDepartment of Environmental HealthNational Institute for Health and Welfare (THL), PO Box 95, FI-70701 Kuopio, FinlandSection WestInstitute for Biomedicine, Aarhus University, Ole Worms Allé 2, build. 1170, 8000 Aarhus C, Denmark
| | - Emil H Ernst
- Department of Occupational MedicineDanish Ramazzini Centre, Aarhus University Hospital, Noerrebrogade 44 Building 2C, DK-8000 Aarhus C, DenmarkSection for EpidemiologyDepartment of Public Health, University of Aarhus, Bartholins Allé 2 Building 1260, DK-8000 Aarhus C, DenmarkStatens Serum InstitutCentre for Fetal Programming, Artellerivej 5, DK-2300 Copenhagen S, DenmarkDepartment of Occupational and Environmental MedicineBispebjerg Hospital of Copenhagen University, Bispebjerg Bakke 23 Building 33 1st floor, DK-2400 Copenhagen NV, DenmarkDepartment of Public HealthBiostatistics, Bartholins Allé 2 Building 1261, DK-8000 Aarhus C, DenmarkFaculty of Food Science and NutritionUniversity of Iceland, Eiríksgata 29, 101 Reykjavík, IcelandDepartment of Environmental HealthNational Institute for Health and Welfare (THL), PO Box 95, FI-70701 Kuopio, FinlandSection WestInstitute for Biomedicine, Aarhus University, Ole Worms Allé 2, build. 1170, 8000 Aarhus C, Denmark
| | - Gunnar Toft
- Department of Occupational MedicineDanish Ramazzini Centre, Aarhus University Hospital, Noerrebrogade 44 Building 2C, DK-8000 Aarhus C, DenmarkSection for EpidemiologyDepartment of Public Health, University of Aarhus, Bartholins Allé 2 Building 1260, DK-8000 Aarhus C, DenmarkStatens Serum InstitutCentre for Fetal Programming, Artellerivej 5, DK-2300 Copenhagen S, DenmarkDepartment of Occupational and Environmental MedicineBispebjerg Hospital of Copenhagen University, Bispebjerg Bakke 23 Building 33 1st floor, DK-2400 Copenhagen NV, DenmarkDepartment of Public HealthBiostatistics, Bartholins Allé 2 Building 1261, DK-8000 Aarhus C, DenmarkFaculty of Food Science and NutritionUniversity of Iceland, Eiríksgata 29, 101 Reykjavík, IcelandDepartment of Environmental HealthNational Institute for Health and Welfare (THL), PO Box 95, FI-70701 Kuopio, FinlandSection WestInstitute for Biomedicine, Aarhus University, Ole Worms Allé 2, build. 1170, 8000 Aarhus C, Denmark
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Sävblom C, Halldén C, Cronin AM, Säll T, Savage C, Vertosick EA, Klein RJ, Giwercman A, Lilja H. Genetic variation in KLK2 and KLK3 is associated with concentrations of hK2 and PSA in serum and seminal plasma in young men. Clin Chem 2013; 60:490-9. [PMID: 24270797 DOI: 10.1373/clinchem.2013.211219] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Genetic variants in KLK2 and KLK3 have been associated with increased serum concentrations of their encoded proteins, human kallikrein-related peptidase 2 (hK2) and prostate-specific antigen (PSA), and with prostate cancer in older men. Low PSA concentrations in seminal plasma (SP) have been associated with low sperm motility. To evaluate whether KLK2 and KLK3 genetic variants affect physiological prostatic secretion, we studied the association of SNPs with hK2 and PSA concentrations in SP and serum of young, healthy men. METHODS Leukocyte DNA was extracted from 303 male military conscripts (median age 18.1 years). Nine SNPs across KLK2-KLK3 were genotyped. We measured PSA and hK2 in SP and serum using immunofluorometric assays. The association of genotype frequencies with hK2 and PSA concentrations was tested with the Kruskal-Wallis test. RESULTS Four KLK2 SNPs (rs198972, rs198977, rs198978, and rs80050017) were strongly associated with hK2 concentrations in SP and serum, with individuals homozygous for the major alleles having 3- to 7-fold higher concentrations than the intermediate concentrations found in other homozygotes and heterozygotes (all P < 0.001). Three of these SNPs were significantly associated with percentage of free PSA (%fPSA) in serum (all P < 0.007). Three KLK3 SNPs showed associations with PSA in SP, and the rs1058205 SNP was associated with total PSA in serum (P = 0.001) and %fPSA (P = 0.015). CONCLUSIONS Associations observed in young, healthy men between the SP and serum concentrations of hK2 and PSA and several genetic variants in KLK2 and KLK3 could be useful to refine models of PSA cutoff values in prostate cancer testing.
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Affiliation(s)
- Charlotta Sävblom
- Department of Laboratory Medicine, Division of Clinical Chemistry, and
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Axelsson J, Rylander L, Rignell-Hydbom A, Silfver KÅ, Stenqvist A, Giwercman A. The Impact of Paternal and Maternal Smoking on Semen Quality of Adolescent Men. PLoS One 2013; 8:e66766. [PMID: 23840528 PMCID: PMC3694111 DOI: 10.1371/journal.pone.0066766] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 05/15/2013] [Indexed: 01/22/2023] Open
Abstract
Background Maternal smoking during pregnancy has been reported to negatively impact sperm counts of the sons. Sufficient data on the effect of paternal smoking is lacking. Objectives We wished to elucidate the impact of maternal and paternal smoking during pregnancy and current own smoking on reproductive function of the male offspring. Methods Semen parameters including sperm DNA integrity were analyzed in 295 adolescents from the general population close to Malmö, Sweden, recruited for the study during 2008–2010. Information on maternal smoking was obtained from the Swedish Medical Birth Register, and regarding own and paternal smoking from questionnaires. The impacts of maternal, paternal and own smoking were evaluated in a multivariate regression model and by use of models including interaction terms. Totally, three exposures and five outcomes were evaluated. Results In maternally unexposed men, paternal smoking was associated with 46% lower total sperm count (95%CI: 21%, 64%) in maternally unexposed men. Both paternal and maternal smoking were associated with a lower sperm concentration (mean differences: 35%; 95%CI: 8.1%, 55% and 36%; 95%CI: 3.9%, 57%, respectively) if the other parent was a non-smoker. No statistically significant impact of own smoking on semen parameters was seen. Conclusions Prenatal both maternal and paternal smoking were separately associated with some decrease in sperm count in men of whom the other parent was not reported to smoke.
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Affiliation(s)
- Jonatan Axelsson
- Reproductive Medicine Centre, Skåne University Hospital, Malmö, Sweden
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
- * E-mail:
| | - Lars Rylander
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Anna Rignell-Hydbom
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | | | - Amelie Stenqvist
- Reproductive Medicine Centre, Skåne University Hospital, Malmö, Sweden
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Serrano T, Chevrier C, Multigner L, Cordier S, Jegou B. International geographic correlation study of the prevalence of disorders of male reproductive health. Hum Reprod 2013; 28:1974-86. [DOI: 10.1093/humrep/det111] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Halling J, Petersen MS, Jørgensen N, Jensen TK, Grandjean P, Weihe P. Semen quality and reproductive hormones in Faroese men: a cross-sectional population-based study of 481 men. BMJ Open 2013; 3:bmjopen-2012-001946. [PMID: 23457323 PMCID: PMC3612804 DOI: 10.1136/bmjopen-2012-001946] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To determine semen quality and reproductive hormone levels in young Faroese men. DESIGN Descriptive cross-sectional study of Faroese men compared with Danish men. SETTING Faroese one-centre study. PARTICIPANTS 481 men born from 1981 to 1987 and investigated from 2007 to 2010. OUTCOME MEASURES Sperm concentration, semen volume, total sperm count, sperm motility, sperm morphology and reproductive hormone levels. RESULTS Sperm concentrations for the Faroese men were lower than for the Danish men (crude median 40 vs 48 mill/ml, p<0.0005). Semen volume was higher, and thus the total sperm counts did not differ (159 vs 151 mill, p=0.2). Motility and morphology did not differ between the Faroese and Danes. The inhibin B/follicle-stimulating hormone ratios for the Faroese men were lower than for the Danes (64 vs 76, p=0.001). Similarly, lower total testosterone/luteinising hormone (LH) ratio (4.6 vs 6.0, p<0.0005) and lower calculated free-testosterone/LH ratio (94 vs 134, p<0.0005) were detected for the Faroese men. CONCLUSIONS Semen quality among the Faroese men is at the same low level as reported for Danish men, and the reproductive hormone levels furthermore indicated a lower Leydig cell capacity for testosterone production. The influence of environmental exposure and genetic factors on semen quality has to be studied further.
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Affiliation(s)
- Jónrit Halling
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Torshavn, Faroe Islands
| | - Maria Skaalum Petersen
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Torshavn, Faroe Islands
| | - Niels Jørgensen
- University Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark
| | - Tina Kold Jensen
- University Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark
- Department of Environmental Medicine, Institute of Public Health, Odense, Denmark
| | - Philippe Grandjean
- Department of Environmental Medicine, Institute of Public Health, Odense, Denmark
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Pál Weihe
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Torshavn, Faroe Islands
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Mendiola J, Jørgensen N, Mínguez-Alarcón L, Sarabia-Cos L, López-Espín JJ, Vivero-Salmerón G, Ruiz-Ruiz KJ, Fernández MF, Olea N, Swan SH, Torres-Cantero AM. Sperm counts may have declined in young university students in Southern Spain. Andrology 2013; 1:408-13. [PMID: 23307495 DOI: 10.1111/j.2047-2927.2012.00058.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 12/06/2012] [Accepted: 12/10/2012] [Indexed: 11/29/2022]
Abstract
Several studies have investigated temporal trends in semen quality in Northern Europe, but none has examined this question in Southern Europe. A prior study conducted in Almeria Province (Southern Spain) reported higher sperm count and concentration among Spanish young men recruited from 2001 to 2002 compared with young men from Northern Europe. The aim of this new study was to examine whether semen quality has changed among Spanish young men in the last decade. In this cross-sectional study, questionnaires and semen samples were collected from 215 healthy young university students from Murcia Region between 2010 and 2011. The 273 men from the Almeria study previously studied were included in a trend analysis of the two populations from Southern Spain. Descriptive statistics were calculated for the Murcia study population and these and semen variables for the Murcia and Almeria study populations were compared. Study methods and population characteristics were similar across the two studies. Therefore, we used multiple linear regression analyses on the combined population (controlling for study centre, age, ejaculation abstinence time, season, smoking, medication during the last 3 months, Body mass index (BMI), presence of varicocoele and prenatal exposure to tobacco) to look for a birth-cohort effect over the combined study period (2001-2011). Sperm concentration and total sperm count declined significantly with year of birth in the pooled analysis (β = -0.04 and β = -0.06, respectively, both p < 0.01). Sperm counts were significantly lower in Murcia study subjects than in the Almeria participants; sperm concentration median (5th-95th) = 44.0 (8.9-129) million/mL vs. 51.0 (5.0-206) million/mL; p < 0.01 and total sperm count = 121 (17.8-400) million vs. 149 (8.0-599) million; p < 0.01. Other semen variables did not differ significantly between the two studies. Our study suggests that total sperm count and sperm concentration may have declined in young Spanish men over the last decade.
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Affiliation(s)
- Jaime Mendiola
- Division of Preventive Medicine and Public Health, University of Murcia School of Medicine, Espinardo Murcia, Spain.
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Brokken LJS, Lundberg-Giwercman Y, Meyts ERD, Eberhard J, Ståhl O, Cohn-Cedermark G, Daugaard G, Arver S, Giwercman A. Association between polymorphisms in the aryl hydrocarbon receptor repressor gene and disseminated testicular germ cell cancer. Front Endocrinol (Lausanne) 2013; 4:4. [PMID: 23420531 PMCID: PMC3572423 DOI: 10.3389/fendo.2013.00004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 01/07/2013] [Indexed: 11/13/2022] Open
Abstract
In the Western world, testicular germ cell cancer (TGCC) is the most common malignancy of young men. The malignant transformation of germ cells is thought to be caused by developmental and hormonal disturbances, probably related to environmental and lifestyle factors because of rapidly increasing incidence of TGCC in some countries. Additionally, there is a strong genetic component that affects susceptibility. However, genetic polymorphisms that have been identified so far only partially explain the risk of TGCC. Many of the persistent environmental pollutants act through the aryl hydrocarbon receptor (AHR). AHR signaling pathway is known to interfere with reproductive hormone signaling, which is supposed to play a role in the pathogenesis and invasive progression of TGCC. The aim of the present study was to identify whether AHR-related polymorphisms were associated with risk as well as histological and clinical features of TGCC in 367 patients and 537 controls. Haplotype-tagging single-nucleotide polymorphisms (SNPs) were genotyped in genes encoding AHR and AHR repressor (AHRR). Binary logistic regression was used to calculate the risk of TGCC, non-seminoma versus seminoma, and metastasis versus localized disease. Four SNPs in AHRR demonstrated a significant allele association with risk to develop metastases (rs2466287: OR = 0.43, 95% CI 0.21-0.90; rs2672725: OR = 0.49, 95% CI: 0.25-0.94; rs6879758: OR = 0.27, 95% CI: 0.08-0.92; rs6896163: OR = 0.34, 95% CI: 0.12-0.98). This finding supports the hypothesis that compounds acting through AHR may play a role in the invasive progression of TGCC, either directly or through modification of reproductive hormone action.
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Affiliation(s)
- Leon J. S. Brokken
- Department of Molecular Reproductive Medicine, Lund University Malmö, Sweden
- *Correspondence: Leon J. S. Brokken, Molecular Reproductive Medicine, Clinical Research Centre, Lund University, House 91, Floor 10, Jan Waldenströms gata 35, 20502 Malmö, Sweden. e-mail:
| | | | | | - Jakob Eberhard
- Department of Oncology, Skåne University HospitalLund, Sweden
| | - Olof Ståhl
- Department of Oncology, Skåne University HospitalLund, Sweden
| | - Gabriella Cohn-Cedermark
- Department of Oncology–Pathology, Radiumhemmet, Karolinska Institute and University HospitalStockholm, Sweden
| | | | - Stefan Arver
- Centre for Andrology and Sexual Medicine, Karolinska University Hospital Huddinge, Department of MedicineStockholm, Sweden
| | - Aleksander Giwercman
- Department of Molecular Reproductive Medicine, Lund University Malmö, Sweden
- Reproductive Medicine Centre, Skåne University HospitalMalmö, Sweden
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Nordkap L, Joensen UN, Blomberg Jensen M, Jørgensen N. Regional differences and temporal trends in male reproductive health disorders: semen quality may be a sensitive marker of environmental exposures. Mol Cell Endocrinol 2012; 355:221-30. [PMID: 22138051 DOI: 10.1016/j.mce.2011.05.048] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 05/19/2011] [Accepted: 05/25/2011] [Indexed: 11/22/2022]
Abstract
The decline in semen quality has been the subject of an animated debate. A recent prospective study now irrefutably shows a decline in semen quality in men from Finland, a country that previously boasted good semen quality. Semen quality has, in some countries, reached a level where a considerable fraction of young men are at risk of fertility problems. Impaired semen quality, testicular cancer, cryptorchidism and hypospadias are risk factors for each other, and the testicular dysgenesis syndrome (TDS) has been put forward to explain the observations. This syndrome implies that the four disease entities share the same patho-physiological etiology caused by disturbed testicular development in early fetal life. It seems likely that the rapid rise in TDS-associated conditions can, at least partly, be explained by environmental factors. Animal studies provide strong evidence that manmade chemicals can disrupt the hormone dependent pathways responsible for fetal gonadal development, subsequently leading to TDS-like symptoms. In humans, fetal exposure to endocrine disrupting substances may play a role, although genetic factors are probably also involved. Recent studies indicate that exposure to endocrine disrupters also in adulthood may affect semen quality and reproductive hormones. Causal relationships are inherently difficult to establish in humans, and a clear connection between the disorders and specific toxicants has not been established. It seems likely that the cumulative effects of various low-dose exposures to endocrine disrupters in our environment are responsible for the adverse effects in the male reproductive system. Semen quality may be the most sensitive marker of adverse environmental exposures, and we suggest that standardized surveillance studies of semen quality are continued or initiated to monitor the combined effects of various preventive actions.
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Affiliation(s)
- Loa Nordkap
- University Department of Growth and Reproduction, Rigshospitalet, Section 5064, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
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Brokken LJS, Lundberg-Giwercman Y, Rajpert De-Meyts E, Eberhard J, Ståhl O, Cohn-Cedermark G, Daugaard G, Arver S, Giwercman A. Association of polymorphisms in genes encoding hormone receptors ESR1, ESR2 and LHCGR with the risk and clinical features of testicular germ cell cancer. Mol Cell Endocrinol 2012; 351:279-85. [PMID: 22245602 DOI: 10.1016/j.mce.2011.12.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 12/22/2011] [Accepted: 12/27/2011] [Indexed: 11/17/2022]
Abstract
Testicular germ cell cancer (TGCC) is the most common malignancy in young men. Genetic variants known to be associated with risk of TGCC only partially account for the observed familial risks. We aimed to identify additional polymorphisms associated with risk as well as histological and clinical features of TGCC in 367 patients and 214 controls. Polymorphisms in ESR2 (rs1256063; OR=0.53, 95% CI: 0.35-0.79) and LHCGR (rs4597581; OR=0.68, 95% CI: 0.51-0.89, and rs4953617; OR=1.88, 95% CI: 1.21-2.94) associated with risk of TGCC. Polymorphisms in ESR1 (rs9397080; OR=1.85, 95% CI: 1.18-2.91) and LHCGR (rs7371084; OR=2.37, 95% CI: 1.26-4.49) associated with risk of seminoma and metastasis, respectively. SNPs in ESR1 (rs9397080) and LHCGR (rs7371084) were predictors of higher LH levels and higher androgen sensitivity index in healthy subjects. The results suggest that polymorphisms in ESR1, ESR2 and LHCGR contribute to the risk of developing TGCC, histological subtype, and risk to metastasis.
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Affiliation(s)
- Leon J S Brokken
- Department of Clinical Sciences, Molecular Reproductive Medicine, Lund University, Sweden.
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33
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Haugen TB, Tefre T, Malm G, Jönsson BA, Rylander L, Hagmar L, Bjørsvik C, Henrichsen T, Sæther T, Figenschau Y, Giwercman A. Differences in serum levels of CB-153 and p,p′-DDE, and reproductive parameters between men living south and north in Norway. Reprod Toxicol 2011; 32:261-7. [DOI: 10.1016/j.reprotox.2011.06.072] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2010] [Revised: 05/22/2011] [Accepted: 06/10/2011] [Indexed: 10/18/2022]
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Sonesson A, Hillarp A, Giwercman A, Malm J. Determination of serum amyloid P component in seminal plasma and correlations with serum hormone levels in young, healthy men. Scandinavian Journal of Clinical and Laboratory Investigation 2011; 71:569-75. [PMID: 21988589 DOI: 10.3109/00365513.2011.596567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Serum amyloid P component (SAP) belongs to the pentraxin family of proteins. SAP is evolutionary conserved, and involved in amyloidosis, innate immunity, inflammation, and apoptosis. We have previously described SAP in the male reproductive tract, where it occurs in seminal fluid, on spermatozoa, and in epididymal, seminal vesicle, and prostate tissue. In the present investigation, our aim was to characterize SAP in male reproduction. In short, we developed and evaluated an immunoassay, analysed the concentration of SAP in seminal plasma and serum in samples from healthy men (N = 203), and studied hormonal regulation. SAP in seminal plasma showed a positively skewed distribution and a median concentration of 1.01 mg/L (inter quartile range [IQR] 0.56-1.65 mg/L). SAP in serum had a Gaussian distribution and a median concentration of 40.5 mg/L (IQR 34.2-49.2 mg/L). Furthermore, SAP concentrations in seminal plasma were not correlated with serum concentrations of SAP, testosterone, sex hormone-binding globulin (SHBG), the testosterone/SHBG ratio, inhibin B, or estradiol. Only a weak negative correlation was found between seminal plasma SAP and serum levels of follicle-stimulating hormone (FSH) (Spearman's rho -0.159; p = 0.023) and luteinizing hormone (LH) (Spearman's rho -0.162; p = 0.021). In conclusion, all men investigated had measurable SAP levels in seminal plasma and in serum. SAP concentrations were 40 times lower in seminal fluid than in serum, and there was no correlation between those two variables. It seems that hormonal regulation is not the major pathway regulating seminal plasma SAP, and seminal plasma SAP and serum SAP are not co-regulated.
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Affiliation(s)
- Annika Sonesson
- Department of Laboratory Medicine, Division of Clinical Chemistry, Lund University, Malmö, Sweden.
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35
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Sk A, V J, G K, D U, P K. Declining semen quality among south Indian infertile men: A retrospective study. J Hum Reprod Sci 2011; 1:15-8. [PMID: 19562058 PMCID: PMC2700673 DOI: 10.4103/0974-1208.38972] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Revised: 01/05/2008] [Accepted: 01/07/2008] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND: Male reproductive function has recently attracted increasing attention due to reports on time-related decline in semen quality. Furthermore, regional differences in the semen quality have also been reported. AIM: To investigate the semen quality among large cohort of infertile individuals at a regional level, in terms of the sperm concentration, total sperm motility, sperm morphology and incidence of azoospermia over a period of 13 years. SETTING: University infertility clinic at Kasturba Hospital, Manipal which is a tertiary healthcare centre serving the general population. DESIGN: Retrospective analysis. MATERIALS AND METHODS: This includes a total of 7770 subjects who presented for semen analysis from 1993 to 2005. The data regarding ejaculate volume, sperm density, motility, morphology and the incidence of azoospermia were collected. STATISTICAL ANALYSIS USED: One way analysis of variance (ANOVA), regression analysis and Chi square analysis. RESULTS: The average sperm density among infertile men during 2004-2005 was 26.61 ± 0.71 millions/mL which was significantly lower than the average sperm density observed in 1993-1994 (38.18 ± 1.46 millions/mL). Similar trend was also observed for sperm motility (47.14% motile sperms vs. 61.16%) and normal sperm morphology (19.75% vs. 40.51%). Interestingly, the incidence of severe oligospermia (mean sperm density <10 millions/mL) observed in 2002-2005 and 1993-1997 demonstrated a significant inverse relationship (P < 0.001). CONCLUSION: Our study provides the first evidence that the quality of human semen evaluated for infertility is deteriorating in the southern part of the India over the years, probably due to environmental, nutritional, life style or socioeconomic causes.
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Affiliation(s)
- Adiga Sk
- Division of Reproductive Medicine, Kasturba Medical College, Manipal University, Manipal, India
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Axelsson J, Rylander L, Rignell-Hydbom A, Giwercman A. No secular trend over the last decade in sperm counts among Swedish men from the general population. Hum Reprod 2011; 26:1012-6. [PMID: 21382832 DOI: 10.1093/humrep/der045] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Based on historical data, a decline in sperm counts during the years 1940-1990 has been suggested and aetiologically linked to a concomitant increase in the incidence of testicular cancer. This study, focusing on possible changes in sperm parameters among young Swedish men, during the past 10 years, was specifically designed in order to answer the question of whether there is a continuing decline in sperm counts. METHODS During the period 2008-2010, 295 young (17-20 years; median 18) men born and raised in Sweden were recruited at the age they were supposed to undergo medical examination prior to military service. The participants filled in questionnaires, underwent andrological examination and delivered an ejaculate. Their semen parameters were compared with those of a similar cohort of men (n = 216) recruited in the year 2000-2001. RESULTS No significant changes (means; 2000-2001 versus 2008-2010) in sperm concentration (78 × 10⁶/ml versus 82 × 10⁶/ml; P = 0.54), semen volume (3.1 ml versus 3.0 ml; P = 0.26) or total sperm counts (220 × 10⁶ versus 250 × 10⁶; P = 0.18) were found. The proportion of progressively motile spermatozoa also remained unchanged. CONCLUSIONS Between the years 2000 and 2010 we found no evidence of time-related deterioration of semen parameters among young Swedish men from the general population. This finding does not exclude that such a decrease may have taken place before year 2000. If the risk of testicular cancer is linked to the sperm counts, the increase in incidence of this malignancy should be levelling off in southern Sweden in the next 10-15 years.
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Affiliation(s)
- J Axelsson
- Reproductive Medicine Centre, Skåne University Hospital, Malmö, 205 02 Malmö, Sweden.
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Fernandez MF, Duran I, Olea N, Avivar C, Vierula M, Toppari J, Skakkebaek NE, Jørgensen N. Semen quality and reproductive hormone levels in men from Southern Spain. ACTA ACUST UNITED AC 2011; 35:1-10. [PMID: 21332503 PMCID: PMC3380555 DOI: 10.1111/j.1365-2605.2010.01131.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In North European countries, a significant difference in semen quality among young men has been shown. Men from the western countries, Denmark, Germany and Norway, have lower semen quality than men from the eastern countries Finland, Estonia and Lithuania. Similarly, men in the western countries have a higher risk of testicular cancer. According to the testicular dysgenesis syndrome (TDS) concept that suggests a link between risk of impaired semen quality and increased risk of testicular cancer, Spanish men would be expected to have a semen quality at a normal level because of their very low testis cancer risk. We therefore investigated 273 men from the Almeria region in the Southern Spain to test this hypothesis. The men delivered semen samples, underwent physical examinations, had a blood sample drawn and provided information on lifestyle and reproductive health parameters. The investigations took place from November 2001 to December 2002. Adjusting for effects of confounders, the median sperm concentration and total sperm count were 62 (95% confidence interval 47-82) million/mL and 206 (153-278) million, respectively. The median numbers of motile and morphologically normal spermatozoa assessed according to strict criteria were 59% (57-62%) and 9.4% (8.6-10.0%), respectively. The median total testosterone and calculated free androgen index were 28 nm (26-30) and 95 (88-103), respectively. Assuming that the investigated men, to a large extent, are representative of the population of young men the Southern Spain, the results show that these have normal semen quality and reproductive hormone levels as expected in a population with a low incidence of testicular cancer.
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Affiliation(s)
- M F Fernandez
- Laboratory of Medical Investigations, San Cecilio University Hospital, University of Granada, Granada, Spain
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Västermark Å, Giwercman YL, Hagströmer O, De-Meyts ER, Eberhard J, Ståhl O, Cedermark GC, Rastkhani H, Daugaard G, Arver S, Giwercman A. Polymorphic variation in the androgen receptor gene: Association with risk of testicular germ cell cancer and metastatic disease. Eur J Cancer 2011; 47:413-9. [DOI: 10.1016/j.ejca.2010.08.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 08/17/2010] [Accepted: 08/24/2010] [Indexed: 10/19/2022]
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Xu X, Valtonen-André C, Sävblom C, Halldén C, Lilja H, Klein RJ. Polymorphisms at the Microseminoprotein-beta locus associated with physiologic variation in beta-microseminoprotein and prostate-specific antigen levels. Cancer Epidemiol Biomarkers Prev 2010; 19:2035-42. [PMID: 20696662 DOI: 10.1158/1055-9965.epi-10-0431] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND rs10993994, a single nucleotide polymorphism (SNP) at the genetic locus encoding beta-microseminoprotein (beta-MSP), is associated with both prostate cancer risk and levels of blood prostate-specific antigen (PSA), a biomarker used in prostate cancer screening. Therefore, we wished to determine the association between SNPs at MSMB, the gene encoding beta-MSP, and the levels of prostate-produced biomarkers beta-MSP, PSA, and human kallikrein 2 (hK2) in blood and semen. METHODS Blood and semen from 304 healthy young Swedish men (ages 18-21) were assayed for beta-MSP, PSA, and hK2. SNPs around MSMB were genotyped from matched DNA and analyzed for quantitative association with biomarker levels. Empirical P values were multiple test-corrected and the independence of each SNP's effect was determined. RESULTS rs10993994 was significantly associated with the blood and semen levels of beta-MSP (both P < 1.0 x 10(-7)) and PSA (P = 0.00014 and P = 0.0019), and semen levels of hK2 (P = 0.00027). Additional copies of the prostate cancer risk allele resulted in lower beta-MSP but higher PSA levels, and singly explained 23% and 5% of the variation seen in semen beta-MSP and PSA, respectively. Additional SNPs at MSMB are associated with beta-MSP and PSA independently of rs10993994. CONCLUSIONS SNPs at MSMB correlate with physiologic variation in beta-MSP and PSA levels in the blood and semen of healthy young Swedish men. In particular, rs10993994 has a strong effect on beta-MSP levels. IMPACT Our results suggest a mechanism by which rs10993994 might predispose to prostate cancer and raise the possibility that genetic variation might need to be considered in interpreting the levels of these biomarkers.
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Affiliation(s)
- Xing Xu
- Program in Cancer Biology and Genetics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Jensen TK, Swan SH, Skakkebaek NE, Rasmussen S, Jørgensen N. Caffeine intake and semen quality in a population of 2,554 young Danish men. Am J Epidemiol 2010; 171:883-91. [PMID: 20338976 DOI: 10.1093/aje/kwq007] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The authors examined the association between semen quality and caffeine intake among 2,554 young Danish men recruited when they were examined to determine their fitness for military service in 2001-2005. The men delivered a semen sample and answered a questionnaire including information about caffeine intake from various sources, from which total caffeine intake was calculated. Moderate caffeine and cola intakes (101-800 mg/day and < or =14 0.5-L bottles of cola/week) compared with low intake (< or =100 mg/day, no cola intake) were not associated with semen quality. High cola (>14 0.5-L bottles/week) and/or caffeine (>800 mg/day) intake was associated with reduced sperm concentration and total sperm count, although only significant for cola. High-intake cola drinkers had an adjusted sperm concentration and total sperm count of 40 mill/mL (95% confidence interval (CI): 32, 51) and 121 mill (95% CI: 92, 160), respectively, compared with 56 mill/mL (95% CI: 50, 64) and 181 mill (95% CI: 156, 210) in non-cola-drinkers, which could not be attributed to the caffeine they consumed because it was <140 mg/day. Therefore, the authors cannot exclude the possibility of a threshold above which cola, and possibly caffeine, negatively affects semen quality. Alternatively, the less healthy lifestyle of these men may explain these findings.
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Affiliation(s)
- Tina Kold Jensen
- University Department of Growth and Reproduction, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
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Stewart T, Liu D, Garrett C, Brown E, Baker H. Recruitment bias in studies of semen and other factors affecting pregnancy rates in fertile men. Hum Reprod 2009; 24:2401-8. [DOI: 10.1093/humrep/dep215] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Erenpreiss J, Tsarev I, Giwercman A, Giwercman Y. The impact of androgen receptor polymorphism and parental ethnicity on semen quality in young men from Latvia. ACTA ACUST UNITED AC 2008; 31:477-82. [DOI: 10.1111/j.1365-2605.2007.00791.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sävblom C, Giwercman A, Malm J, Halldén C, Lundin K, Lilja H, Giwercman Y. Association between polymorphisms in the prostate-specific antigen (PSA) promoter and release of PSA. ACTA ACUST UNITED AC 2008; 32:479-85. [PMID: 18336535 DOI: 10.1111/j.1365-2605.2008.00882.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Variations in serum prostate-specific antigen (PSA) have been ascribed to A/G nucleotide polymorphisms located at -158 bp (rs266882) and -4643 bp (rs925013), relative to the transcription start site within the promoter of the PSA gene. PSA is also an androgen receptor target (AR) gene and polymorphisms in AR gene are known to affect AR function. Our objective was to compare the impact of these A/G polymorphisms separately or in combination with AR CAG micro satellite on regulation of PSA secretion into seminal plasma and blood in young men. Leukocyte DNA was extracted from 291 conscripts and genotyping performed with the Sequenom Mass Array System. PSA was measured with an immunofluorometric assay. Linear regression analysis was used to test the association of polymorphism frequencies with serum and seminal plasma levels of PSA. PSA gene polymorphisms at -158 bp or -4643 bp did not alone influence total PSA (tPSA) levels in seminal plasma or in blood. Homozygotes for the A-allele at -158 bp in combination with CAG > 22 had significantly higher serum levels of tPSA than subjects carrying the G-allele (p = 0.01). In conclusion, the PSA gene polymorphisms did not importantly influence the levels of tPSA in seminal plasma or in blood. tPSA in serum was influenced by interactions between PSA promoter variants and AR CAG polymorphism.
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Affiliation(s)
- C Sävblom
- Department of Laboratory Medicine, Division of Clinical Chemistry, Lund University, Malmö University Hospital, Malmö, Sweden.
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Richthoff J, Elzanaty S, Rylander L, Hagmar L, Giwercman A. Association between tobacco exposure and reproductive parameters in adolescent males. INTERNATIONAL JOURNAL OF ANDROLOGY 2008; 31:31-9. [PMID: 17376217 DOI: 10.1111/j.1365-2605.2007.00752.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cigarette smoking is quite prevalent in the general population but our knowledge of its effect on male reproductive function is still very limited. Therefore, we investigated the impact of tobacco exposure on reproductive characteristics in young males. Military conscripts, 217 non-smokers and 85 smokers, with a median age of 18 years were enrolled. Physical examination and semen analysis, including measurement of accessory sex gland markers and reproductive hormone levels, were performed. Lifestyle-associated factors, including maternal smoking during pregnancy and snuffing, were recorded. Non-smokers had 49% higher total sperm number than smokers (95% CI 4.5-112%, p = 0.01). In addition, sperm concentration was 37% higher among non-smokers (95% CI -4% to 95%, p = 0.08). Serum levels of follicle-stimulating hormone (FSH) were 17% higher among non-smokers (95% CI 3-33%, p = 0.02), whereas no significant differences between smokers and non-smokers were found for inhibin B, testosterone, sex hormone binding globulin, luteinizing hormone and oestradiol. Those who smoked >10 cigarettes per day exhibited 37% lower (95% CI 10-69%, p = 0.005) FSH levels than those who smoked less. Maternal smoking during pregnancy had a negative impact on epididymal and seminal vesicle marker secretion. Smoking seems to impair sperm production and epididymal as well as accessory sex gland function and could be one of the factors contributing to regional differences in sperm parameters.
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Affiliation(s)
- Jonas Richthoff
- Centre of Reproductive Medicine, Scanian Andrology Centre, Malmö University Hospital, Lund University, Malmö, Sweden.
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Giwercman A, Rylander L, Lundberg Giwercman Y. Influence of endocrine disruptors on human male fertility. Reprod Biomed Online 2008; 15:633-42. [PMID: 18062860 DOI: 10.1016/s1472-6483(10)60530-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
It has been suggested that during the past five decades human sperm counts have declined and the incidence of testicular cancer, hypospadias and cryptorchidism has increased. Furthermore, geographical differences, with respect to these markers of male reproductive function, have been reported. According to a recent hypothesis, all these abnormalities of the male genital system do have a common cause, namely exposure to endocrine disruptors affecting the male in early fetal life. Reduced sperm production as well as congenital abnormalities of male genitalia can be evoked in laboratory animals by exposing them to chemicals with endocrine-disrupting effect, and in humans similar effects have been seen following accidental exposures to very high concentrations of these environmental toxicants. However, the evidence for association between levels of exposure found in the general population and serious adverse effects on male reproduction, including fertility, is still lacking. A recent European Union-supported study, on the effect of persistent organohalogen pollutants on human reproduction, failed to show any correlation between post-natal exposure levels and fertility. Future studies will reveal whether prenatal exposure does more strongly affect male fertility and whether genetic predisposition regulates the susceptibility of an individual to the adverse effects of endocrine disruptors.
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Affiliation(s)
- Aleksander Giwercman
- Reproductive Medicine Centre and Molecular Reproductive Research Group, Lund University, Malmö University Hospital, SE 205 02 Malmö, Sweden.
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Andersson AM, Jørgensen N, Main KM, Toppari J, Rajpert-De Meyts E, Leffers H, Juul A, Jensen TK, Skakkebaek NE. Adverse trends in male reproductive health: we may have reached a crucial 'tipping point'. ACTA ACUST UNITED AC 2008; 31:74-80. [PMID: 18194282 PMCID: PMC2440492 DOI: 10.1111/j.1365-2605.2007.00853.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Healthy men produce an enormous number of sperms, far more than necessary for conception. However, several studies suggest that semen samples where the concentration of sperms is below 40 mill/mL may be associated with longer time to pregnancy or even subfertility, and specimens where the concentration of sperms is below 15 mill/mL may carry a high risk of infertility. Historic data from the 1940s show that the bulk of young men at that time had sperm counts far above 40 mill/mL with averages higher than 100 mill/mL. However, recent surveillance studies of young men from the general populations of young men in Northern Europe show that semen quality is much poorer. In Denmark approximately 40 percent of the men have now sperm counts below 40 mill/mL. A simulation assuming that average sperm count had declined from 100 mill/mL in ‘old times’ to a current level close to 40 mill/mL indicated that the first decline in average sperm number of 20–40 mill/mL might not have had much effect on pregnancy rates, as the majority of men would still have had counts far above the threshold value. However, due to the assumed decline in semen quality, the sperm counts of the majority of 20 year old European men are now so low that we may be close to the crucial tipping point of 40 mill/mL spermatozoa. Consequently, we must face the possibility of more infertile couples and lower fertility rates in the future.
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Giwercman C, Giwercman A, Pedersen HS, Toft G, Lundin K, Bonde JP, Lundberg Giwercman Y. Polymorphisms in genes regulating androgen activity among prostate cancer low-risk Inuit men and high-risk Scandinavians. ACTA ACUST UNITED AC 2007; 31:25-30. [PMID: 17376218 DOI: 10.1111/j.1365-2605.2007.00750.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In Greenland, with a male population of approximately 30 000 individuals, the incidence of prostate cancer is extremely low with only three cases described during the period 1988-1997. Polymorphisms related to high androgen metabolism and/or response in the 5alpha-reductase type 2 (SRD5A2) and the androgen receptor (AR) genes, respectively, have been linked to prostate cancer. Our objective was to analyse whether the distribution of these polymorphisms differed between the prostate cancer low-risk population from Greenland and the relatively high-risk Swedish male population. The SRD5A2 polymorphisms A49T, V89L and R227Q, and the CAG and GGN repeats in the AR gene were genotyped in leucocyte DNA from 196 Greenlanders and 305 Swedish military conscripts. All subjects had the wild-type R/R genotype of the R227Q marker. The high-activity variants A49T A/T and V89L V/V occurred less frequently (2% vs. 5%, p = 0.048 and 33% vs. 46%, p = 0.0027) in Greenland compared with Sweden, whereas the low-activity L/L genotype was more frequent in Greenland (24% vs. 13%, p = 0.0024). Greenlanders also had longer AR CAG repeats than the Swedish population (median 24 vs 22, p < 0.0005). Greenlanders also had a higher frequency of the GGN = 23 allele (85% vs. 54%, p < 0.0001). Our results suggest that Greenlanders are genetically predisposed to a lower activity in testosterone to 5alpha-dihydrotestosterone turnover and to lower AR activity, which, at least partly, could explain their low incidence of prostate cancer.
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Affiliation(s)
- Charlotte Giwercman
- Fertility Centre, Scanian Andrology Centre, Malmö University Hospital, Lund University, Malmö, Sweden
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Gao J, Gao ES, Yang Q, Walker M, Wu JQ, Zhou WJ, Wen SW. Semen quality in a residential, geographic and age representative sample of healthy Chinese men. Hum Reprod 2006; 22:477-84. [PMID: 17023488 DOI: 10.1093/humrep/del383] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Population-based study of semen quality is rare in literature. METHODS Healthy men aged 20-60 years from six Chinese provinces were invited to participate in the study between December 2000 and November 2002. Posters were distributed in the participating counties to enroll 200 subjects from each province. Medians, percentiles, and proportions below lower threshold of the WHO criteria for semen parameters were calculated. Generalized linear models were used to examine the determinants of semen quality. RESULTS Semen samples from 1191 healthy Chinese men were collected and analysed. The medians (5th and 95th percentiles) were 2.3 ml (1.0-4.5) for semen volume, 65 x 10(6)/ml (20-150) for semen concentration, 154 x 10(6)/ejection (29-421) for sperm count, 19% (5-32) for rapid progressive motility, 46% (29-66) for progressive motility, 67% (47-81) for total motile spermatozoa, 70% (48-88) for sperm viability and 39% (23-76) for normal morphology. Many healthy Chinese men had semen parameter values below the lower threshold of the WHO criteria. Region, age, abstinence duration and season were important determinants of semen quality. CONCLUSIONS Chinese men have lower values of semen parameters according to WHO standard, and a lower threshold for normal semen parameters for Chinese men should be considered.
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Affiliation(s)
- J Gao
- Shanghai Institute of Planned Parenthood Research, Shanghai, P.R. China
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Lundin KB, Nordenskjöld A, Giwercman A, Giwercman YL. Frequent finding of the androgen receptor A645D variant in normal population. J Clin Endocrinol Metab 2006; 91:3228-31. [PMID: 16705072 DOI: 10.1210/jc.2006-0406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND The androgen receptor A645D mutation has been described in one patient with ambiguous genitalia and one boy with normal phenotype. OBJECTIVE Because of this phenotypic variation, we screened a cohort of men from the general population (n = 293) as well as men with the following disorders of the genital tract for the mutation: men with prostate cancer (n = 89), testicular cancer (n = 87), and infertility (n = 103). We also investigated the influence of the polymorphic CAG and GGN repeats on the phenotypic outcome. RESULTS The A645D variant was found in three men from the general population (1.0%). These men did not differ regarding testosterone or LH concentrations, compared with the rest of this population. In addition, two men with prostate cancer (2.3%) and one infertile man (1.0%) presented with the mutation. No statistical differences in frequency were noted between the study groups, and none of these individuals had any genital malformations. All men who presented with the mutation carried an extraordinarily short GGN repeat of 10 base triplets in combination with long CAG repeats of 26-28 (average 27.3). In contrast, men with GGN=10, but CAG less than 26 did not have the A645D mutation. A single-nucleotide polymorphism analysis revealed that the A645D variant has emerged from the most common haplogroup in our population. CONCLUSIONS We conclude that the A645D mutation, which is present in 1% of the general Swedish population, is linked to GGN10 and long CAG repeats. Its effect on androgen receptor function is currently unknown.
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Affiliation(s)
- Kristina B Lundin
- Department of Clinical Sciences, Fertility Centre, Malmö University Hospital, Lund University, SE-205 02 Malmö, Sweden
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Elzanaty S, Giwercman YL, Giwercman A. Significant impact of 5alpha-reductase type 2 polymorphisms on sperm concentration and motility. INTERNATIONAL JOURNAL OF ANDROLOGY 2006; 29:414-20. [PMID: 16487406 DOI: 10.1111/j.1365-2605.2005.00625.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Androgens, including 5alpha-dihydrotestosterone (DHT), are known to play a role for spermatogenesis and accessory sex gland function. The enzyme 5alpha-reductase (SRD5A) catalyses the conversion of testosterone to DHT. Our objective was to investigate whether polymorphisms in the SRD5A2 gene influence semen parameters in the general population. DNA from 182 Swedish military conscripts was examined for the A49T, V89L, and R227Q polymorphisms in the SRD5A type 2 gene. Ejaculates were analysed according to WHO guidelines. In addition, sperm motility was assessed using computer-aided sperm analysis (CASA). Seminal markers of epididymal (neutral alpha-glucosidase), prostatic (prostate specific-antigen and zinc), and seminal vesicles function (fructose) were measured. The A49TT-allele was associated with significantly higher sperm concentration compared with the wild type A-allele (mean: 102 x 10(6)/mL vs. 57 x 10(6)/mL, p = 0.02). The V89LV-genotype was correlated with significantly higher proportion progressive motile spermatozoa compared with the L-variant (mean: 55% vs. 48%, p = 0.04). The same trend was found regarding the CASA motile spermatozoa (mean: 52% vs. 41%, p = 0.02). No association between any of the polymorphisms and biochemical markers was found. SRD5A2 gene variants were associated with sperm concentration and motility, but not with epididymal and accessory sex gland markers. This effect on sperm parameters might therefore be exerted via a direct effect of DHT on spermatogenesis.
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Affiliation(s)
- S Elzanaty
- Scanian Andrology Centre, Fertility Centre, Malmö University Hospital, Lund University, Malmö, Sweden.
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