Male mediated teratogenesis

Patterns of paternal medication dispensation around the time of conception

BACKGROUND

Past research on the safety of prenatal exposure to medications has focused on maternal use during gestation, with limited research into the potential effects of paternal use during the spermatogenic period preceding conception. Knowing the most common medications used by fathers around the time of conception can inform research priorities in this field.

OBJECTIVES

To identify the most common medications dispensed to fathers in the preconception period.

METHODS

Within the MarketScan research database of commercially insured individuals in the United States from 2011 to 2020, we identified pregnancies, estimated the date of conception, linked each pregnancy to the father using family enrolment information and required minimum enrolment period and prescription benefits. Then, we described the use of prescription medications by the father during the 90 days before conception based on pharmacy dispensation claims.

RESULTS

Of 4,437,550 pregnancies, 51.6% were linked with a father. Among the 1,413,762 pregnancies connected with a father that also met the inclusion criteria, the most common classes of medications dispensed were psychotropics (8.66%), antibiotics (7.21%), and analgesics (6.82%). The most frequently dispensed medications were amoxicillin (3.75%), azithromycin (3.15%), fluticasone (2.70%) and acetaminophen/hydrocodone (2.70%). Some fathers filled prescriptions for medications associated with foetal embryopathy when used by the mother, including mycophenolate (0.04%), methotrexate (0.03%) and isotretinoin (0.02%).

CONCLUSIONS

More than a third of fathers filled at least one prescription medication in the preconception period, and several of them are known to be embryotoxic, emphasizing the necessity for further investigation into the potential teratogenicity of paternal exposure.

Impact of black soot emissions on public health in Niger Delta, Nigeria: understanding the severity of the problem

Rivers State, Niger Delta, Nigeria often referred to as the 'treasure bed of the nation' is the seat of crude oil production activities with the accompanying environmental degradation. The severity of the environmental pollution and contaminated air quality took a new turn for the worse in November 2016, when the residents of Port Harcourt city, Rivers State, a major oil producing State experienced for the first time, aerosol deposition of plumes of black soot. This systematic review paper is aimed at quantifying the severity of this public health challenge. Using appropriate search words, the following databases SCOPUS, PUBMED, Google Scholar, and AJOL were searched from 1990 to 2022 to enable comparative analyses of data before and after the emergence of black soot deposition. Air-related morbidities and mortalities such as cerebrospinal meningitis (CSM), chronic bronchitis, measles, pertussis, hemoptysis, cough, pulmonary tuberculosis, pneumonia, and upper respiratory tract infection (URTI), pneumonia, eye irritation, conjunctivitis, traumatic skin outgrowth, cancers, cardiovascular diseases, and child deformities were compared with levels of air pollutants and particulate matter. The results showed that Port Harcourt city's ambient air quality data were above the standard National Ambient Air Quality data and that of other regulatory agencies having higher levels of both inorganic and organic pollutants. There were significant relationships between air pollutants concentration with morbidities. These correlations were significant in the period covering 2016-2022. Consequently, it is concluded that the black soot emissions in Port Harcourt city, Nigeria has worsened the public health situation in the city.

Exploring Family Planning, Parenting, and Sexual and Reproductive Health Care Experiences of Men with Rheumatic Diseases

OBJECTIVE

To explore family planning, parenting, and sexual and reproductive health (SRH) care needs and experiences of men with rheumatic diseases.

METHODS

Men aged 18-45 years who were diagnosed with at least one rheumatic disease and used at least one anti-rheumatic drug were recruited from rheumatology clinics. Research coordinators engaged participants in semi-structured phone interviews. A codebook was developed based on the interview transcripts and used to conduct an inductive thematic analysis.

RESULTS

Participants ranged in age from 22 to 44 years old (N=20). Most were heterosexual and had at least one child. The most common disease diagnoses were spondyloarthritis, systemic lupus erythematosus, and rheumatoid arthritis. Four themes emerged from the interviews: 1) Men had family planning concerns, particularly related to the heritability of their diseases, their fertility, and potential effects of their medications on their offspring's health; 2) Men felt that fatigue, disability, and/or pain from their diseases either impaired or would impair their abilities to parent; 3) Men often did not discuss sexual dysfunction with their rheumatologists, even when they believed that it arose from their diseases or anti-rheumatic drugs; 4) Men rarely discussed any family planning, parenting, or SRH issues with their rheumatologists-and gender discordance with rheumatologists did not affect men's comfort in discussing these issues.

CONCLUSION

Men expressed concerns related to family planning, parenting, and SRH, which they rarely discussed with their rheumatologists. Our study suggests that some men's SRH information needs are incompletely addressed in the rheumatology clinical setting.

A systematic overview of the spermatotoxic and genotoxic effects of methotrexate, ganciclovir and mycophenolate mofetil

INTRODUCTION

Immunosuppressant drugs are increasingly being used in the reproductive years. Theoretically, such medications could affect fetal health either through changes in the sperm DNA or through fetal exposure caused by a presence in the seminal fluid. This systematic overview summarizes existing literature on the spermatotoxic and genotoxic potentials of methotrexate (MTX), a drug widely used to treat rheumatic and dermatologic diseases, and mycophenolate mofetil (MMF), which alone or supplemented with ganciclovir (GCV) may be crucial for the survival of organ transplants.

MATERIAL AND METHODS

The systematic overview was performed in accordance with the PRISMA guidelines: A systematic literature search of the MEDLINE and Embase databases was done using a combination of relevant terms to search for studies on spermatotoxic or genotoxic changes related to treatment with MTX, GCV or MMF. The search was restricted to English language literature, and to in vivo animal studies (mammalian species) and clinical human studies.

RESULTS

A total of 102 studies were identified, hereof 25 human and 77 animal studies. For MTX, human studies of immunosuppressive dosages show transient effect on sperm quality parameters, which return to reference values within 3 months. No human studies have investigated the sperm DNA damaging effect of MTX, but in other organs the genotoxic effects of immunosuppressive doses of MTX are fluctuating. In animals, immunosuppressive and cytotoxic doses of MTX adversely affect sperm quality parameters and show widespread genotoxic damages in various organs. Cytotoxic doses transiently change the DNA material in all cell stages of spermatogenesis in rodents. For GCV and MMF, data are limited and the results are indeterminate, for which reason spermatotoxic and genotoxic potentials cannot be excluded.

CONCLUSIONS

Data from human and animal studies indicate transient spermatotoxic and genotoxic potentials of immunosuppressive and cytotoxic doses of MTX. There are a limited number of studies investigating GCV and MMF.

2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases

OBJECTIVE

To develop an evidence-based guideline on contraception, assisted reproductive technologies (ART), fertility preservation with gonadotoxic therapy, use of menopausal hormone replacement therapy (HRT), pregnancy assessment and management, and medication use in patients with rheumatic and musculoskeletal disease (RMD).

METHODS

We conducted a systematic review of evidence relating to contraception, ART, fertility preservation, HRT, pregnancy and lactation, and medication use in RMD populations, using Grading of Recommendations Assessment, Development and Evaluation methodology to rate the quality of evidence and a group consensus process to determine final recommendations and grade their strength (conditional or strong). Good practice statements were agreed upon when indirect evidence was sufficiently compelling that a formal vote was unnecessary.

RESULTS

This American College of Rheumatology guideline provides 12 ungraded good practice statements and 131 graded recommendations for reproductive health care in RMD patients. These recommendations are intended to guide care for all patients with RMD, except where indicated as being specific for patients with systemic lupus erythematosus, those positive for antiphospholipid antibody, and/or those positive for anti-Ro/SSA and/or anti-La/SSB antibodies. Recommendations and good practice statements support several guiding principles: use of safe and effective contraception to prevent unplanned pregnancy, pre-pregnancy counseling to encourage conception during periods of disease quiescence and while receiving pregnancy-compatible medications, and ongoing physician-patient discussion with obstetrics/gynecology collaboration for all reproductive health issues, given the overall low level of available evidence that relates specifically to RMD.

CONCLUSION

This guideline provides evidence-based recommendations developed and reviewed by panels of experts and RMD patients. Many recommendations are conditional, reflecting a lack of data or low-level data. We intend that this guideline be used to inform a shared decision-making process between patients and their physicians on issues related to reproductive health that incorporates patients' values, preferences, and comorbidities.

Assessment of Pradosia huberi effects on the reproductive system of male rats

Pradosia huberi is a species found in the Amazon region and used as an antiulcerogenic and gastroprotective agent; however, phytochemical analysis has revealed the presence of compounds with potential toxic effects on the reproductive system. For the evaluation of the toxicity of P. huberi on male fertility, male Wistar rats were divided into four groups: one control (distilled water p.o.) and three treated (hydroalcoholic extract of the stem bark of P. Huberi (PH-HAE) at doses of 1.22, 6.1, and 30.5 mg/kg p.o.) once daily, for 63 days. In the last week of treatment (from the 57th to the 63rd day), the rats were mated with untreated virgin females (n = 30/group) and were killed on day 64. To investigate the toxic potential of PH-HAE on the reproductive system of rats the following parameters were evaluated: sperm production, genotoxicity, and general development. The production of gametes and their morphology did not differ between control and treated groups. Treatment with PH-HAE did not result in fewer vaginal plugs formed, indicating that the ability to mate was not impaired, but caused an increase of 14.3 and 10.8% in the preimplantation loss index, a reduction of 14.3 and 10.8% in the implantation index, and a reduction of 5.6 and 8.2% in the postimplantation loss index of female rats mated with rats treated with 6.1 and 30.5 mg/kg, respectively, indicating a possible toxic action of PH-HAE on the reproductive system of rats.

Desenvolvimento pós-natal e potencial teratogênico da prole de ratos Wistar no estudo da toxicidade reprodutiva de duas preparações fitoterápicas contendo soja Glycine max (L.) Merr

Avaliou-se o efeito de duas preparações fitoterápicas comerciais que continham soja sobre o desenvolvimento geral e sexual da progênie de ratos Wistar e sobre o potencial teratogênico das preparações fitoterápicas durante um estudo de toxicidade reprodutiva. Para tanto, observaram-se, diariamente, as características de desenvolvimento dos filhotes e analisou-se o comportamento em campo aberto, e, para avaliar o potencial teratogênico, realizou-se diafanização dos fetos removidos por cesariana. Inferiu-se que o tratamento dos pais não comprometeu o desenvolvimento de sua progênie e também não determinou efeitos teratogênicos aos fetos de ratos Wistar.

Occupational hazards to male fecundity

Research methods and knowledge in the field of male reproductive toxicology have gradually improved since reports in the late 1970s on severe impairment of spermatogenesis in workers with occupational exposure to certain chlorinated hydrocarbon pesticides (the nematocide 1,2-dibromochloropropan and the insecticide and fungicide chlordecone, but still we have only vague answers to basic questions about the overall significance of the environmental and occupational impact of these compounds on male reproductive capability.

Paternal and maternal exposure to welding fumes and metal dusts or fumes and adverse pregnancy outcomes

OBJECTIVE

We assessed whether paternal exposure prior to conception and maternal exposure during pregnancy to welding fumes (WF) and metal dusts or fumes (MD/F) independently and jointly increases the risk of preterm delivery, low birth weight, and small-for-gestational age.

METHODS

The study population was selected from The Finnish Prenatal Environment and Health Study of 2,568 newborns (response rate 94%) and included 1,670 women who worked during pregnancy of which 68 were exposed either to WF and/or MD/F.

RESULTS

The risk of SGA was related to maternal exposure to WF only (adjusted OR = 1.78; 95% CI 0.53-5.99), MD/F only (adjusted OR = 1.77; 95% CI 0.38-8.35) and both exposures (2.92; 1.26-6.78). The corresponding effect estimates for preterm delivery were 2.66 (0.32-22.08), 5.64 (1.14-27.81) and for birth weight below 3,000 g 3.79 (1.09-13.19), 1.85 (0.56-6.14) and 1.70 (0.70-4.15), respectively. There was some suggestive, inconsistent evidence that the risk of preterm delivery and SGA is related to paternal exposure to WF.

CONCLUSIONS

The present results provide evidence that maternal exposure to WF or MD/F combination during pregnancy may reduce fetal growth and suggestive evidence that paternal exposure to WF may increase the risk of preterm delivery and small-for-gestational age. The small number of exposed women and the lack of data for exposure concentrations suggest the need for further study to verify our findings.

Men at risk: occupation and male infertility

There is accumulating evidence that workplace exposure to toxic substances contributes to male infertility. Men suffering from infertility problems may do well to look at their occupations, where exposure to certain substances may be a contributory factor, if not a direct cause, of infertility. Most of the studies to date are either case reports or epidemiological studies (population-based, case-control, or cohort studies). Additional, controlled studies need to be done to ascertain the effects of occupational toxins on male infertility. Until then, men and their employers should work together to minimize exposure to these substances.

Reproductive health of Gulf War veterans

In this review we summarize the scientific literature on reproductive health following deployment to the first Gulf war by armed service personnel. All the studies examined had methodological limitations, making interpretation difficult. Nonetheless we conclude that for male veterans there is no strong or consistent evidence to date for an effect of service in the first Gulf war on the risk of major, clearly defined, birth defects or stillbirth in offspring conceived after deployment. Effects on specific rare defects cannot be excluded at this stage since none of the studies had the statistical power to examine them. For miscarriage and infertility, there is some evidence of small increased risks associated with service, but the role of bias is likely to be strong. For female veterans, there is insufficient information to make robust conclusions, although the weight of evidence to date does not indicate any major problem associated specifically with deployment to the Gulf. None of the studies have been able to examine risk according particular exposures, and so possible associations with specific exposures for smaller groups of exposed veterans cannot be excluded. We suggest that the way forward to address the question of veterans' reproductive health with confidence in the future is prospective surveillance following deployment. Anything less will result in further problems of interpretation and continued anxiety for parents, as well as prospective parents, in the armed forces.

Adverse reproductive outcomes among male painters with occupational exposure to organic solvents

OBJECTIVES

To assess the risks of reproductive disorders and birth defects in offspring of male painters with exposure to organic solvents, and to determine the shape of the dose-response relationship.

METHODS

Random samples of painters and carpenters were drawn from workers affiliated with the Dutch Trade Union for Construction Workers, the Netherlands, 2001. Information on reproductive outcomes, occupational exposures, and lifestyle habits was retrospectively obtained through self-administered questionnaires filled in by 398 painters exposed to organic solvents in paints, thinners, and cleansers in the period of three months before the last pregnancy, and 302 carpenters with little or no exposure to solvents. A statistical model was used to estimate quantitative exposure measures.

RESULTS

Workers employed as painters at three months before pregnancy had an increased risk (odds ratio 6.2, 95% CI 1.4 to 27.9) of congenital malformations in offspring compared to carpenters. There was a positive exposure-response trend with increasing exposure to organic solvents based on quantitative model predicted exposure estimates using toluene as a marker. There was some indication of an increased risk of functional developmental disorders in offspring among painters with intermediate and high model predicted exposure. The risk of low birth weight children seemed to be slightly increased among painters as well. Results for other reproductive outcomes (time to pregnancy, spontaneous abortion, and preterm birth) did not show increased risks.

CONCLUSION

This study showed a positive association between paternal occupational exposure to organic solvents and congenital malformations in offspring. However, the small numbers of cases, especially when examining different exposure levels, as well as the self-reported nature of exposure and outcome variables, may hamper interpretation of the results.

Assessment of sperm DNA integrity in workers exposed to styrene

BACKGROUND

Occupational exposure to toxic agents may cause infertility, congenital anomalies or death in offspring, but few studies have evaluated DNA integrity in germ cells of male workers. We investigated sperm DNA integrity in individuals occupationally exposed to styrene.

METHODS AND RESULTS

Semen samples were obtained from 46 male workers exposed to styrene and 27 unexposed controls (age range 18-45 years). Exposed individuals had worked for at least 2 years in the last 5 years and continuously for 6 months in factories producing reinforced plastics. The Comet assay was performed to evaluate DNA integrity in sperm, as well as semen quality analysis to assess sperm concentration and morphology. There were no differences in the results of the standard semen analysis between exposed subjects and the reference group. However, we found a significant difference (P < 0.001) in sperm DNA damage by the Comet assay between exposed subjects and the reference group.

CONCLUSIONS

The Comet assay proved to be sensitive in detecting an alteration in DNA integrity in germ cells of workers exposed to styrene. This finding contributes towards the understanding of the importance of male occupational exposure within the context of genetic risk assessment in humans.

Parental occupation and neural tube defect-affected pregnancies among Mexican Americans

In a case-control study, we examined whether parental occupational exposures were related to neural tube defect (NTD)-affected pregnancies among Mexican Americans living along the Texas-Mexico border. Case women were 184 Mexican-American women with NTD-affected pregnancies; control women were 225 study-area residents who delivered normal babies during the same period as the case women. The women were interviewed in person about maternal and paternal occupations and work exposures during the periconceptional period. Compared with control women, case women were more likely to have had occupational exposures to solvents (odds ratio [OR], infinity; 95% confidence interval [CI], 2.4-infinity) and also were more likely to have worked in cleaning (OR 9.5; 95% CI, 1.1 to 82.2) or health care occupations (OR 3.0; 95% CI, 1.0 to 9.0) than control women. No compelling associations were found between paternal work exposures or occupations and NTDs in offspring in this population.

Race and the inheritance of low birth weight

This paper uses intergenerational data from the Panel Study of Income Dynamics (PSID) to address the black-white difference in propensities toward low birth weight (LBW). We determine that socioeconomic conditions account for some variation in low birth weight across race. Further, while race differences in the risk of low birth weight cannot be explained entirely, we find that the inheritance of parental birth weight status dramatically reduces the black-white gap in low birth weight. Intergenerational legacies of poor infant health explain the largest share of racial disparities in filial birth weight. We then try to assess whether this intergenerational transmission of low birth weight is indeed genetic by using grandparent-fixed effects models to factor out, to a great extent, family socioeconomic circumstances. We find that even within this framework, both father's and mother's birth weight status have an important impact on filial outcomes. However, the degree of inheritance is weaker for African Americans than for other races. Finally, we theorize that the importance of paternal birth weight status implies a genetic association that does not work through the uterine environment but rather through the fetus itself.

Cisplatin-DNA adduct formation in rat spermatozoa and its effect on fetal development

Exposure of males to some genotoxic chemicals causes DNA damage in spermatozoa resulting in embryotoxicity and developmental defects in their offspring. This study demonstrates that cisplatin-DNA adducts could be measured in spermatozoa following treatment with the antineoplastic drug, cisplatin. The formation of spermatozoa cisplatin-DNA adducts showed dose and time-dependent increases both in vitro, and in vivo up to 168 h (7 days) after dosing. Treatment of rats with 10 mg cisplatin/kg resulted in spermatozoa Pt-GG adduct levels of approximately 1.0 fmol/microg DNA. When cisplatin-treated male rats were bred to untreated females 6-24 h after cisplatin administration, no adverse developmental effects or decreases in body weight were seen in the offspring although there was a trend towards increased early embryo mortality.

Spina bifida and parental occupation: results from three malformation monitoring programs in Europe

As the evidence for an association between spina bifida and parental agricultural occupations is inconclusive, we evaluated this association and the potential associations between spina bifida and other parental occupations. Three register-based case-referent studies were conducted in Sweden, Spain, and Hungary. From the registries of congenital malformations in each country, 482, 478, and 1119 cases with spina bifida were identified, respectively. Identified as referents were 964, 434, and 1489 children without abnormalities. Information on parental occupation was available in the registries from questionnaires or interviews conducted among the parents. Occupations with a potential for physical or chemical exposure were compared to non-exposed occupations. Increased odds ratios (ORs) were observed for women in agricultural occupations in Sweden (OR: 1.8, 95% CI: 0.8-4.2) and in Spain (OR: 2.2, 95% CI: 0.8-5.9), but not in Hungary (OR: 1.1, 95% CI: 0.7-1.7). Several other parental occupations were analysed, but the associations with spina bifida were inconsistent. Concluding, the results are not totally consistent but point to an increased risk of spina bifida among women in agricultural occupations.

Declining male fertility and environmental factors

Male reproductive function has recently attracted increasing attention due to reports on time-related decline in semen quality. Analysis of retrospective data indicates that sperm counts may have declined in some parts of the world, but there seem to be regional differences both in the quality of semen and regarding the secular trend. Whereas data on sperm counts may be somewhat difficult to interpret, there is no doubt that incidence of testicular cancer has increased worldwide. In occupational studies, only a few types of exposures were shown to have an impact on male reproductive function; lifestyle and general environmental factors may play a more important role. Prospective studies on secular and geographic trends in male reproductive function are warranted.

Paternal exposure of rabbits to lead: behavioral deficits in offspring

Paternal exposures to exogenous agents have been reported to produce a variety of developmental defects in the offspring. In experimental animals, these effects include decreased litter size and weight, increased stillbirth and neonatal death, birth defects, tumors, and functional/behavioral abnormalities-some of these effects being transmitted to the second and third generations. The majority of experimental studies assessing nervous system function of offspring following paternal exposures have utilized rats as the experimental animal, but other species can be used. The National Toxicology Program (NTP) has initiated studies to validate the rabbit as an animal model for human reproductive toxicity, because rabbits are the smallest laboratory animal from which ejaculates can be collected repeatedly. An important part of reproductive toxicology is assessment of the reproductive ability of males following exposure, as well as developmental and functional assessment of their offspring. This article describes a pilot study and a main study to investigate the feasibility of using rabbits to assess the functional effects of paternal exposure to lead. The pilot study included seven male rabbits per group exposed for 15 weeks to lead acetate sufficient to produce 0, 50, or 110 micrograms/dl blood lead. The main study included 15 male rabbits per group exposed for 15 weeks to lead acetate to produce 0, 20, 40, and 80 micrograms/dl blood lead. At the conclusion of the exposure, male rabbits were mated with unexposed females. These females carried their litters to term, delivered, and reared their own offspring. The offspring were weighed at 5, 10, 15, 20, 25, 30, and some at 35 days of age. They were also tested for exploratory activity in a standard figure-eight "maze" for 30 min/day on days 15, 20, 25, and 30. A second assessment of exploratory behavior, along with a simple test of aversive conditioning, was attempted in the pilot study, but was judged not to be suitable for the main study. Of the 21 male rabbits that were mated in the pilot study, 16 produced viable litters (6/7, 6/7, and 4/7 in control, low- and high-lead groups, respectively), with a mean number of 6 live births/litter in each treatment group (range 2-8). Of the 60 rabbits mated in the main study, 57 produced litters, and two rabbits died giving birth. Significant postnatal deaths were observed in all groups, with about one half of the offspring dying before testing was initiated at day 15. There were no treatment-related effects on offspring weight gain through wearing. The data suggest that paternal lead exposure of rabbits may reduce figure-eight activity on day 25, the time of peak activity in the offspring.

An in vivo and in vitro investigation into the effects of alpha- chlorohydrin on sperm motility and correlation with fertility in the Han Wistar rat

Following a recommendation from the International Conference on Harmonisation, pharmaceutical companies are now monitoring possible drug effects on sperm motility in the rat during preclinical safety studies by assessing sperm motility (velocity). However, it is not known precisely how changes in sperm motility relate to fertility. Therefore, the effects of alpha-chlorohydrin on sperm motility were investigated and related to fertility both in vivo and in vitro. alpha-Chlorohydrin was given orally to male rats using a range of doses: 0, 5, 10, and 20 mg/kg for at least 5 consecutive days. Sperm were than assessed for motility using a standard scoring system (operators' observation of sperm) that graded degree of motility (i.e., 0 = i mmotile to 4 = very motile). The results showed a dose-related decrease in sperm motility. The sperm also appeared to move with a "jerky" action. Surprisingly, when this was correlated to fertility, none of the females mated with treated males became pregnant. A dose-related decrease in pregnancy would perhaps have been expected. There was no effect on sperm morphology, and testicular and epididymal pathology were only seen after doses of 20 mg/kg. When sperm from untreated rats were incubated with alpha-chlorohydrin in vitro at concentrations of 0, 0.5, 1.0, and 1.5 mM, sperm motility and motion were similarly affected as observed in vivo. However, the fertilization capacity (in vitro fertilization) of the treated sperm showed a concentration-related reduction in percentage fertilization, and there was also evidence of abnormal embryo development. These findings suggest that the present standard scoring system used in preclinical safety studies is not a comprehensive indicator of sperm function and/or fertility. A better understanding of sperm movement, therefore, is desirable so effects on sperm motility can be related to fertility.

Occupational hazards for the male reproductive system

The etiology of male infertilities is largely undetermined, and our knowledge of exogenous factors affecting the male reproductive system is still limited. In particular, the role of specific environmental and occupational factors is incompletely elucidated. Various occupational (physical and chemical) agents have been shown to affect male reproductive functions in animals, but large differences in reproductive function and/or xenobiotic handling between species limit extrapolation to humans. When available, human data are often conflicting and, except in a few instances, usually refer to broad and heterogenous occupational categories or to groups of agents (e.g., solvents). It is often difficult to elucidate the role of a single agent because occupational exposure conditions are often complex and various confounding factors related to lifestyle (smoking, alcohol, and diet) or socioeconomic state may also affect sperm quality, fertility, or pregnancy outcomes. The objective of this work is to summarize the main epidemiological and, where relevant, experimental findings pertaining to agents (physical and chemical) encountered in the occupational environment that might affect the male reproductive system (sperm count, motility and morphology, libido, and fertility) and/or related pregnancy outcomes (spontaneous abortion, stillbirth, low birth weight, and birth defects and childhood malignancy in offspring). Some methodological issues related to research on the reproductive effects of toxicants are also discussed briefly.

Reproductive Health Hazards in the Workplace: Guidelines for Policy Development and Implementation

To provide occupational health professionals and employers with guidelines for reproductive health policy making, the authors-both of whom are obstetrician-gynecologists and occupational medicine physicians-review the history of and legal basis for U.S. policy on work and reproduction, delineate the goals and important elements of a reproductive health policy (RHP), and emphasize the need to incorporate an RHP into a comprehensive occupational injury and illness prevention program. After suggesting practical ways to achieve the goals of an RHP (maximal health protection, compliance with legal mandates, and reduction of liability), the authors propose a team-based model for RHP implementation with shared responsibility of management and workers in designing, enforcing, and evaluating the policy.