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Feferkorn I, Azani L, Kadour-Peero E, Hizkiyahu R, Shrem G, Salmon-Divon M, Dahan MH. An evaluation of changes over time in the semen parameters data used for the World Health Organization semen analysis reference ranges. Andrology 2021; 10:660-668. [PMID: 34964554 DOI: 10.1111/andr.13150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous meta-analyses concluded that there is a decline in sperm parameters over time. This conclusion might be incorrect due to inherent biases or focusing only on a single parameter - sperm concentration. OBJECTIVE To study trends in sperm parameters over the past twenty years using data from the trials that defined the reference ranges of the World Health Organization manual. MATERIALS AND METHODS Retrospective evaluation of the data used to define the World Health Organization reference ranges. The data from 11 studies, including 3589 participants between 1996-2016, were divided into three period groups based on the decade of study. Differences in semen parameters' distribution were presented in boxplot. P-values were calculated by the Kruskal Wallis rank-sum test followed by Dunn post-hoc test. Analyses were conducted using the R programming language. RESULTS A small decrease was noted in mean sperm concentrations (88.1 million/ml, 87.6 million/ml and 77.2 million/ml for the first second and third decades respectively) (p<0.01). However, the 5th percentile of sperm concentration for the third decade was higher than the first or second decades (18 million/ml vs. 14.9 million/ml and 15 million/ml respectively). No significant differences were noted in progressive motility over the years (p = 0.32). The percent of morphologically normal sperm decreased between the first (24.2%) and the second (12.6%) periods of the study (p<0.001) and then increased in the third decade (14.2%) (p<0.01). While TMC declined between the second and third decades (189 million and 153.9 million respectively, p<0.001), at levels unlikely to decrease fertility. However, the 5th percentile of the TMC remained stable at 24.9, 20.8 and 20.6 million, for the first, second and third decades respectively (p = 0.36). DISCUSSION AND CONCLUSION AND RELEVANCE Trends in sperm parameters over the last three decades do not seem to be clinically significant. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ido Feferkorn
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, 888 Boul. de Maisonneuve E #200, Montréal, QC, H2L 4S8, Canada
| | - Liat Azani
- Department of Molecular Biology, Ariel University, 65 Ramat HaGolan St, Ariel, Israel
| | - Einav Kadour-Peero
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, 888 Boul. de Maisonneuve E #200, Montréal, QC, H2L 4S8, Canada
| | - Ranit Hizkiyahu
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, 888 Boul. de Maisonneuve E #200, Montréal, QC, H2L 4S8, Canada
| | - Guy Shrem
- IVF unit, Department of Obstetrics and Gynecology, Kaplan Medical Center, 1 Derech Pasternak, Rehovot, Israel
| | - Mali Salmon-Divon
- Department of Molecular Biology, Ariel University, 65 Ramat HaGolan St, Ariel, Israel.,Adelson School of Medicine, Ariel University, 65 Ramat HaGolan St, Ariel, Israel
| | - Michael H Dahan
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, 888 Boul. de Maisonneuve E #200, Montréal, QC, H2L 4S8, Canada
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Agarwal A, Baskaran S, Parekh N, Cho CL, Henkel R, Vij S, Arafa M, Panner Selvam MK, Shah R. Male infertility. Lancet 2021; 397:319-333. [PMID: 33308486 DOI: 10.1016/s0140-6736(20)32667-2] [Citation(s) in RCA: 478] [Impact Index Per Article: 159.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 08/13/2020] [Accepted: 08/19/2020] [Indexed: 02/06/2023]
Abstract
It is estimated that infertility affects 8-12% of couples globally, with a male factor being a primary or contributing cause in approximately 50% of couples. Causes of male subfertility vary highly, but can be related to congenital, acquired, or idiopathic factors that impair spermatogenesis. Many health conditions can affect male fertility, which underscores the need for a thorough evaluation of patients to identify treatable or reversible lifestyle factors or medical conditions. Although semen analysis remains the cornerstone for evaluating male infertility, advanced diagnostic tests to investigate sperm quality and function have been developed to improve diagnosis and management. The use of assisted reproductive techniques has also substantially improved the ability of couples with infertility to have biological children. This Seminar aims to provide a comprehensive overview of the assessment and management of men with infertility, along with current controversies and future endeavours.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - Saradha Baskaran
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Neel Parekh
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Chak-Lam Cho
- SH Ho Urology Center, Department of Surgery, Chinese University of Hong Kong, Hong Kong
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA; Department of Medical Bioscience, University of Western Cape, Bellville, South Africa; Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Sarah Vij
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamed Arafa
- Male Infertility Unit, Urology Department, Hamad Medical Corporation, Doha, Qatar; Andrology Department, Cairo University, Cairo, Egypt
| | | | - Rupin Shah
- Department of Urology, Lilavati Hospital and Research Center, Mumbai, India
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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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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: 748] [Impact Index Per Article: 124.7] [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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Pandiyan N, Pandiyan R, Raja DR. A perspective on sperm DNA fragmentation. Transl Androl Urol 2017; 6:S661-S664. [PMID: 29082196 PMCID: PMC5643677 DOI: 10.21037/tau.2017.03.84] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/08/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Natarajan Pandiyan
- Department of Andrology and Reproductive Medicine, Chettinad University, Kelambakkam, Chennai, Tamil Nadu, India
| | - Radha Pandiyan
- Reproductive Medicine, Chettinad University, Kelambakkam, Chennai, Tamil Nadu, India
| | - D. Ramesh Raja
- Clinical Embryology, Chettinad University, Kelambakkam, Chennai, Tamil Nadu, India
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Sengupta P, Borges E, Dutta S, Krajewska-Kulak E. Decline in sperm count in European men during the past 50 years. Hum Exp Toxicol 2017; 37:247-255. [DOI: 10.1177/0960327117703690] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Purpose: To investigate whether the sperm concentration of European men is deteriorating over the past 50 years of time. Materials and Methods: We analysed the data published in English language articles in the past 50 years in altering sperm concentration in European men. Results: A time-dependent decline of sperm concentration ( r = −0.307, p = 0.02) in the last 50 years and an overall 32.5% decrease in mean sperm concentration was noted. Conclusion: This comprehensive, evidence-based meta-analysis concisely presents the evidence of decreased sperm concentration in European male over the past 50 years to serve the scientific research zone related to male reproductive health.
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Affiliation(s)
- P Sengupta
- Physiology Unit, Faculty of Medicine, Lincoln University College, Malaysia
- Integrated Medical Care, Medical University of Bialystok, Bialystok, Poland
| | - E Borges
- Fertility Medical Group, Avenida Brigadeiro Luiz Antônio, São Paulo, Brazil
| | - S Dutta
- Faculty of Science, Lincoln University College, Malaysia
| | - E Krajewska-Kulak
- Integrated Medical Care, Medical University of Bialystok, Bialystok, Poland
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Galimova EF, Amirova ZK, Galimov SN. Dioxins in the semen of men with infertility. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2015; 22:14566-9. [PMID: 24894758 DOI: 10.1007/s11356-014-3109-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 05/26/2014] [Indexed: 05/09/2023]
Abstract
The purpose of the present study was to assess ejaculate contamination by polychlorinated dibenzo-p-dioxins/furans in male infertility. The database of 168 infertile and 49 fertile men was included in the study. Dioxin content was determined using gas chromatography/high-resolution mass spectrometry (GC/HRMS). In the ejaculate of infertile men, the content of dioxins and furans was 2.2-2.3 times higher than in fertile donors. The maximum level of the most toxic dioxin congener was detected in pathospermia. Contamination of semen of infertile men by polychlorinated dibenzo-p-dioxins/furans supports the hypothesis about the relationship between environmental factors and reproductive health.
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Affiliation(s)
- E F Galimova
- Central Research Laboratory, Bashkir State Medical University, 450000, Ufa, Russia.
| | - Z K Amirova
- State-financed Institution of the Republic of Bashkortostan Environmental Research and Protection Center, 450075, Ufa, Russia.
| | - Sh N Galimov
- Department of Biochemistry, Bashkir State Medical University, 450000, Ufa, Russia.
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9
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Cooper TG, Handelsman DJ. Falling sperm counts and global oestrogenic pollution: postscript. Asian J Androl 2013; 15:208-11. [PMID: 23416896 PMCID: PMC3739167 DOI: 10.1038/aja.2013.17] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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10
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John Aitken R. Falling sperm counts twenty years on: where are we now? Asian J Androl 2013; 15:204-7. [PMID: 23353718 DOI: 10.1038/aja.2012.167] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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