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Frederiksen H, Johannsen TH, Andersen SE, Petersen JH, Busch AS, Ljubicic ML, Fischer MB, Upners EN, Hagen CP, Main KM, Aksglaede L, Jørgensen N, Lund Kårhus L, Linneberg A, Andersson AM, Flück CE, Juul A. Sex- and age-specific reference intervals of 16 steroid metabolites quantified simultaneously by LC-MS/MS in sera from 2458 healthy subjects aged 0 to 77 years. Clin Chim Acta 2024; 562:119852. [PMID: 38977173 DOI: 10.1016/j.cca.2024.119852] [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: 06/03/2024] [Revised: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Reference intervals covering the whole life span for all the metabolites in the steroid hormone biosynthesis quantified by sensitive and robust analytical methods are sparse or not existing. OBJECTIVE To develop a state-of-the-art LC-MS/MS method for simultaneous quantification of multiple steroid metabolites and to establish detailed sex- and age-specific reference intervals for 16 steroid metabolites. MATERIALS AND METHOD An isotope diluted LC-MS/MS method was developed for simultaneous quantitation of 16 steroid hormones. Serum samples from cross-sectional cohorts of healthy infants, children, adolescents, and adults aged 0.17 months to 77 years (n = 2458) were analysed. RESULTS With this novel, specific, and sensitive LC-MS/MS method, it was possible to quantify progesterone, 17-hydroxypregnenolone, 17-hydroxyprogesterone, dehydroepiandrosterone sulfate, androstenedione, testosterone, dihydrotestosterone, 11-deoxycorticosterone, corticosterone, 11-deoxycortisol, cortisol, and cortisone in ≥90 % of the samples, while estrone sulfate, aldosterone and dehydroepiandrosterone were quantified in 77 %, 75 % and 60 % of the samples, respectively. 21-deoxycortisol was only detectable in 2.5 % of samples from healthy subjects. Sex- and age-dependent fluctuations observed in minipuberty, puberty and adulthood including the menopausal transition were modelled. This enabled us to establish valid reference intervals from birth to late adult life for both males and females. CONCLUSION Detailed sex- and age-specific reference intervals of multiple, simultaneously quantified steroid metabolites by a novel and specific LC-MS/MS method provides a valuable tool for clinical practice and for future research.
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Affiliation(s)
- Hanne Frederiksen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Trine Holm Johannsen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Stine Ehlern Andersen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jørgen Holm Petersen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Biostatistics, University of Copenhagen, Denmark
| | - Alexander Siegfried Busch
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Marie Lindhardt Ljubicic
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Margit Bistrup Fischer
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Emmie N Upners
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Casper P Hagen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Katharina M Main
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Lise Aksglaede
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Niels Jørgensen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Line Lund Kårhus
- Center for Clinical Research and Disease Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, Denmark
| | - Allan Linneberg
- Center for Clinical Research and Disease Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Anna-Maria Andersson
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Christa E Flück
- Division of Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, Switzerland; Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Lassen E, Pacey A, Skytte AB, Montgomerie R. Recent decline in sperm motility among donor candidates at a sperm bank in Denmark. Hum Reprod 2024; 39:1618-1627. [PMID: 38834185 PMCID: PMC11291611 DOI: 10.1093/humrep/deae115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/07/2024] [Indexed: 06/06/2024] Open
Abstract
STUDY QUESTION Has there been variation in semen quality among men applying to be sperm donors (i.e. donor candidates) in Denmark in recent years (2017-2022)? SUMMARY ANSWER The motile sperm concentration and total motile sperm count (TMSC) in ejaculates-both measures of sperm quality-declined by as much as 22% from 2019 to 2022. WHAT IS KNOWN ALREADY Questions remain about whether human semen quality has declined in recent years. Whilst some studies provide evidence for a decline in human semen quality, these findings have been disputed owing to potential biases in the populations studied or in the methods used to measure semen quality. Resolution of this issue has important implications for human fertility, as well as for those involved in the recruitment of sperm donors for use in medically assisted reproduction. STUDY DESIGN, SIZE, DURATION We obtained data on the semen quality of ejaculates previously collected from 2017 to 2022 at sperm bank locations in four cities in Denmark: Aarhus, Aalborg, Copenhagen, and Odense. Our study focuses on the single semen samples provided by 6758 donor candidates aged between 18 and 45 years old to determine whether their sperm quality met a minimum criterion for them to be accepted as sperm donors. PARTICIPANTS/MATERIALS, SETTING, METHODS All ejaculates were analyzed within 1 hour of production. Semen volume (ml) was estimated by weight and both the concentration (106/ml) of sperm as well as the concentration of motile sperm (World Health Organization grades a and b) were measured using the same protocols and computer-assisted semen analysis system across all years at each site. Statistical analyses of the semen variables were controlled for age and donation site, as well as the average monthly high temperature when the ejaculate was produced. MAIN RESULTS AND THE ROLE OF CHANCE From 2017 to 2019, semen volume, sperm concentration, and total sperm count in the ejaculates of donor candidates increased by 2-12%. Then, from 2019 to 2022, sperm concentration and total sperm count changed by 0.1-5% from year to year, but none of those changes were statistically significant. In contrast, both motile sperm concentration and TMSC declined significantly, by 16% and 22%, respectively, between 2019 and 2022. Thus, the concentration of motile sperm in donor candidates declined from 18.4 [95% CL: 17.0, 20.0] million/ml in 2019 to 15.5 [14.4, 16.7] million/ml in 2022, and TMSC declined from 61.4 [55.8, 67.5] million per ejaculate in 2019 to 48.1 [44.1, 52.4] million in 2022. LIMITATIONS, REASONS FOR CAUTION We cannot determine from the available data the causes of the decline in semen quality of donor candidates from 2019 to 2022. However, as this period coincides with lockdowns and changes in work patterns during the coronavirus disease 2019 pandemic, it is possible that changes in motile sperm concentration and TMSC were the result of changes in the lifestyles of the men whose semen was analyzed. WIDER IMPLICATIONS OF THE FINDINGS Men providing initial semen samples at sperm banks, when applying to be sperm donors, are a useful population in which to monitor changes in human semen quality over time. Our results have implications for human fertility and the recruitment of sperm donors for medically assisted reproduction, where motile sperm concentration is an essential selection criterion because it influences fertility. We suggest that gathering health and lifestyle data on donor candidates at sperm banks might help to identify causal factors for the decline of sperm quality that could be addressed and intervention, if desired, could be personalized for each accepted donor. STUDY FUNDING/COMPETING INTEREST(S) No external funding was obtained for this study. E.L. and A.-B.S. are employees of Cryos International. AP reports paid consultancy for Cryos International, Cytoswim Ltd, Exceed Health, and Merck Serono in the last 2 years of this study, but all monies were paid to the University of Sheffield (former employer). AP is also an unpaid trustee of the Progress Educational Trust (Charity Number 1139856). RM declares support from Cryos International to present results of this research at ESHRE 2023. None of the authors were directly involved in the collection or physical analysis of semen samples. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Emilie Lassen
- Cryos International Sperm and Egg Bank, Aarhus, Denmark
| | - Allan Pacey
- School of Medical Sciences, Faculty of Biology, Medicine and Health, Core Technology Facility, University of Manchester, Manchester, UK
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Gaml-Sørensen A, Frølich MK, Brix N, Ernst A, Bonde JPE, Hougaard KS, Tøttenborg SS, Clemmensen PJ, Toft G, Ramlau-Hansen CH. Sleep duration and biomarkers of fecundity in young men: a cross-sectional study from a population-based cohort. Andrology 2024; 12:1125-1136. [PMID: 37985426 DOI: 10.1111/andr.13560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/05/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Poor male fecundity is of concern and warrants the identification of potential modifiable risk factors. Short and long sleep duration might be risk factors for poor male fecundity although evidence in this research field is inconsistent. OBJECTIVES To investigate the association between sleep duration and biomarkers of male fecundity in young men. MATERIALS AND METHODS We conducted a cross-sectional study of 1,055 young men from the Fetal Programming of Semen Quality (FEPOS) cohort, Denmark, 2017-2019. Sleep duration was obtained from an online survey answered by the participants prior to the clinical visit, where semen and blood samples were obtained, and testis volume was self-assessed using an Orchidometer. Percentage differences in semen characteristics, testes volume, and reproductive hormone levels were analysed according to sleep duration using multivariable negative binomial regression models. Sleep duration was dichotomised (recommended (6-9 h/night) versus deviant sleep) and visualised continuously as restricted cubic spline plots. RESULTS Deviation from recommended sleep duration was associated with higher high DNA stainability (HDS) of 5% (95% CI: -1%; 13%), higher testosterone of 3% (95% CI: 0%; 7%) and higher free androgen index (FAI) of 6% (95% CI: 0%; 13%). The spline plots overall supported these results, suggesting u-shaped associations between sleep duration and HDS, testosterone and FAI, a linear association between sleep duration and semen volume and sex hormone binding globulin (SHBG) and an inverse u-shaped association with normal morphology. DISCUSSION Information on sleep duration was obtained by self-report in broad categories with at least 3 h intervals. We were not able to investigate short or long sleep duration separately, since only few participants reported this. CONCLUSION Sleep duration was associated with some biomarkers of fecundity in young men. Maintaining a recommended sleep duration may thus be beneficial for young men with regard to reproductive health.
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Affiliation(s)
| | | | - Nis Brix
- Department of Public Health, Aarhus University, Aarhus C, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus N, Denmark
| | - Andreas Ernst
- Department of Public Health, Aarhus University, Aarhus C, Denmark
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen NV, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Karin Sørig Hougaard
- Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
- National Research Centre for the Working Environment, Copenhagen Oest, Denmark
| | - Sandra Søgaard Tøttenborg
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen NV, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | | | - Gunnar Toft
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
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Gaml-Sørensen A, Thomsen AH, Tøttenborg SS, Brix N, Hougaard KS, Toft G, Håberg SE, Myrskylä M, Bonde JP, Ramlau-Hansen CH. Maternal pre-pregnancy BMI and reproductive health in adult sons: a study in the Danish National Birth Cohort. Hum Reprod 2024; 39:219-231. [PMID: 37935951 PMCID: PMC10767916 DOI: 10.1093/humrep/dead230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/12/2023] [Indexed: 11/09/2023] Open
Abstract
STUDY QUESTION Is maternal pre-pregnancy BMI associated with semen quality, testes volume, and reproductive hormone levels in sons? SUMMARY ANSWER Maternal pre-pregnancy BMI was associated with an altered reproductive hormone profile in young adult sons, characterized by higher levels of oestradiol, LH, and free androgen index (FAI) and lower levels of sex hormone-binding globulin (SHBG) in sons born of mothers with pre-pregnancy overweight and obesity. WHAT IS KNOWN ALREADY Evidence suggests that maternal pre-pregnancy BMI may influence reproductive health later in life. Only one pilot study has investigated the association between maternal pre-pregnancy BMI and reproductive health outcomes in sons, suggesting that a high BMI was associated with impaired reproductive function in the adult sons. STUDY DESIGN, SIZE, DURATION A population-based follow-up study of 1058 young men from the Fetal Programming of Semen Quality (FEPOS) cohort nested within the Danish National Birth Cohort (DNBC), 1998-2019, was carried out. PARTICIPANTS/MATERIALS, SETTING, METHODS In total, 1058 adult sons (median age 19 years, 2 months), born 1998-2000 by mothers included in the DNBC, participated in FEPOS. At a clinical examination, they provided a semen and blood sample, measured their testes volume, and had height and weight measured. Maternal pre-pregnancy BMI was obtained by self-report in early pregnancy. Semen characteristics, testes volume, and reproductive hormone levels were analysed according to maternal pre-pregnancy BMI categories and as restricted cubic splines using negative binomial and ordinary least square regression models. Mediation analyses examined potential mediation by the sons' birthweight, pubertal timing, fat mass, and BMI. Additional analyses investigated the role of paternal BMI in the potential associations between maternal BMI and reproductive health outcomes. MAIN RESULTS AND THE ROLE OF CHANCE We found no consistent associations between maternal pre-pregnancy BMI and semen characteristics or testes volume. Sons of mothers with higher pre-pregnancy BMI had higher oestradiol and lower SHBG levels, both in a dose-dependent manner. Sons of mothers with pre-pregnancy obesity (≥30 kg/m2) had higher LH levels and a higher FAI than sons born by mothers with normal pre-pregnancy BMI (18.5-24.9 kg/m2). The mediation analyses suggested that the effect of maternal pre-pregnancy BMI on higher levels of oestrogen, LH, and FAI was partly mediated by the sons' birthweight, in addition to adult fat mass and BMI measured at the clinical examination, whereas most of the effect on lower levels of SHBG was primarily mediated by the sons' own fat mass and BMI. Paternal BMI was not a strong confounder of the associations in this study. LIMITATIONS, REASONS FOR CAUTION This study was based in a population-based cohort with a low prevalence of overweight and obesity in both mothers and adult sons. Some men (10%) had blood for reproductive hormone assessment drawn in the evening. While several potential confounding factors were accounted for, this study's inherent risk of residual and unmeasured confounding precludes provision of causal estimates. Therefore, caution should be given when interpreting the causal effect of maternal BMI on sons' reproductive health. WIDER IMPLICATIONS OF THE FINDINGS Given the widespread occurrence of overweight and obesity among pregnant women, it is imperative to thoroughly examine the potential consequences for reproductive hormone levels in adult sons. The potential effects of maternal pre-pregnancy obesity on sons' reproductive hormone profile may potentially be partly avoided by the prevention of overweight and obesity in the sons. STUDY FUNDING/COMPETING INTEREST(S) The project was funded by the Lundbeck Foundation (R170-2014-855), the Capital Region of Denmark, Medical doctor Sofus Carl Emil Friis and spouse Olga Doris Friis's Grant, Axel Muusfeldt's Foundation (2016-491), AP Møller Foundation (16-37), the Health Foundation, Dagmar Marshall's Fond, Aarhus University, Independent Research Fund Denmark (9039-00128B), and the European Union (ERC, BIOSFER, 101071773). Views and opinions expressed are, however, those of the authors only and do not necessarily reflect those of the European Union or the European Research Council. Neither the European Union nor the granting authority can be held responsible. The authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Anne Gaml-Sørensen
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Anne Hjorth Thomsen
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Sandra Søgaard Tøttenborg
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nis Brix
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Karin Sørig Hougaard
- Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- National Research Centre for Working Environment, Copenhagen, Denmark
| | - Gunnar Toft
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Siri Eldevik Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Mikko Myrskylä
- Max Planck Institute for Demographic Research, Rostock, Germany
- Center for Social Data Science and Population Research Unit, University of Helsinki, Helsinki, Finland
- Max Planck—University of Helsinki Center for Social Inequalities in Population Health, Rostock, Germany
| | - Jens Peter Bonde
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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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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Rod NH, Andersen TO, Severinsen ER, Sejling C, Dissing A, Pham VT, Nygaard M, Schmidt LKH, Drews HJ, Varga T, Freiesleben NLC, Nielsen HS, Jensen AK. Cohort profile: The SmartSleep Study, Denmark, combining evidence from survey, clinical and tracking data. BMJ Open 2023; 13:e063588. [PMID: 37793923 PMCID: PMC10551986 DOI: 10.1136/bmjopen-2022-063588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/31/2023] [Indexed: 10/06/2023] Open
Abstract
PURPOSE The SmartSleep Study is established to comprehensively assess the impact of night-time smartphone use on sleep patterns and health. An innovative combination of large-scale repeated survey information, high-resolution sensor-driven smartphone data, in-depth clinical examination and registry linkage allows for detailed investigations into multisystem physiological dysregulation and long-term health consequences associated with night-time smartphone use and sleep impairment. PARTICIPANTS The SmartSleep Study consists of three interconnected data samples, which combined include 30 673 individuals with information on smartphone use, sleep and health. Subsamples of the study population also include high-resolution tracking data (n=5927) collected via a customised app and deep clinical phenotypical data (n=245). A total of 7208 participants are followed in nationwide health registries with full data coverage and long-term follow-up. FINDINGS TO DATE We highlight previous findings on the relation between smartphone use and sleep in the SmartSleep Study, and we evaluate the interventional potential of the citizen science approach used in one of the data samples. We also present new results from an analysis in which we use 803 000 data points from the high-resolution tracking data to identify clusters of temporal trajectories of night-time smartphone use that characterise distinct use patterns. Based on these objective tracking data, we characterise four clusters of night-time smartphone use. FUTURE PLANS The unprecedented size and coverage of the SmartSleep Study allow for a comprehensive documentation of smartphone activity during the entire sleep span. The study has been expanded by linkage to nationwide registers, which allow for further investigations into the long-term health and social consequences of night-time smartphone use. We also plan new rounds of data collection in the coming years.
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Affiliation(s)
- Naja Hulvej Rod
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thea Otte Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Elin Rosenbek Severinsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Hvidovre Hospital, Hvidovre, Denmark
| | | | - Agnete Dissing
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Vi Thanh Pham
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mette Nygaard
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Tibor Varga
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nina La Cour Freiesleben
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Hvidovre Hospital, Hvidovre, Denmark
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Eisenberg ML, Esteves SC, Lamb DJ, Hotaling JM, Giwercman A, Hwang K, Cheng YS. Male infertility. Nat Rev Dis Primers 2023; 9:49. [PMID: 37709866 DOI: 10.1038/s41572-023-00459-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/16/2023]
Abstract
Clinical infertility is the inability of a couple to conceive after 12 months of trying. Male factors are estimated to contribute to 30-50% of cases of infertility. Infertility or reduced fertility can result from testicular dysfunction, endocrinopathies, lifestyle factors (such as tobacco and obesity), congenital anatomical factors, gonadotoxic exposures and ageing, among others. The evaluation of male infertility includes detailed history taking, focused physical examination and selective laboratory testing, including semen analysis. Treatments include lifestyle optimization, empirical or targeted medical therapy as well as surgical therapies that lead to measurable improvement in fertility. Although male infertility is recognized as a disease with effects on quality of life for both members of the infertile couple, fewer data exist on specific quantification and impact compared with other health-related conditions.
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Affiliation(s)
- Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Sandro C Esteves
- ANDROFERT Andrology and Human Reproduction Clinic, Campinas, Brazil
- Division of Urology, Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Dolores J Lamb
- Center for Reproductive Genomics, Weill Cornell Medical College, New York, NY, USA
- Englander Institute for Precision Medicine, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Kathleen Hwang
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yu-Sheng Cheng
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Henriksen LS, Frederiksen H, Jørgensen N, Juul A, Skakkebæk NE, Toppari J, Petersen JH, Main KM. Maternal phthalate exposure during pregnancy and testis function of young adult sons. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 871:161914. [PMID: 36736395 DOI: 10.1016/j.scitotenv.2023.161914] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/26/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Phthalate exposure during fetal life may disrupt testicular development. Congruent with this, studies have found shorter anogenital distance, reduced penile size and altered hormone levels in infant boys whose mothers were exposed to higher levels of some phthalates during pregnancy. Few studies have explored if such adverse effects persist in adulthood. Thus, we aimed to explore if there is an association between fetal phthalate exposure and markers of testicular function in young adult men. METHODS In a longitudinal mother-child cohort from Copenhagen, Denmark, we examined 100 young men whose mothers during pregnancy had serum drawn and analyzed for 34 phthalate metabolites. Examinations of the young men took place at 18-20 years of age and included measurements of adult markers of testicular function (reproductive hormones, penile size, anogenital distance (AGD), testis volume, semen quality) and growth factors. Associations between maternal serum concentrations of phthalate metabolites and reproductive measures in the young men were tested using multiple linear regression. RESULTS Most consistently, higher maternal phthalate exposure was associated with higher luteinizing hormone (LH) but unchanged testosterone in adult sons. Congruently, higher maternal exposure was associated with lower total and free testosterone/LH ratios in adult sons. For example, twice as high maternal MiNP was associated with a 7.9 % (95 % CI 1.6-13.8) lower free testosterone/LH ratio. There was no consistent pattern of associations between the different phthalate metabolites and other reproductive hormones, clinical outcomes, or semen quality. None of the tested associations was significant after multiplicity adjustment. CONCLUSIONS In this exploratory study, higher maternal exposure to some phthalates was associated with impaired testicular Leydig cell function evidenced by a lower total and free testosterone/LH ratio in adult sons. This unique 18-20-year follow-up study raises concern and suggests that exposure of pregnant women to phthalates may have long-term effects on adult reproductive health in male offspring.
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Affiliation(s)
- Louise Scheutz Henriksen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research & Training in Endocrine Disruption of Male Reproduction & Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Hanne Frederiksen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research & Training in Endocrine Disruption of Male Reproduction & Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Niels Jørgensen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research & Training in Endocrine Disruption of Male Reproduction & Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research & Training in Endocrine Disruption of Male Reproduction & Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Niels E Skakkebæk
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research & Training in Endocrine Disruption of Male Reproduction & Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jorma Toppari
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland; Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Jørgen Holm Petersen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Katharina M Main
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research & Training in Endocrine Disruption of Male Reproduction & Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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9
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Dornfeldt MM, Andersen AMN, Hougaard KS, Ramlau-Hansen CH, Toft G, Bonde JPE, Haervig KK, Petersen KU, Kofoed ABB, Deen L, Tøttenborg SS. Maternal fever during pregnancy and male offspring reproductive health: A longitudinal cohort study in young Danish males. Andrology 2023; 11:523-536. [PMID: 36415019 DOI: 10.1111/andr.13345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/28/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Maternal fever during pregnancy has been associated with an increased risk of genital malformations, but the implication for long-term reproductive health in the offspring is unknown. OBJECTIVES To investigate associations between timing, duration, and temperature of fetal exposure to maternal fever and sons' semen quality, testicular volume, and levels of reproductive hormones in early adulthood. Further, to examine whether concurrent use of antipyretics and/or antibiotics modified the effect. MATERIALS AND METHODS We used the Fetal Programming of Semen Quality cohort consisting of men born to women enrolled in the Danish National Birth Cohort. Self-reported information on maternal fever was collected twice during pregnancy (median 16 and 31 pregnancy weeks) and categorized as any fever during pregnancy, fever during early pregnancy (weeks 1-15), and fever exclusively during late pregnancy (weeks 16-42). Semen quality and concentrations of reproductive hormones were measured at a clinical examination at the age of 18.9 years. We used negative binomial regression to examine the associations, adjusting for maternal age at birth, maternal smoking, family occupational status, and precision variables related to semen quality and hormonal levels, for example, abstinence time. RESULTS 986 men were included in the study, of which 23% had mothers reporting at least one episode of fever. We found no strong indications of associations between maternal fever during pregnancy and male reproductive health in young men. Concurrent use of antipyretics and antibiotics did not modify the association. DISCUSSION Strengths include the large sample size, prospectively collected data, and the adjustment for maternal factors during pregnancy and important precision variables. A limitation is the crude self-reported information on maternal fever. CONCLUSION We found no evidence to support that timing, duration, or temperature of maternal fever during pregnancy has a long-term impact on semen characteristics, testicular volume, or level of reproductive hormones in male offspring.
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Affiliation(s)
- Mette Møller Dornfeldt
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Anne-Marie Nybo Andersen
- Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Karin Sørig Hougaard
- Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Gunnar Toft
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Katia Keglberg Haervig
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Kajsa Ugelvig Petersen
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Ane Berger Bungum Kofoed
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Laura Deen
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Sandra Søgaard Tøttenborg
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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10
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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: 151] [Impact Index Per Article: 151.0] [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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11
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Hansen LS, Priskorn L, Holmboe SA, Jensen TK, Hansen AH, Andersson AM, Jørgensen N. Testicular function is associated with cardiometabolic health markers: A cross-sectional study of 2289 young men. Andrology 2023; 11:561-574. [PMID: 36520458 DOI: 10.1111/andr.13365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/26/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Testicular function, including compensated Leydig cell function, has been indicated to be an early marker of morbidity. OBJECTIVE To study the association of testicular function and markers of metabolic and cardiovascular health in a population of young men. MATERIALS AND METHODS A cross-sectional study of 2289 men (median age 19 years, 5-95 percentile 18.4-22.2) from the general population examined between 2012 and 2019. Participants answered a questionnaire, had a blood sample drawn for assessment of reproductive hormone levels and health markers (lipids, glycosylated hemoglobin), delivered a semen sample, underwent physical examination including blood pressure measurements, and dual-energy X-ray absorptiometry scan for assessment of body composition. Associations were assessed in both crude and adjusted linear regression analyses. RESULTS The men were within the normal reference intervals of their age for reproductive and health biomarkers. Compared to the lowest quartile, having luteinizing hormone levels in the highest quartile was associated with higher mean arterial pressure (1.6 [95% confidence interval: 0.8; 2.5] mmHg), cholesterol (0.1 [95% confidence interval: 0.02; 0.18] mmol/L), and total body fat percentage (1.1 [95% confidence interval: 0.4; 1.8] %-points). Higher serum testosterone levels were associated with more advantageous cardiometabolic health markers and higher total sperm count with a healthier body composition and lower glycosylated hemoglobin. DISCUSSION AND CONCLUSION In this study of young men, unselected regarding reproductive hormones and semen quality, higher luteinizing hormone was associated with cardiovascular risk factors. Higher testosterone and total sperm count were associated with more favorable cardiometabolic indices. Thus, serum reproductive hormones and semen quality may be early appearing biomarkers of cardiovascular health even among young healthy men, which could potentially be useful for preventive initiatives to reduce the excess mortality and morbidity risk among infertile men. However, our study was cross-sectional and cannot determine causation. Future longitudinal studies of reproductive health in young men are warranted.
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Affiliation(s)
- Laura Smidt Hansen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Laerke Priskorn
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Stine A Holmboe
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Tina Kold Jensen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Ann Holm Hansen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Anna-Maria Andersson
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Niels Jørgensen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,International Center 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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12
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Hansen AH, Priskorn L, Hansen LS, Carlsen E, Joensen UN, Jacobsen FM, Jensen CFS, Jørgensen N. Testicular torsion and subsequent testicular function in young men from the general population. Hum Reprod 2023; 38:216-224. [PMID: 36610456 DOI: 10.1093/humrep/deac271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/13/2022] [Indexed: 01/09/2023] Open
Abstract
STUDY QUESTION Is prior testicular torsion associated with testicular function (semen quality and reproductive hormones) in young men from the general population? SUMMARY ANSWER In young men from the general population, no differences in semen parameters were observed in those who had experienced testicular torsion compared to controls and observations of higher FSH and lower inhibin B were subtle. WHAT IS KNOWN ALREADY Testicular function may be impaired after testicular torsion, but knowledge is sparse and based on studies with small sample sizes and no control group or a less than ideal control group. STUDY DESIGN, SIZE, DURATION A cross-sectional population-based study was carried out including 7876 young Danish men with unknown fertility potential, examined from 1996 to 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS All men (median age 19.0 years) had a physical examination, provided a blood and semen sample, and filled in a questionnaire including information about prior testicular torsion, birth, lifestyle and current and previous diseases. Markers of testicular function, including testis volume, semen parameters and reproductive hormones, were compared between men operated for testicular torsion and controls, using multiple linear regression analyses. MAIN RESULTS AND THE ROLE OF CHANCE The average participation rate was 24% for the entire study period. In total, 57 men (0.72%) were previously operated for testicular torsion (median age at surgery 13.4 years) of which five had only one remaining testicle. Men with prior testicular torsion were more often born preterm (25% versus 9.5% among controls), and they had significantly higher FSH and lower inhibin B levels, and a lower inhibin B/FSH ratio than controls in crude and adjusted models. The association was mainly driven by the subgroup of men who had undergone unilateral orchiectomy. No differences in semen parameters were observed. LIMITATIONS, REASONS FOR CAUTION A limitation is the retrospective self-reported information on testicular torsion. Also, results should be interpreted with caution owing to the high uncertainty of the observed differences. WIDER IMPLICATIONS OF THE FINDINGS Overall, the results of our study are reassuring for men who have experienced testicular torsion, especially when treated with orchiopexy, for whom reproductive hormone alterations were subtle and without obvious clinical relevance. Our study found no differences in semen parameters, but follow-up studies are needed to assess any long-term consequences for fertility. STUDY FUNDING/COMPETING INTEREST(S) Financial support was received from the Danish Ministry of Health; the Danish Environmental Protection Agency; the Research fund of Rigshospitalet, Copenhagen University Hospital; the European Union (Contract numbers BMH4-CT96-0314, QLK4-CT-1999-01422, QLK4-CT-2002-00603, FP7/2007-2013, DEER Grant agreement no. 212844); A.P. Møller and wife Chastine Mckinney Møllers Foundation; Svend Andersens Foundation; the Research Fund of the Capital Region of Denmark; and ReproUnion (EU/Interreg). The authors have nothing to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- A H Hansen
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,International Center for Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - L Priskorn
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,International Center for Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - L S Hansen
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,International Center for Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - E Carlsen
- Fertility Department, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - U N Joensen
- Department of Urology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - F M Jacobsen
- Department of Urology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - C F S Jensen
- Department of Urology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - N Jørgensen
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,International Center for Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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13
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Pedersen MK, Bräuner EV, Hansen AH, Hansen LS, Jensen TK, Jørgensen N, Priskorn L. Self-Reported Asthma Is Associated with Reduced Sperm Count-A Cross-Sectional Study of More than 6000 Young Men from the General Population. Life (Basel) 2023; 13:278. [PMID: 36836635 PMCID: PMC9966775 DOI: 10.3390/life13020278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Asthma is driven by an inflammatory response that may impact testicular function. In this cross-sectional study, we investigated the association between self-reported asthma and testicular function (semen parameters, reproductive hormone levels), and determined whether potential further inflammation due to self-reported allergy modified this association. A total of 6177 men from the general population completed a questionnaire including information on doctor-diagnosed asthma or allergy, had a physical examination, delivered a semen sample, and had a blood sample drawn. Multiple linear regression analyses were performed. A total of 656 (10.6%) men reported having ever been diagnosed with asthma. Generally, self-reported asthma was consistently associated with a poorer testicular function; however, few estimates were statistically significant. Specifically, self-reported asthma was associated with statistically significant lower total sperm count [median: 133 vs. 145 million; adjusted β (95% CI): -0.18 (-0.33 to -0.04) million on cubic-root-transformed scale] and borderline statistically significant lower sperm concentration compared with no self-reported asthma. The association between asthma and total sperm count was of similar magnitude among men with and without allergy. In conclusion, men with self-reported asthma had poorer testicular function than men without asthma. However, the cross-sectional design of the study limits ascertainment of causality.
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Affiliation(s)
- Marc K. Pedersen
- Department of Growth and Reproduction, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Elvira V. Bräuner
- Department of Growth and Reproduction, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Ann H. Hansen
- Department of Growth and Reproduction, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Laura S. Hansen
- Department of Growth and Reproduction, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Tina K. Jensen
- Department of Growth and Reproduction, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Research Unit of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, 5000 Odense, Denmark
| | - Niels Jørgensen
- Department of Growth and Reproduction, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Lærke Priskorn
- Department of Growth and Reproduction, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
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14
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Langergaard MJ, Ernst A, Brix N, Gaml-Sørensen A, Tøttenborg SS, Bonde JPE, Toft G, Hougaard KS, Ramlau-Hansen CH. Maternal age at menarche and reproductive health in young adult men: a cohort study. Hum Reprod 2023; 38:125-138. [PMID: 36303450 DOI: 10.1093/humrep/deac231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/27/2022] [Indexed: 01/11/2023] Open
Abstract
STUDY QUESTION Is maternal age at menarche associated with reproductive health in sons measured by semen quality, testes volume and reproductive hormone levels? SUMMARY ANSWER Later maternal age at menarche was associated with impaired semen characteristics, lower testes volume and altered levels of reproductive hormones, while earlier maternal age at menarche was not strongly associated with reproductive outcomes in sons. WHAT IS KNOWN ALREADY Both earlier and later maternal age at menarche may be associated with altered male reproductive health outcomes. This is the first study to investigate the potential association between maternal age at menarche and semen quality, testes volume and reproductive hormone levels in sons. STUDY DESIGN, SIZE, DURATION In this population-based cohort study, we used data from the Fetal Programming of Semen Quality Cohort nested within the Danish National Birth Cohort. In total, 5697 sons born in 1998-2000 were invited to participate in the cohort in 2017-2019. PARTICIPANTS/MATERIALS, SETTING, METHODS In total, 1043 (18% of the invited) young men with information on maternal age at menarche provided a semen and blood sample, measured their testes volume, and filled in a questionnaire on health behavior and pubertal development. Maternal age at menarche was reported by the mothers during pregnancy and examined categorically (as earlier, at the same time or later than their peers), continuously and modeled as splines. We estimated relative percentage differences in the reproductive outcomes using negative binomial regression models. Further, we did a mediation analysis to investigate the potential mediating role of timing of the sons' pubertal development. MAIN RESULTS AND THE ROLE OF CHANCE Sons whose mothers had age at menarche later than peers had 15% lower (95% CI: -27%; 0%) sperm concentration, 14% lower (95% CI: -28%; 1%) total sperm count, 7% higher (95% CI: 0%; 14%) proportion of nonprogressive or immotile spermatozoa, 6% lower (95% CI: -11%; 0%) testes volume, 6% lower (95% CI: -12%; 1%) luteinizing hormone, 6% lower (95% CI: -12%; 1%) sex hormone-binding globulin and 5% lower (95% CI: -9%; 0%) testosterone levels compared with sons whose mothers had age at menarche at the same time as peers. Our study did not suggest that earlier maternal age at menarche was strongly associated with semen quality, testes volume or reproductive hormones in sons. However, the spline analyses indicated a potential inverted U-shaped association for sperm concentration and testes volume, and levels of sex hormone-binding globulin and testosterone. We found no strong evidence of mediation by timing of the sons' own pubertal development. LIMITATIONS, REASONS FOR CAUTION There was a rather low participation rate in the Fetal Programming of Semen Quality Cohort and we tried to counter it by applying selection weights. Maternal age at menarche was recalled during pregnancy, which may introduce misclassification, most likely nondifferential. Inaccuracy of the sons' recalled pubertal development years after the event may result in underestimation of the possible mediating role of pubertal timing. WIDER IMPLICATIONS OF THE FINDINGS Our findings may represent a degree of shared heritability of reproductive health or be a result of an underlying epigenetic profile or unknown shared environmental, cultural or dietary exposure, causing both altered age at menarche and impaired reproductive health outcomes in sons. However, the exact mechanism for the investigated association remains unknown. STUDY FUNDING/COMPETING INTEREST(S) This article is part of the ReproUnion collaborative study, cofinanced by the European Union, Intereg V ÖKS (20200407). The FEPOS project was further funded by the Lundbeck Foundation (R170-2014-855), the Capital Region of Denmark, Medical doctor Sofus Carl Emil Friis and spouse Olga Doris Friis's Grant, Axel Muusfeldt's Foundation (2016-491), A.P. Møller Foundation (16-37), the Health Foundation and Dagmar Marshall's Fond. Additionally, this study received funding from Aarhus University. There are no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
| | - Andreas Ernst
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus C, Denmark
- Department of Urology, Aarhus University Hospital, Aarhus N, Denmark
| | - Nis Brix
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus C, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus N, Denmark
| | - Anne Gaml-Sørensen
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus C, Denmark
| | - Sandra S Tøttenborg
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, Copenhagen NV, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen K, Denmark
| | - Jens Peter E Bonde
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, Copenhagen NV, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen K, Denmark
| | - Gunnar Toft
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
| | - Karin S Hougaard
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen K, Denmark
- National Research Centre for the Working Environment, Copenhagen East, Denmark
| | - Cecilia H Ramlau-Hansen
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus C, Denmark
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15
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Lund KH, Laursen ASD, Grønborg TK, Toft G, Jacobsen BH, Wang TR, Wesselink AK, Hatch EE, Sommer GJ, Eisenberg ML, Rothman KJ, Sørensen HT, Wise LA, Mikkelsen EM. Perceived stress and semen quality. Andrology 2023; 11:45-53. [PMID: 36151857 PMCID: PMC10092477 DOI: 10.1111/andr.13301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/25/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Psychological stress is prevalent among reproductive-aged men. Assessment of semen quality for epidemiological studies is challenging as data collection is expensive and cumbersome, and studies evaluating the effect of perceived stress on semen quality are inconsistent. OBJECTIVE To examine the association between perceived stress and semen quality. MATERIAL AND METHODS We analyzed baseline data on 644 men (1,159 semen samples) from two prospective preconception cohort studies during 2015-2021: 592 in Pregnancy Study Online (PRESTO) and 52 in SnartForaeldre.dk (SF). At study entry, men aged ≥21 years (PRESTO) and ≥18 years (SF) trying to conceive without fertility treatment completed a questionnaire on reproductive and medical history, socio-demographics, lifestyle, and the 10-item version of the Perceived Stress Scale (PSS; interquartile range [IQR] of scores: 0-40). After enrollment (median weeks: 2.1, IQR: 1.3-3.7), men were invited to perform in-home semen testing, twice with 7-10 days between tests, using the Trak Male Fertility Testing System. Semen quality was characterized by semen volume, sperm concentration, and total sperm count. We fit generalized estimating equation linear regression models to estimate the percent difference in mean log-transformed semen parameters by four PSS groups (<10, 10-14, 15-19, ≥20), adjusting for potential confounders. RESULTS The median PSS score and IQR was 15 (10-19), and 136 men (21.1%) had a PSS score ≥20. Comparing men with PSS scores ≥20 with <10, the adjusted percent difference was -2.7 (95% CI: -9.8; 5.0) for semen volume, 6.8 (95% CI: -10.9; 28.1) for sperm concentration, and 4.3 (95% CI: -13.8; 26.2) for total sperm count. CONCLUSION Our findings indicate that perceived stress is not materially associated with semen volume, sperm concentration, or total sperm count.
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Affiliation(s)
- Katrine H Lund
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Sofie D Laursen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Therese K Grønborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Gunnar Toft
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Bjarke H Jacobsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Tanran R Wang
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Greg J Sommer
- Laboratory Corporation of America, Pleasanton, California, USA
| | | | - Kenneth J Rothman
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.,RTI, Health Solutions, Research Triangle Park, Triangle Park, North Carolina, USA
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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16
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Boulicault M, Perret M, Galka J, Borsa A, Gompers A, Reiches M, Richardson S. The future of sperm: a biovariability framework for understanding global sperm count trends. HUM FERTIL 2022; 25:888-902. [PMID: 33969777 DOI: 10.1080/14647273.2021.1917778] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The past 50 years have seen heated debate in the reproductive sciences about global trends in human sperm count. In 2017, Levine and colleagues published the largest and most methodologically rigorous meta-regression analysis to date and reported that average total sperm concentration among men from 'Western' countries has decreased by 59.3% since 1973, with no sign of halting. These results reverberated in the scientific community and in public discussions about men and masculinity in the modern world, in part because of scientists' public-facing claims about the societal implications of the decline of male fertility. We find that existing research follows a set of implicit and explicit assumptions about how to measure and interpret sperm counts, which collectively form what we term the Sperm Count Decline hypothesis (SCD). Using the study by Levine and colleagues, we identify weaknesses and inconsistencies in the SCD, and propose an alternative framework to guide research on sperm count trends: the Sperm Count Biovariability hypothesis (SCB). SCB asserts that sperm count varies within a wide range, much of which can be considered non-pathological and species-typical. Knowledge about the relationship between individual and population sperm count and life-historical and ecological factors is critical to interpreting trends in average sperm counts and their relationships to health and fertility.
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Affiliation(s)
- Marion Boulicault
- Department of Philosophy and Linguistics, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Philosophy, University of Adelaide, Adelaide, Australia
| | - Meg Perret
- Department of the History of Science, Harvard University, Cambridge, MA, USA
| | - Jonathan Galka
- Department of the History of Science, Harvard University, Cambridge, MA, USA
| | - Alex Borsa
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA
| | - Annika Gompers
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Meredith Reiches
- Department of Anthropology, University of Massachusetts, Boston, MA, USA
| | - Sarah Richardson
- Department of the History of Science, Harvard University, Cambridge, MA, USA.,Committee on Degrees in Studies of Women, Gender, and Sexuality, Harvard University, Cambridge, MA, USA
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17
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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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18
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Kortenkamp A, Scholze M, Ermler S, Priskorn L, Jørgensen N, Andersson AM, Frederiksen H. Combined exposures to bisphenols, polychlorinated dioxins, paracetamol, and phthalates as drivers of deteriorating semen quality. ENVIRONMENT INTERNATIONAL 2022; 165:107322. [PMID: 35691715 DOI: 10.1016/j.envint.2022.107322] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 05/09/2023]
Abstract
BACKGROUND Semen quality in men continues to decline in Western countries, but the contours of the issue remain obscure, in relation to contributing chemicals. OBJECTIVES To obtain more clarity about the chemicals that drive the deterioration of semen quality, we conducted a mixture risk assessment based on European exposures. METHODS We included chemicals capable of affecting semen quality after prenatal exposures, among them androgen receptor antagonists, substances that disrupt prostaglandin signalling, suppress testosterone synthesis, inhibit steroidogenic enzymes or activate the aryl hydrocarbon receptor. We employed the Hazard Index approach (HI), based on risk quotients of exposures in Europe and reference doses for reductions in semen quality. By summing up the risk quotients of the 29 chemicals included in the assessment we examined fold-exceedances of "acceptable" mixture exposures relative to an index value of 1. For bisphenols A, F, S, phthalates DEHP, DnBP, BBzP, DiNP, n-butyl paraben and paracetamol we relied on biomonitoring studies in which these 9 chemicals were measured together in the same subjects. This allowed us to construct personalised Hazard Indices. RESULTS Highly exposed subjects experienced combined exposures to the 9 chemicals that exceeded the index value of 1 by more than 100-fold; the median was a 17-fold exceedance. Accounting for median background exposures to the remaining 20 chemicals added a Hazard Index of 1.39. Bisphenol A made the largest contribution to the HI, followed by polychlorinated dioxins, bisphenols S and F and DEHP. Eliminating bisphenol A alone would still leave unacceptably high mixture risks. Paracetamol is also a driver of mixture risks among subjects using the drug. CONCLUSIONS Tolerable exposures to substances associated with deteriorations of semen quality are exceeded by a large margin. Bisphenols, polychlorinated dioxins, phthalates and analgesics drive these risks. Dedicated efforts towards lowering exposures to these substances are necessary to mitigate risks.
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Affiliation(s)
- Andreas Kortenkamp
- Brunel University London, Centre for Pollution Research and Policy, College of Health, Medicine and Life Sciences, Kingston Lane, Uxbridge UB8 3PH, United Kingdom.
| | - Martin Scholze
- Brunel University London, Centre for Pollution Research and Policy, College of Health, Medicine and Life Sciences, Kingston Lane, Uxbridge UB8 3PH, United Kingdom
| | - Sibylle Ermler
- Brunel University London, Centre for Pollution Research and Policy, College of Health, Medicine and Life Sciences, Kingston Lane, Uxbridge UB8 3PH, United Kingdom
| | - Lærke Priskorn
- Copenhagen University Hospital - Rigshospitalet, Department of Growth and Reproduction, Blegdamsvej, Copenhagen, Denmark; International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej, Copenhagen, Denmark
| | - Niels Jørgensen
- Copenhagen University Hospital - Rigshospitalet, Department of Growth and Reproduction, Blegdamsvej, Copenhagen, Denmark; International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej, Copenhagen, Denmark
| | - Anna-Maria Andersson
- Copenhagen University Hospital - Rigshospitalet, Department of Growth and Reproduction, Blegdamsvej, Copenhagen, Denmark; International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej, Copenhagen, Denmark
| | - Hanne Frederiksen
- Copenhagen University Hospital - Rigshospitalet, Department of Growth and Reproduction, Blegdamsvej, Copenhagen, Denmark; International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej, Copenhagen, Denmark
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19
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Scheutz Henriksen L, Holm Petersen J, Skakkebæk NE, Jørgensen N, Virtanen HE, Priskorn L, Juul A, Toppari J, Main KM. Serum Testosterone Levels in 3-Month-Old Boys Predict Their Semen Quality as Young Adults. J Clin Endocrinol Metab 2022; 107:1965-1975. [PMID: 35323957 PMCID: PMC9202716 DOI: 10.1210/clinem/dgac173] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT It remains unknown how the postnatal activation of the hypothalamic-pituitary-gonadal axis in infancy, also known as "minipuberty", relates to adult testis function. OBJECTIVE To investigate how markers of reproductive function in 3-month-old boys correlate with adult reproductive health parameters. METHODS This population-based birth cohort study (the Copenhagen Mother-Child cohort), conducted at Copenhagen University Hospital, Denmark, included 259 boys examined once around 3 months of age and again at 18 to 20 years. Reproductive hormones, penile length, testis volume, and semen quality were analyzed. Minipubertal markers of testis function (by tertiles, T1-T3) were explored as predictors of adult semen quality using linear regression models. Associations between reproductive outcomes in infancy and young adulthood were estimated by intraclass correlation coefficients (ICCs), describing how well measurements in infancy correlate with those in adulthood. RESULTS Serum testosterone concentration in infancy was positively associated with adult total sperm count. Median (IQR) total sperm count was 84 (54-138) million spermatozoa for boys in T1, 141 (81-286) million spermatozoa in T2, and 193 (56-287) million spermatozoa in T3. We found the highest ICC for FSH (0.41; 95% CI, 0.26-0.57), while ICCs for inhibin B, SHBG, penile length, and testis volume ranged between 0.24 and 0.27. ICCs for LH and for total and free testosterone were lower and statistically nonsignificant. CONCLUSION Serum testosterone in infancy was a predictor of adult total sperm count. Other reproductive hormones and genital measures showed good correlation between infancy and adulthood, suggesting that an individual's reproductive setpoint starts shortly after birth in boys and persists until adulthood.
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Affiliation(s)
- Louise Scheutz Henriksen
- Correspondence: Louise Scheutz Henriksen, MD, Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
| | - Jørgen Holm Petersen
- Department of Growth and Reproduction, Copenhagen University Hospital – Rigshospitalet, DK-2100 Copenhagen, Denmark
- International Centre for Research & Training in Endocrine Disruption of Male Reproduction & Child Health (EDMaRC), Copenhagen University Hospital – Rigshospitalet, DK-2100 Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, DK-1353 Copenhagen, Denmark
| | - Niels E Skakkebæk
- Department of Growth and Reproduction, Copenhagen University Hospital – Rigshospitalet, DK-2100 Copenhagen, Denmark
- International Centre for Research & Training in Endocrine Disruption of Male Reproduction & Child Health (EDMaRC), Copenhagen University Hospital – Rigshospitalet, DK-2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | - Niels Jørgensen
- Department of Growth and Reproduction, Copenhagen University Hospital – Rigshospitalet, DK-2100 Copenhagen, Denmark
- International Centre for Research & Training in Endocrine Disruption of Male Reproduction & Child Health (EDMaRC), Copenhagen University Hospital – Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Helena E Virtanen
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, 20520 Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, 20520 Turku, Finland
| | - Lærke Priskorn
- Department of Growth and Reproduction, Copenhagen University Hospital – Rigshospitalet, DK-2100 Copenhagen, Denmark
- International Centre for Research & Training in Endocrine Disruption of Male Reproduction & Child Health (EDMaRC), Copenhagen University Hospital – Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital – Rigshospitalet, DK-2100 Copenhagen, Denmark
- International Centre for Research & Training in Endocrine Disruption of Male Reproduction & Child Health (EDMaRC), Copenhagen University Hospital – Rigshospitalet, DK-2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | - Jorma Toppari
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, 20520 Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, 20520 Turku, Finland
- Department of Pediatrics, Turku University Hospital, 20520 Turku, Finland
| | - Katharina M Main
- Department of Growth and Reproduction, Copenhagen University Hospital – Rigshospitalet, DK-2100 Copenhagen, Denmark
- International Centre for Research & Training in Endocrine Disruption of Male Reproduction & Child Health (EDMaRC), Copenhagen University Hospital – Rigshospitalet, DK-2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
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20
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Andersen E, Juhl CR, Kjøller ET, Lundgren JR, Janus C, Dehestani Y, Saupstad M, Ingerslev LR, Duun OM, Jensen SBK, Holst JJ, Stallknecht BM, Madsbad S, Torekov SS, Barrès R. Sperm count is increased by diet-induced weight loss and maintained by exercise or GLP-1 analogue treatment: a randomized controlled trial. Hum Reprod 2022; 37:1414-1422. [PMID: 35580859 PMCID: PMC9247415 DOI: 10.1093/humrep/deac096] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/25/2022] [Indexed: 01/11/2023] Open
Abstract
STUDY QUESTION Does diet-induced weight loss improve semen parameters, and are these possible improvements maintained with sustained weight loss? SUMMARY ANSWER An 8-week low-calorie diet-induced weight loss was associated with improved sperm concentration and sperm count, which were maintained after 1 year in men who maintained weight loss. WHAT IS KNOWN ALREADY Obesity is associated with impaired semen quality. Weight loss improves metabolic health in obesity, but there is a lack of knowledge on the acute and long-term effects of weight loss on semen parameters. STUDY DESIGN, SIZE, DURATION This is a substudy of men with obesity enrolled in a randomized, controlled, double-blinded trial (the S-LITE trial). The trial was conducted between August 2016 and November 2019. A total of 56 men were included in the study and assigned to an initial 8-week low-calorie diet (800 kcal/day) followed by randomization to 52 weeks of either: placebo and habitual activity (placebo), exercise training and placebo (exercise), the Glucagon Like Peptide 1 (GLP-1) analogue liraglutide and habitual activity (liraglutide) or liraglutide in combination with exercise training (combination). PARTICIPANTS/MATERIALS, SETTING, METHODS Inclusion criteria were men who delivered semen samples, 18 to 65 years of age, and a body mass index between 32 and 43 kg/m2, but otherwise healthy. The study was carried out at Hvidovre Hospital and at the University of Copenhagen, and the participants were from the Greater Copenhagen Area. We assessed semen parameters and anthropometrics and collected blood samples before (T0), after the 8-week low-calorie dietary intervention (T1), and after 52 weeks (T2). MAIN RESULTS AND THE ROLE OF CHANCE The men lost on average 16.5 kg (95% CI: 15.2-17.8) body weight during the low-calorie diet, which increased sperm concentration 1.49-fold (95% CI: 1.18-1.88, P < 0.01) and sperm count 1.41-fold (95% CI: 1.07-1.87, P < 0.01). These improvements were maintained for 52 weeks in men who maintained the weight loss, but not in men who regained weight. Semen volume, sperm motility and motile sperm count did not change. LIMITATIONS, REASONS FOR CAUTION The S-LITE trial was a randomized controlled trial of weight loss maintenance. Analysis of semen was preregistered to explore the effects of weight loss and weight loss maintenance on semen parameters, but definite inferences cannot be made. WIDER IMPLICATIONS OF THE FINDINGS This study shows that sperm concentration and sperm count were improved after a diet-induced weight loss in men with obesity. Our findings indicate that either or both liraglutide and exercise as weight maintenance strategies may be used to maintain the improvements in sperm concentration and count. STUDY FUNDING/COMPETING INTEREST(S) This work is supported by an excellence grant from the Novo Nordisk Foundation (NNF16OC0019968), a Challenge Programme Grant from the Novo Nordisk Foundation (NNF18OC0033754) and a grant from Helsefonden. The Novo Nordisk Foundation Center for Basic Metabolic Research is an independent research centre at the University of Copenhagen, partially funded by an unrestricted donation from the Novo Nordisk Foundation (NNF18CC0034900). Saxenda (liraglutide) and placebo pens were provided by Novo Nordisk. Cambridge Weight Plan diet products for the 8-week low-calorie diet were provided by Cambridge Weight Plan. E.A.: shareholder, employee of ExSeed Health Ltd. Grant Recipient from ExSeed Health Ltd and listed on Patents planned, issued or pending with ExSeed Health Ltd; J.J.H.: consultant for Eli Lilly A/S and Novo Nordisk A/S. Lecture fees for Novo Nordisk A/S. Listed on Patents planned, issued or pending with the University of Copenhagen, Advocacy group for Antag Therapeutics and Bainan Biotech; S.M.: lecture fees for Novo Nordisk A/S. Recipient of Support for attending meetings from Novo Nordisk A/S. Advisory boards of Novo Nordisk A/S; Sanofi Aventis and Merck Sharp & Dohme. S.S.T.: research grant recipient Novo Nordisk. The remaining authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER The trial was approved by the Ethical Committee of the Capital Region of Denmark (H-16027082) and the Danish Medicines Agency (EudraCT Number: 2015-005585-32). ClinicalTrials.gov identifier (NCT number): NCT04122716. TRIAL REGISTRATION DATE 11 May 2016. DATE OF FIRST PATIENT’S ENROLMENT August 2016.
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Affiliation(s)
| | | | - Emma T Kjøller
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie R Lundgren
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Janus
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Yasmin Dehestani
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marte Saupstad
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars R Ingerslev
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Olivia M Duun
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Simon B K Jensen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens J Holst
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bente M Stallknecht
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sten Madsbad
- Department of Endocrinology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Signe S Torekov
- Correspondence address. Mærsk Tower 7.7, Blegdamsvej 3B, 2200 Copenhagen N, Denmark. Tel: +45-35-33-72-88; E-mail: (R.B.); Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Panum 12.4.08, Blegdamsvej 3B, DK-2200 Copenhagen N, Denmark. Tel: +45-22-98-38-27; E-mail: (S.S.T.)
| | - Romain Barrès
- Correspondence address. Mærsk Tower 7.7, Blegdamsvej 3B, 2200 Copenhagen N, Denmark. Tel: +45-35-33-72-88; E-mail: (R.B.); Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Panum 12.4.08, Blegdamsvej 3B, DK-2200 Copenhagen N, Denmark. Tel: +45-22-98-38-27; E-mail: (S.S.T.)
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21
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Hærvig KK, Petersen KU, Giwercman A, Hougaard KS, Høyer BB, Lindh C, Ramlau-Hansen CH, Nybo Andersen AM, Toft G, Bonde JP, Tøttenborg SS. Fetal exposure to maternal cigarette smoking and male reproductive function in young adulthood. Eur J Epidemiol 2022; 37:525-538. [PMID: 35476275 DOI: 10.1007/s10654-022-00869-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 04/04/2022] [Indexed: 11/03/2022]
Abstract
Maternal smoking during pregnancy constitutes a potential, major risk factor for adult male reproductive function. In the hitherto largest longitudinal cohort, we examined biomarkers of reproductive function according to maternal smoking during the first trimester and investigated whether associations were mitigated by smoking cessation prior to the fetal masculinization programming window. Associations between exposure to maternal smoking and semen characteristics, testicular volume and reproductive hormones were assessed among 984 young men from the Fetal Programming of Semen Quality (FEPOS) cohort. Maternal smoking was assessed through interview data and measured plasma cotinine levels during pregnancy. We applied negative binomial, logistic and linear regression models to estimate differences in outcomes according to levels of maternal smoking. Sons of light smokers (≤ 10 cigarettes/day) had a 19% (95% CI - 29%, - 6%) lower sperm concentration and a 24% (95% CI - 35%, - 11%) lower total sperm count than sons of non-smokers. These estimates were 38% (95% CI - 52%, - 22%) and 33% (95% CI - 51%, - 8%), respectively, for sons of heavy smokers (> 10 cigarettes/day). The latter group also had a 25% (95% CI 1%, 54%) higher follitropin level. Similarly, sons exposed to maternal cotinine levels of > 10 ng/mL had lower sperm concentration and total sperm count. Smoking cessation prior to gestational week seven was not associated with a higher reproductive capacity. We observed substantial and consistent exposure-response associations, providing strong support for the hypothesis that maternal smoking impairs male reproductive function. This association persisted regardless of smoking cessation in early pregnancy.
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Affiliation(s)
- Katia Keglberg Hærvig
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark. .,Department of Occupational and Environmental Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23F, entrance 20F, 1st floor, 2400, Copenhagen, NV, Denmark.
| | - Kajsa Ugelvig Petersen
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Aleksander Giwercman
- Molecular Reproductive Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Karin Sørig Hougaard
- Department of Public Health, The Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.,National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Birgit Bjerre Høyer
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Regional Development, Region of Southern Denmark, Vejle, Denmark
| | - Christian Lindh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | | | - Anne-Marie Nybo Andersen
- Department of Public Health, The Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar Toft
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Peter Bonde
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Public Health, The Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sandra Søgaard Tøttenborg
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Public Health, The Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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22
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Skakkebæk NE, Lindahl-Jacobsen R, Levine H, Andersson AM, Jørgensen N, Main KM, Lidegaard Ø, Priskorn L, Holmboe SA, Bräuner EV, Almstrup K, Franca LR, Znaor A, Kortenkamp A, Hart RJ, Juul A. Environmental factors in declining human fertility. Nat Rev Endocrinol 2022; 18:139-157. [PMID: 34912078 DOI: 10.1038/s41574-021-00598-8] [Citation(s) in RCA: 106] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 12/14/2022]
Abstract
A severe decline in child births has occurred over the past half century, which will lead to considerable population declines, particularly in industrialized regions. A crucial question is whether this decline can be explained by economic and behavioural factors alone, as suggested by demographic reports, or to what degree biological factors are also involved. Here, we discuss data suggesting that human reproductive health is deteriorating in industrialized regions. Widespread infertility and the need for assisted reproduction due to poor semen quality and/or oocyte failure are now major health issues. Other indicators of declining reproductive health include a worldwide increasing incidence in testicular cancer among young men and alterations in twinning frequency. There is also evidence of a parallel decline in rates of legal abortions, revealing a deterioration in total conception rates. Subtle alterations in fertility rates were already visible around 1900, and most industrialized regions now have rates below levels required to sustain their populations. We hypothesize that these reproductive health problems are partially linked to increasing human exposures to chemicals originating directly or indirectly from fossil fuels. If the current infertility epidemic is indeed linked to such exposures, decisive regulatory action underpinned by unconventional, interdisciplinary research collaborations will be needed to reverse the trends.
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Affiliation(s)
- Niels E Skakkebæk
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, 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.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | | | - Hagai Levine
- School of Public Health, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Anna-Maria Andersson
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, 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
| | - Niels Jørgensen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, 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
| | - Katharina M Main
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, 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
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Øjvind Lidegaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lærke Priskorn
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, 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
| | - Stine A Holmboe
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, 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
| | - Elvira V Bräuner
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, 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
| | - Kristian Almstrup
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, 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
| | - Luiz R Franca
- Department of Morphology, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ariana Znaor
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Andreas Kortenkamp
- Division of Environmental Sciences, Brunel University London, Uxbridge, UK
| | - Roger J Hart
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Western Australia, Australia
- Fertility Specialists of Western Australia, Bethesda Hospital, Claremont, Western Australia, Australia
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, 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
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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23
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24
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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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25
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Nassan FL, Priskorn L, Salas-Huetos A, Halldorsson TI, Jensen TK, Jørgensen N, Chavarro JE. Association between intake of soft drinks and testicular function in young men. Hum Reprod 2021; 36:3036-3048. [PMID: 34585250 DOI: 10.1093/humrep/deab179] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 06/24/2021] [Indexed: 01/05/2023] Open
Abstract
STUDY QUESTION Is intake of sugar-sweetened beverages (SSB) or artificially sweetened beverages (ASB) associated with testicular function in young men? SUMMARY ANSWER Among young men unaware of their semen quality and reproductive hormone levels, intake of SSBs was associated with lower sperm concentration, lower total sperm count, and a lower ratio of serum inhibin-B/FSH. WHAT IS KNOWN ALREADY SSBs may adversely impact testicular function, but results are not consistent across studies. Moreover, the associations of ASB, energy-drinks or fruit juices with testicular function are unclear. STUDY DESIGN, SIZE, DURATION Young healthy men and unselected for fertility status men enrolled in a cross-sectional study between 2008 and 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 2935 young (median age: 19 years) men enrolled in the study. Intake of SSBs, ASBs, fruit juices, and energy-drinks was assessed with a validated food frequency questionnaire. Testicular function was assessed through conventional semen quality parameters (semen volume, sperm concentration, total count, motility and morphology), testicular volume assessed with ultrasound, and serum reproductive hormone concentrations (total testosterone, free testosterone, E2, inhibin-B, LH, FSH, sex hormone-binding globulin) were measured. MAIN RESULTS AND THE ROLE OF CHANCE In multivariable-adjusted analyses, men in the highest category of SSB intake (median: 1.1 servings (∼220 ml)/day) had a 13.2 million/ml lower median sperm concentration (95% CI: -21.0, -5.5) than non-consumers. A similar pattern was observed with total sperm count (-28 million (95% CI: -48, -9)), serum inhibin-B (-12 pg/ml (95% CI: -21, -4)), and inhibin-B/FSH ratio (-9 (95% CI: -18, 0)). The adjusted median difference in sperm concentration and inhibin-B associated with increasing SSB intake by 1 serving (∼200ml)/day at the expense of water was -3.4 million sperm/ml (95% CI: -5.8, -1.0) and -7 pg/ml (95% CI: -11, -3), respectively. LIMITATIONS, REASONS FOR CAUTION Inferring causality is limited owing to the cross-sectional design. We adjusted for a number of potential confounders but cannot exclude that unmeasured lifestyle and behavior associated with soft drink intake is associated with testicular function in these young men. WIDER IMPLICATIONS OF THE FINDINGS In the largest study to date, intake of SSBs was associated with lower sperm concentration, total sperm count, and serum inhibin-B/FSH ratio, consistent with a direct suppressive effect of SSB intake on testicular function among otherwise healthy men, potentially affecting fertility. However, the observed association between higher SSB intake and lower semen quality does not necessarily imply a decrease in fertility. STUDY FUNDING/COMPETING INTEREST(S) Supported by research from the Danish Council for Strategic Research (2101-08-0058), Independent Research Fund Denmark (8020-00218B), European Union (212844), the Kirsten and Freddy Johansen's Foundation (95-103-72087), the Research Fund of the Capital Region of Denmark (A6176), and the NIH (P30DK046200). The authors report no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- F L Nassan
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - L Priskorn
- Department of Growth and Reproduction, and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - A Salas-Huetos
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - T I Halldorsson
- Department of Epidemiology Research, Centre for Foetal Programming, Statens Serum Institut, Copenhagen, Denmark.,Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - T K Jensen
- Department of Growth and Reproduction, and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.,Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - N Jørgensen
- Department of Growth and Reproduction, and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - J E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
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26
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Østergaard CS, Ernst A, Gaml-Sørensen A, Brix N, Toft G, Haervig KK, Hougaard KS, Bonde JP, Tøttenborg SS, Ramlau-Hansen CH. Use of paracetamol (acetaminophen) as a nonprescription analgesic and semen quality in young men: A cross-sectional study. Andrology 2021; 10:495-504. [PMID: 34779581 DOI: 10.1111/andr.13129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 08/31/2021] [Accepted: 11/08/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Paracetamol (acetaminophen) is a frequently used nonprescription analgesic with suggested endocrine-disrupting properties. Epidemiological evidence on the effect of paracetamol on male fecundity is sparse. OBJECTIVES To investigate if the use of paracetamol as an oral nonprescription mild analgesic was associated with semen quality in young men. MATERIALS AND METHODS This cross-sectional study was based on data from the Fetal Programming of Semen Quality (FEPOS; 2017-2019) cohort of 1058 young men (18-21 years) included in the Danish National Birth Cohort. Participants completed a comprehensive online questionnaire on health behavior including analgesic use and provided a semen sample. Negative binomial regression models were used to estimate the percentage differences (adjusted mean ratios [aMR]) in semen quality characteristics according to paracetamol use (no; yes) and frequency of use (almost never; <1/month; ≥1/month; ≥1/week). RESULTS In total, 28% of the 913 participants with available data reported the use of paracetamol within the last 6 months. We found a slightly higher total sperm count (aMR 1.13 95% CI [0.99-1.30]) in users compared to nonusers but other semen characteristics were unaffected. The frequency of use was suggestive of lower total sperm count and morphologically normal sperm cells primarily among users ≥1/week, however, CIs were wide. DISCUSSION We were unable to account for the underlying reason for paracetamol use, which may induce confounding by indication. Exposure misclassification due to recall is likely but probably nondifferential due to the participants' young age and unawareness of semen quality. Due to the rapid plasma half-life of paracetamol and few frequent users, it was not possible to conclude on potential high-dose effects. CONCLUSION Our findings do not suggest any strong detrimental effect of paracetamol use on semen quality within this sample of young Danish men. However, the effects of high dose and frequent use cannot be excluded.
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Affiliation(s)
| | - Andreas Ernst
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark.,Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Gaml-Sørensen
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Nis Brix
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Gunnar Toft
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Katia Keglberg Haervig
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Karin Sørig Hougaard
- Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.,National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Jens Peter Bonde
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sandra Søgaard Tøttenborg
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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27
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Feferkorn I, Shrem G, Azani L, Son WY, Nehushtan T, Salmon-Divon M, Dahan MH. Hope for male fecundity: clinically insignificant changes in semen parameters over 10 years at a single clinic while assessing an infertility population. J Assist Reprod Genet 2021; 38:2995-3002. [PMID: 34386934 PMCID: PMC8609088 DOI: 10.1007/s10815-021-02298-8] [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: 06/13/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE What is the trend in sperm parameters in a group of men attending a single reproductive center, over a 10-year period? METHODS A retrospective study was conducted on 12,188 semen samples obtained from unique individuals who attended a university reproductive clinic from 2009 to 2018, inclusively. Semen analysis was done using computer-assisted sperm analysis and verified by an andrologist. Analysis was done after dividing the dataset into two groups: above WHO 2010 lower reference limits (ARL) (N = 6325) and below the reference limits (BRL) (N = 5521). RESULTS Volume increased slightly (ARL, p = 0.049) before returning to baseline or was stable (BRL, p = 0.59). Sperm concentration and total count of the BRL and ARL group declined initially and then recovered slightly (p < 0.0001, in all cases). Although these changes were statistically significant, this was due to the large study population; clinically, these changes were quite mild and would not have been significant for fertility. Sperm total motility and progressive motility of both the BRL group and the ARL group increased slightly from 2009 until 2015 and then decreased back to baseline (p < 0.0001). This change offset the decrease in count seen in those years. A spurious change was observed with sperm morphology that declined after the first 2 years and remained stable thereafter (p < 0.0001, in both groups). However, this change was attributed to a contemporaneous change in the method of analyzing strict morphology which happened when the change occurred. CONCLUSION While statistically significant changes were found, clinically, these changes were quite mild and would not have been significant for fertility.
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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.
| | - Guy Shrem
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, 888 Boul. de Maisonneuve E #200, Montréal, QC, H2L 4S8, Canada
- IVF Unit, Department of Obstetrics and Gynecology, Kaplan Medical Center, 1 Derech Pasternak, Rehovot, Israel
| | - Liat Azani
- Department of Molecular Biology, Ariel University, 65 Ramat HaGolan St, Ariel, Israel
| | - Weon-Young Son
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, 888 Boul. de Maisonneuve E #200, Montréal, QC, H2L 4S8, Canada
| | - Tamar Nehushtan
- Department of Molecular Biology, Ariel University, 65 Ramat HaGolan St, Ariel, 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 Haim 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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Priskorn L, Kreiberg M, Bandak M, Lauritsen J, Daugaard G, Petersen JH, Aksglaede L, Juul A, Jørgensen N. Testicular cancer survivors have shorter anogenital distance that is not increased by 1 year of testosterone replacement therapy. Hum Reprod 2021; 36:2443-2451. [PMID: 34223605 DOI: 10.1093/humrep/deab162] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/20/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is anogenital distance (AGD) shorter in testicular cancer (TC) survivors than in men from the general population, and is AGD affected by testosterone replacement therapy in adulthood? SUMMARY ANSWER AGD, measured as distance from anus to scrotum (AGDas), is shorter in TC survivors and does not change as a result of testosterone replacement therapy. WHAT IS KNOWN ALREADY Animal studies have shown that AGD is a postnatal 'read-out' of foetal androgen action, and short AGD in male offspring is considered a sign of feminization caused by in utero disruption of the reproductive system. Likewise, measurement of AGD in human studies has suggested AGD to be part of the testicular dysgenesis syndrome hypothesis, which proposes that male reproductive disorders, such as hypospadias, cryptorchidism, some cases of impaired semen quality and TC, all share a common foetal origin. STUDY DESIGN, SIZE, DURATION The aim was to assess AGD in men with a history of TC and controls, and furthermore to examine AGD during testosterone replacement therapy in adulthood. Study participants were TC survivors with a mild Leydig cell insufficiency who participated in a randomized double-blind study of testosterone replacement therapy versus placebo for 52 weeks (N = 69). Men from the general population were prospectively included from a study on testicular function as controls (N = 67). PARTICIPANTS/MATERIALS, SETTING, METHODS We measured two variants of AGD; as our primary outcome the anoscrotal distance (AGDas) measured from the centre of the anus to the posterior base of the scrotum, and secondarily the anopenile distance (AGDap) measured from the anus to the cephalad insertion of the penis. Using multiple regression analysis, the mean difference in AGD between TC survivors and men from the general population was assessed, adjusted for height, BMI and examiner. Next, AGD was measured before and after 52 weeks of treatment with testosterone or placebo, and with covariance analysis differences between the two groups at follow-up was assessed after adjustment for baseline AGD, examiner, BMI and change in BMI during treatment. MAIN RESULTS AND THE ROLE OF CHANCE TC survivors had a shorter AGDas (-0.84 cm, 95% CI: -1.31; -0.37) compared to men from the general population, and AGDas did not differ between the testosterone and placebo treated group at follow-up (0.11 cm, 95% CI: -0.22; 0.44). In contrast, AGDap was not shorter in TC survivors after adjustment (0.05 cm, 95% CI: -0.30; 0.39), and was 0.48 cm longer (95% CI: 0.13; 0.82) at follow-up in the testosterone treated compared to the placebo-treated group. LIMITATIONS, REASONS FOR CAUTION A limitation of the study is that the number of included men was limited, and results need confirmation in a larger study. Furthermore, TC survivors were significantly older than controls. For the comparison of AGD in TC survivors and controls, it was not possible to conduct the examinations with the examiner being blinded to which group he was examining, and it cannot be excluded that this can cause a bias. WIDER IMPLICATIONS OF THE FINDINGS The shorter AGDas in TC survivors compared to controls, which did not change upon adult testosterone replacement therapy, supports the hypothesis that reduced AGD is part of the testicular dysgenesis syndrome and may be a marker of disrupted foetal testicular development. By contrast, AGDap was not shorter in TC survivors and might be modestly sensitive to adult testosterone treatment, and thus inferior to AGDas as a constant postnatal marker of the foetal androgen environment. STUDY FUNDING/COMPETING INTEREST(S) Expenses were paid by the Department of Oncology, Copenhagen University Hospital, Rigshospitalet. Kiowa Kirin International covered expenses for Tostran and placebo. The Danish Cancer Society, The Danish Cancer Research Foundation, the Preben & Anna Simonsen Foundation, and Rigshospitalet have supported the study. L.P. was financed by the Research Fund of the Capital Region of Denmark. The authors have no competing interests. TRIAL REGISTRATION NUMBER Part of the study is based on men participating in a randomized controlled trial registered at ClinicalTrials.gov, NCT02991209, 25 November 2016.
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Affiliation(s)
- L Priskorn
- Department of Growth and Reproduction and EDMaRC, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - M Kreiberg
- Department of Oncology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - M Bandak
- Department of Oncology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - J Lauritsen
- Department of Oncology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - G Daugaard
- Department of Oncology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - J H Petersen
- Department of Growth and Reproduction and EDMaRC, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - L Aksglaede
- Department of Growth and Reproduction and EDMaRC, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - A Juul
- Department of Growth and Reproduction and EDMaRC, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - N Jørgensen
- Department of Growth and Reproduction and EDMaRC, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Priskorn L, Joensen UN, Petersen JH, Jensen TK, Skakkebaek NE, Jørgensen N. Familial resemblance in markers of testicular function in fathers and their young sons: a cross-sectional study. Hum Reprod 2021; 36:543-550. [PMID: 33367654 DOI: 10.1093/humrep/deaa314] [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: 05/28/2020] [Revised: 09/25/2020] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Is testicular function associated within father-son pairs? SUMMARY ANSWER Familial resemblance in testis volume and serum markers of spermatogenesis was observed in father-son pairs. WHAT IS KNOWN ALREADY Studies suggest familial clustering of male subfertility and impaired spermatogenesis, but in men from the general population little is known about concordance in testicular function between fathers and sons. STUDY DESIGN, SIZE, DURATION This cross-sectional study with simultaneous collection of data in fathers and sons included 72 pairs (144 fathers and sons), unselected regarding testicular function were included. PARTICIPANTS/MATERIALS, SETTING, METHODS A subgroup of men from the background population and participating in a study on testicular function were asked permission to invite their fathers to participate in a similar setup. Fathers (median age of 53 years) and sons (median age of 19 years) participated in the same study setup including assessment of testis size, having a blood sample taken and analysed for serum levels of reproductive hormones (FSH, inhibin B, LH, testosterone, oestradiol, sex hormone-binding globulin (SHBG) and calculated free testosterone) and delivering a semen sample for assessment of traditional semen parameters. Mixed-effects models were fitted to estimate the familial resemblance as the proportion of variance in markers of testicular function due to shared factors for fathers and sons accounted for using random-effects. Variance components were calculated from both unadjusted and adjusted models. MAIN RESULTS AND THE ROLE OF CHANCE After adjustments, variance component analyses showed that familial resemblance between fathers and sons accounted for 48% (P < 0.001) of the variation in testicular volume, 32% (P = 0.009) of the variation in FSH, 31% (P = 0.009) of the variation in the inhibin B/FSH ratio, 33% (P = 0.007) and 45% (P < 0.001) of the variation in testosterone and free testosterone, respectively, and 31% (P = 0.009) of the variation in SHBG. None of the semen parameters were associated within father-son pairs. LIMITATIONS, REASONS FOR CAUTION The present study may have lacked power to detect associations for semen quality, as large intra- and inter-individual variation occur in semen parameters. WIDER IMPLICATIONS OF THE FINDINGS In this study, testis volume, serum testosterone and serum markers of spermatogenesis including FSH were associated in fathers and sons, suggesting an impact of paternal genetics for testicular function in the son. However, the estimated familial resemblance for spermatogenesis markers highlights that other factors, such as maternal genetics and prenatal as well as adult exposures, are also of major importance for testicular function. STUDY FUNDING/COMPETING INTEREST(S) The study has received funding from Danish Health Authority, Research Fund of the Capital Region of Denmark and Independent Research Fund Denmark (8020-00218B). None of the funders had any role in the study design, collection, analysis or interpretation of data, writing of the paper of publication decisions. The authors have nothing to disclose. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Lærke Priskorn
- Department of Growth and Reproduction and EDMaRC, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Nordström Joensen
- Department of Growth and Reproduction and EDMaRC, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Holm Petersen
- Department of Growth and Reproduction and EDMaRC, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Tina Kold Jensen
- Department of Growth and Reproduction and EDMaRC, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Niels Erik Skakkebaek
- Department of Growth and Reproduction and EDMaRC, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Niels Jørgensen
- Department of Growth and Reproduction and EDMaRC, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Holmboe SA, Priskorn L, Jensen TK, Skakkebaek NE, Andersson AM, Jørgensen N. Use of e-cigarettes associated with lower sperm counts in a cross-sectional study of young men from the general population. Hum Reprod 2021; 35:1693-1701. [PMID: 32558890 DOI: 10.1093/humrep/deaa089] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/13/2020] [Indexed: 12/11/2022] Open
Abstract
STUDY QUESTION Are use of e-cigarettes and snuff associated with testicular function as previously shown for conventional cigarettes and marijuana? SUMMARY ANSWER Use of e-cigarettes is associated with reduced semen quality but not with higher serum testosterone level as observed for conventional cigarette use. Snuff use was not associated with markers of testicular function. WHAT IS KNOWN ALREADY Cigarette smoking has previously been associated with higher testosterone levels and impaired semen quality, whereas it is unresolved whether use of e-cigarettes or snuff influence the testicular function. STUDY DESIGN, SIZE, DURATION This cross-sectional population-based study included 2008 men with information on cigarette and marijuana use (enrolled between 2012 and 2018), among whom 1221 men also had information on e-cigarette and snuff use (enrolled between 2015 and 2018). PARTICIPANTS/MATERIALS, SETTING, METHODS Men (median age 19.0 years) from the general population provided a semen and blood sample and filled out a questionnaire on lifestyle including information on smoking behaviour. Associations between different types of smoking (e-cigarettes, snuff, marijuana and cigarettes) and reproductive hormones (total and free testosterone, sex hormone-binding globulin, LH, oestradiol and ratios of inhibin B/FSH, testosterone/LH and free testosterone/LH) and semen parameters (total sperm count and sperm concentration) were examined using multiple linear regression analyses adjusted for relevant confounders. MAIN RESULTS AND THE ROLE OF CHANCE Approximately half of the men (52%) were cigarette smokers, 13% used e-cigarettes, 25% used snuff and 33% used marijuana. Users of e-cigarettes and marijuana were often also cigarette smokers. Compared to non-users, daily e-cigarette users had significantly lower total sperm count (147 million vs 91 million) as did daily cigarette smokers (139 million vs 103 million), in adjusted analyses. Furthermore, significantly higher total and free testosterone levels were seen in cigarette smoking men (6.2% and 4.1% higher total testosterone and 6.2% and 6.2% higher free testosterone in daily smokers and occasional smokers, respectively, compared to non-smoking men), but not among e-cigarette users. Daily users of marijuana had 8.3% higher total testosterone levels compared to non-users. No associations were observed for snuff in relation to markers of testicular function. LIMITATIONS, REASONS FOR CAUTION We cannot exclude that our results can be influenced by residual confounding by behavioural factors not adjusted for. The number of daily e-cigarette users was limited and findings should be replicated in other studies. WIDER IMPLICATIONS OF THE FINDINGS This is the first human study to indicate that not only cigarette smoking but also use of e-cigarettes is associated with lower sperm counts. This could be important knowledge for men trying to achieve a pregnancy, as e-cigarettes are often considered to be less harmful than conventional cigarette smoking. STUDY FUNDING/COMPETING INTEREST(S) Funding was received from the Danish Ministry of Health (1-1010-308/59), the Independent Research Fund Denmark (8020-00218B), ReproUnion (20200407) and the Research Fund of the Capital Region of Denmark (A6176). The authors have nothing to disclose. TRIAL REGISTRATION NUMBER NA.
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Affiliation(s)
- Stine Agergaard Holmboe
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark.,International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Lærke Priskorn
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark.,International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Tina Kold Jensen
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark.,International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark.,Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense 5000, Denmark
| | - Niels Erik Skakkebaek
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark.,International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Anna-Maria Andersson
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark.,International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Niels Jørgensen
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark.,International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
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Juel Mortensen L, Lorenzen M, Jørgensen A, Albrethsen J, Jørgensen N, Møller S, Andersson AM, Juul A, Blomberg Jensen M. Possible Relevance of Soluble Luteinizing Hormone Receptor during Development and Adulthood in Boys and Men. Cancers (Basel) 2021; 13:cancers13061329. [PMID: 33809538 PMCID: PMC7999540 DOI: 10.3390/cancers13061329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 11/21/2022] Open
Abstract
Simple Summary The reproductive hormones luteinizing hormone (LH) and human chorionic gonadotropin (hCG) are both agonists for the luteinizing hormone receptor (LHCGR) and essential for male reproduction during development and adulthood. LHCGR is expressed and stimulates testosterone production from the testicular Leydig cells. In this study, we demonstrate the presence of soluble LHCGR in blood, urine, and seminal fluid in both healthy boys and men, and patients with aberrations in sex-chromosomes. We show how circulating levels of sLHCGR are associated with pubertal development, testicular function, and semen quality and demonstrate that LHCGR is released from fetal human non-gonadal tissue. sLHCGR is released into serum by testis and other organs, which suggests possible extra-gonadal effects of LH or hCG in boys and men. Abstract Luteinizing hormone (LH) and human chorionic gonadotropin (hCG) are agonists for the luteinizing hormone receptor (LHCGR) which regulates male reproductive function. LHCGR may be released into body fluids. We wish to determine whether soluble LHCGR is a marker for gonadal function. Cross-sectional, longitudinal, and intervention studies on 195 healthy boys and men and 396 men with infertility, anorchia, or Klinefelter Syndrome (KS) were used to correlate LHCGR measured in serum, seminal fluid, urine, and hepatic/renal artery and vein with gonadal function. LHCGR was determined in fluids from in vitro and in vivo models of human testicular tissue and cell lines, xenograft mouse models, and human fetal kidney and adrenal glands. Western blot showed LHCGR fragments in serum and gonadal tissue of similar size using three different antibodies. The LHCGR-ELISA had no species cross-reactivity or unspecific reaction in mouse serum even after human xenografting. Instead, sLHCGR was released into the media after the culture of a human fetal kidney and adrenal glands. Serum sLHCGR decreased markedly during puberty in healthy boys (p = 0.0001). In healthy men, serum sLHCGR was inversely associated with the Inhibin B/FSH ratio (β −0.004, p = 0.027). In infertile men, seminal fluid sLHCGR was inversely associated with serum FSH (β 0.006, p = 0.009), sperm concentration (β −3.5, p = 0.003) and total sperm count (β −3.2, p = 0.007). The injection of hCG lowered sLHCGR in serum and urine of healthy men (p < 0.01). In conclusion, sLHCGR is released into body-fluids and linked with pubertal development and gonadal function. Circulating sLHCGR in anorchid men suggests that sLHCGR in serum may originate from and possibly exert actions in non-gonadal tissues. (ClinicalTrials: NTC01411527, NCT01304927, NCT03418896).
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Affiliation(s)
- Li Juel Mortensen
- Group of Skeletal, Mineral and Gonadal Endocrinology, University Department of Growth and Reproduction, Rigshospitalet, 2100 Copenhagen, Denmark; (L.J.M.); (M.L.)
| | - Mette Lorenzen
- Group of Skeletal, Mineral and Gonadal Endocrinology, University Department of Growth and Reproduction, Rigshospitalet, 2100 Copenhagen, Denmark; (L.J.M.); (M.L.)
| | - Anne Jørgensen
- Department of Growth and Reproduction and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark; (A.J.); (J.A.); (N.J.); (A.-M.A.); (A.J.)
| | - Jakob Albrethsen
- Department of Growth and Reproduction and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark; (A.J.); (J.A.); (N.J.); (A.-M.A.); (A.J.)
| | - Niels Jørgensen
- Department of Growth and Reproduction and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark; (A.J.); (J.A.); (N.J.); (A.-M.A.); (A.J.)
| | - Søren Møller
- Center for Functional and Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine 260, Hvidovre Hospital, 2650 Copenhagen, Denmark;
- Department of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, 2200 Copenhagen, Denmark
| | - Anna-Maria Andersson
- Department of Growth and Reproduction and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark; (A.J.); (J.A.); (N.J.); (A.-M.A.); (A.J.)
| | - Anders Juul
- Department of Growth and Reproduction and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark; (A.J.); (J.A.); (N.J.); (A.-M.A.); (A.J.)
- Department of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, 2200 Copenhagen, Denmark
| | - Martin Blomberg Jensen
- Group of Skeletal, Mineral and Gonadal Endocrinology, University Department of Growth and Reproduction, Rigshospitalet, 2100 Copenhagen, Denmark; (L.J.M.); (M.L.)
- Division of Bone and Mineral Research, Harvard School of Dental Medicine/Harvard Medical School, Boston, MA 02115, USA
- Correspondence: ; Tel.: +45-3545-5064
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Sugihara A, De Neubourg D, Punjabi U. Is there a temporal trend in semen quality in Belgian candidate sperm donors and in sperm donors' fertility potential from 1995 onwards? Andrology 2021; 9:846-853. [PMID: 33336502 DOI: 10.1111/andr.12963] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/04/2020] [Accepted: 12/14/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND A recent meta-regression analysis reported a temporal trend in sperm count showing a significant decline in sperm count between 1973 and 2011. This decline is thought to affect fecundity. Moreover, semen quality is considered of key interest to public health given its association with all-cause male morbidity/mortality. The issue requires ongoing investigation due to geographical variation in semen quality and methodological errors in semen analysis. OBJECTIVE To study whether there is a temporal trend in semen quality in Belgian candidate sperm donors and in sperm donors' fertility potential. MATERIALS AND METHODS Retrospective analysis of samples provided by 439 candidate donors and pregnancy outcome in acceptors over a period of 23 years. RESULTS A total of 807 specimens from 439 candidate donors were examined from January 1995 to December 2017 (Table S1). Sub-analyses performed with regard to TSC from 2010 onwards (weighing) revealed a significant negative trend (R2 =-0.033; β=-0.18; CI: -0.16 to 0.07; p < 0.05). We found a statistically significant association between year of donation and morphology (R2 = 0.036; β= -0.19; CI: -0.26 to -0.08; p < 0.0001). The mean (±SD) clinical pregnancy rate per effective donor recruited (n = 104), defined as the number of women with a clinical pregnancy, per number of women who initiated treatment with a donor's spermatozoa, was 68.5 (± 24.9) %. This measure did not show a significant change in function of year of donation. DISCUSSION Candidate sperm donors represent a select group of men; as such, these results are not to be interpreted as representative for the general population. CONCLUSION The study did not show a significant change in sperm concentration or fertility potential in sperm donors over a period of 23 years. However, a negative trend was found for TSC from 2010 onwards. Also, the results show a significant decrease in ideal morphology over time.
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Affiliation(s)
- Alessa Sugihara
- Centre for Reproductive Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Diane De Neubourg
- Centre for Reproductive Medicine, Antwerp University Hospital, Edegem, Belgium.,University of Antwerp, Wilrijk, Belgium
| | - Usha Punjabi
- Centre for Reproductive Medicine, Antwerp University Hospital, Edegem, Belgium.,University of Antwerp, Wilrijk, Belgium
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Krzastek SC, Farhi J, Gray M, Smith RP. Impact of environmental toxin exposure on male fertility potential. Transl Androl Urol 2021; 9:2797-2813. [PMID: 33457251 PMCID: PMC7807371 DOI: 10.21037/tau-20-685] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Idiopathic infertility is the most common individual diagnosis in male infertility, representing nearly 44% of cases. Research studies dating over the last half-century consistently demonstrate a decline in male fertility that is incompletely explained by obesity, known genetic causes, or diet and lifestyle changes alone. Human exposures have changed dramatically over the same time course as this fertility decline. Synthetic chemicals surround us. Some are benevolent; however, many are known to cause disruption of the hypothalamic-pituitary-gonadal axis and impair spermatogenesis. More than 80,000 chemicals are registered with the United States National Toxicology Program and nearly 2,000 new chemicals are introduced each year. Many of these are known toxins, such as phthalates, polycyclic aromatic hydrocarbons, aromatic amines, and organophosphate esters, and have been banned or significantly restricted by other countries as they carry known carcinogenic effects and are reproductively toxic. In the United States, many of these chemicals are still permissible in exposure levels known to cause reproductive harm. This contrasts to other chemical regulatory legislature, such as the European Union’s REACH (Registration, Evaluation, Authorization and Restriction of Chemicals) regulations which are more comprehensive and restrictive. Quantification of these diverse exposures on an individual level has proven challenging, although forthcoming technologies may soon make this data available to consumers. Establishing causality and the proportion of idiopathic infertility attributable to environmental toxin exposures remains elusive, however, continued investigation, avoidance of exposure, and mitigation of risk is essential to our reproductive health. The aim of this review is to examine the literature linking changes in male fertility to some of the most common environmental exposures. Specifically, pesticides and herbicides such as dichlorodiphenyltrichloroethane (DDT), dibromochloropropane (DBCP), organophosphates and atrazine, endocrine disrupting compounds including plastic compounds phthalates and bisphenol A (BPA), heavy metals, natural gas/oil, non-ionizing radiation, air and noise pollution, lifestyle factors including diet, obesity, caffeine use, smoking, alcohol and drug use, as well as commonly prescribed medications will be discussed.
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Affiliation(s)
- Sarah C Krzastek
- Department of Urology, University of Virginia, Charlottesville, VA, USA.,Division of Urology, Virginia Commonwealth University, Richmond, VA, USA.,Division of Urology, Hunter Holmes McGuire VAMC, Richmond, VA, USA
| | - Jack Farhi
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | - Marisa Gray
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | - Ryan P Smith
- Department of Urology, University of Virginia, Charlottesville, VA, USA
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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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Ugelvig Petersen K, Balkiss AM, Hærvig KK, Ellekilde Bonde JP, Hougaard KS, Toft G, Ramlau-Hansen CH, Tøttenborg SS. Use of Personal Care Products and Semen Quality: A Cross-Sectional Study in Young Danish Men. TOXICS 2020; 8:toxics8030062. [PMID: 32842629 PMCID: PMC7560353 DOI: 10.3390/toxics8030062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 01/01/2023]
Abstract
Personal care products (PCPs) may contain multiple chemicals capable of harming male reproductive function. The aim of this study was, therefore, to assess aggregated PCP exposure and potential associations with measures of semen quality in young men. Participants (n = 1058, age 18–21) were sampled among young men from the Danish National Birth Cohort (DNBC). Upon recruitment in 2017–2019, each man answered an online questionnaire and provided a semen sample. Exposure to 12 common types of PCPs was derived from the questionnaire, and the extent of use and co-use was analyzed. We applied a negative binomial regression model to estimate percentage differences in semen parameters between low, medium and high PCP exposure groups. All participants were exposed to at least one PCP more than once a week, resulting in a mean number (SD) of 5.3 (2.0) PCPs currently used. Most participants (92%) were also exposed to fragranced products on a weekly basis. Little association was observed between aggregated exposure to PCPs and sperm concentration, total sperm count, semen volume, sperm motility and morphology. Despite prevalent use of multiple PCPs, we found little indication of adverse effects of aggregated overall or fragranced PCP exposure on semen quality.
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Affiliation(s)
- Kajsa Ugelvig Petersen
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark; (A.M.B.); (K.K.H.); (J.P.E.B.); (S.S.T.)
- Correspondence:
| | - Ahmad Mahmoud Balkiss
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark; (A.M.B.); (K.K.H.); (J.P.E.B.); (S.S.T.)
| | - Katia Keglberg Hærvig
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark; (A.M.B.); (K.K.H.); (J.P.E.B.); (S.S.T.)
| | - Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark; (A.M.B.); (K.K.H.); (J.P.E.B.); (S.S.T.)
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark;
| | - Karin Sørig Hougaard
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark;
- National Research Centre for the Working Environment, Lersø Parkallé 105, 2100 Copenhagen Ø, Denmark
| | - Gunnar Toft
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark;
| | - Cecilia Høst Ramlau-Hansen
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark;
| | - Sandra Søgaard Tøttenborg
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark; (A.M.B.); (K.K.H.); (J.P.E.B.); (S.S.T.)
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Koch T, Hansen AH, Priskorn L, Petersen JH, Carlsen E, Main KM, Skakkebaek NE, Jørgensen N. A history of cryptorchidism is associated with impaired testicular function in early adulthood: a cross-sectional study of 6376 men from the general population. Hum Reprod 2020; 35:1765-1780. [DOI: 10.1093/humrep/deaa127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/03/2020] [Indexed: 12/27/2022] Open
Abstract
Abstract
STUDY QUESTION
Is there a difference in testicular function in early adulthood between men born with cryptorchidism and men born with normally descended testes?
SUMMARY ANSWER
In men from the general population, a history of cryptorchidism was associated with lower total testis volume and impaired semen quality as well as altered serum levels of reproductive hormones.
WHAT IS KNOWN ALREADY
The association between cryptorchidism and testicular function is well documented in studies based on sub-fertile or infertile men recruited from a clinical setting. However, the association has not previously been investigated in men from the general population, who were unselected regarding fertility status.
STUDY DESIGN, SIZE, DURATION
This is a cross-sectional population-based study of 6376 young Danish men examined from 1996 to 2017.
PARTICIPANTS/MATERIALS, SETTING, METHODS
This study is based on young men from the greater Copenhagen area, Denmark (median age of 19 years) who were unselected regarding fertility status and semen quality. The young men delivered a semen sample, had a blood sample drawn and underwent a physical examination including assessment of testis volume. Participants completed a questionnaire regarding cryptorchidism at birth, current lifestyle and their mother’s pregnancy, after consulting their mother. The differences in markers of testicular function, including testis volume, semen parameters and reproductive hormones between men with and without a history of cryptorchidism were investigated with multiple linear regression analyses.
MAIN RESULTS AND THE ROLE OF CHANCE
The participation rate was 24% for the entire study period. Overall, a history of cryptorchidism was associated with reduced testicular function. In the adjusted models, a history of cryptorchidism was associated with a 3.5 ml lower total testis volume, determined by orchidometer (P < 0.001), 28% lower sperm concentration (95% CI: −37 to −20) and 26% lower inhibin B/FSH ratio (95% CI: −50 to −22) compared to men without a history of cryptorchidism, suggesting a reduced spermatogenetic capacity. Men with a history of cryptorchidism also had a slightly reduced Leydig cell function expressed as a 6% lower testosterone/LH ratio (95% CI: −12 to −0.7). The significant effect sizes and different markers of testicular function pointing in the same direction across the different models based on a large sample size support that the results are not chance findings.
LIMITATIONS, REASONS FOR CAUTION
Information on cryptorchidism at birth and treatment modus was obtained by retrospective self-report, and each participant only delivered one semen sample.
WIDER IMPLICATIONS OF THE FINDINGS
The results suggest that men with a history of cryptorchidism could be at increased risk of experiencing fertility problems. However, among these men there is a wide variation in semen quality and further research is needed in order to identify the subgroup of boys born with cryptorchidism who are at the greatest risk of impaired semen quality when reaching adulthood.
STUDY FUNDING/COMPETING INTEREST(S)
The study received financial support from the Research fund of Rigshospitalet, Copenhagen University Hospital; the European Union (Contract numbers BMH4-CT96-0314, QLK4-CT-1999-01422, QLK4-CT-2002-00603. FP7/2007-2013, DEER Grant agreement no. 212844); the Danish Ministry of Health; the Danish Environmental Protection Agency; A.P. Møller and wife Chastine McKinney Møllers Foundation; and Svend Andersens Foundation. None of the founders had any role in the study design, collection, analysis or interpretation of data, writing of the paper or publication decisions. The authors have nothing to declare.
TRIAL REGISTRATION NUMBER
N/A.
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Affiliation(s)
- Trine Koch
- 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
| | - Ann H Hansen
- 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
| | - Lærke Priskorn
- 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
| | - Jørgen H Petersen
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth Carlsen
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Fertility Clinic, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Katharina M Main
- 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
| | - Niels E Skakkebaek
- 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
| | - 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
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Keglberg Hærvig K, Bonde JP, Ramlau-Hansen CH, Toft G, Hougaard KS, Specht IO, Giwercman A, Nybo Andersen AM, Olsen J, Lindh C, Bjerre Høyer B, Tøttenborg SS. Fetal Programming of Semen Quality (FEPOS) Cohort - A DNBC Male-Offspring Cohort. Clin Epidemiol 2020; 12:757-770. [PMID: 32765110 PMCID: PMC7373412 DOI: 10.2147/clep.s242631] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/11/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Prenatal exposures may contribute to male infertility in adult life, but large-scale epidemiological evidence is still lacking. The Fetal Programming of Semen quality (FEPOS) cohort was founded to provide means to examine if fetal exposures can interfere with fetal reproductive development and ultimately lead to reduced semen quality and reproductive hormone imbalances in young adult men. METHODS Young adult men at least 18 years and 9 months of age born to women in the Danish National Birth Cohort living in relative proximity to Copenhagen or Aarhus and for whom a maternal blood sample and two maternal interviews during pregnancy were available were invited to FEPOS. Recruitment began in March 2017 and ended in December 2019. The participants answered a comprehensive questionnaire and underwent a physical examination where they delivered a semen, urine, and hair sample, measured their own testicular volume, and had blood drawn. RESULTS In total 21,623 sons fulfilled eligibility criteria of whom 5697 were invited and 1058 participated making the response rate 19%. Semen characteristics did not differ between sons from the Copenhagen and Aarhus clinics. When comparing the FEPOS semen parameters to similar cohorts, the median across all semen characteristics was slightly lower for FEPOS participants, although with smaller variation. CONCLUSION With its 1058 young adult men, the FEPOS cohort is the largest population-based male-offspring cohort worldwide specifically designed to investigate prenatal determinants of semen quality. Wide-ranging information on maternal health, lifestyle, socioeconomic status, occupation, and serum concentrations of potential reproductive toxicants during pregnancy combined with biological markers of fertility in their sons collected after puberty allow for in-depth investigations of the 'fetal origins of adult disease hypothesis'.
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Affiliation(s)
- Katia Keglberg Hærvig
- Department of Occupational and Environmental Medicine, Bispebjerg & Frederiksberg Hospital, Copenhagen, Denmark
- Department of Public Health, The Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Peter Bonde
- Department of Occupational and Environmental Medicine, Bispebjerg & Frederiksberg Hospital, Copenhagen, Denmark
- Department of Public Health, The Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Gunnar Toft
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Karin Sørig Hougaard
- Department of Public Health, The Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Ina Olmer Specht
- The Parker Institute, Research Unit for Dietary Studies, Bispebjerg & Frederiksberg Hospital, Copenhagen, Denmark
| | - Aleksander Giwercman
- Molecular Reproductive Medicine, Department of Translational Medicine, Lund University, Lund, Sweden
| | - Anne-Marie Nybo Andersen
- Department of Public Health, The Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jørn Olsen
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Christian Lindh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Birgit Bjerre Høyer
- Department of Occupational and Environmental Medicine, Bispebjerg & Frederiksberg Hospital, Copenhagen, Denmark
| | - Sandra Søgaard Tøttenborg
- Department of Occupational and Environmental Medicine, Bispebjerg & Frederiksberg Hospital, Copenhagen, Denmark
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Anvari Aria S, Nordström Joensen U, Bang AK, Priskorn L, Nordkap L, Andersson AM, Jørgensen N. Testicular microlithiasis on scrotal ultrasound in 4850 young men from the general population: associations with semen quality. Andrology 2020; 8:1736-1743. [PMID: 32619084 DOI: 10.1111/andr.12854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/12/2020] [Accepted: 06/24/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Testicular microlithiasis (TM) is sometimes found on scrotal ultrasound. The prevalence seems higher in populations of men with testicular dysfunction, and TM may be a risk factor for testicular germ cell neoplasia in situ in men with additional risk factors. The association between TM and testicular function is controversial, especially in incidentally found TM. OBJECTIVES To determine the frequency of TM in young men from the general population, and associations between TM, semen quality, and reproductive hormones. MATERIALS AND METHODS A cross-sectional study of 4850 Danish men, median age 19 years. Testicular pattern, including the presence of TM, was assessed by ultrasound examination. Participants provided a questionnaire, one semen sample, and one blood sample. Semen variables and serum reproductive hormones were analyzed as outcomes using multivariable regression analysis to determine associations with TM. RESULTS TM was detected in 53 men (1%), of which 19 (36%) were unilateral and 34 (64%) were bilateral cases. A history of cryptorchidism was associated with presence of TM. Bilateral TM was associated with slightly lower testicular volume, sperm concentration, and total sperm count. TM was not significantly associated with serum testosterone or other reproductive hormones. DISCUSSION AND CONCLUSION TM is rare in men from the general population and is associated with lower sperm count if bilateral, although effect sizes were small. Current European guidelines do not recommend any follow-up in cases of TM with no other risk factors for testicular cancer. We suggest that men with incidentally found bilateral TM may be offered a semen analysis, but analysis of reproductive hormones seems unnecessary.
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Affiliation(s)
- Sheida Anvari Aria
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark
| | | | - Anne Kirstine Bang
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark
| | - Laerke Priskorn
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark
| | - Loa Nordkap
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark
| | | | - Niels Jørgensen
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark
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Liu J, Dai Y, Li Y, Yuan E, Wang Q, Wang X, Guan Y. A longitudinal study of semen quality among Chinese sperm donor candidates during the past 11 years. Sci Rep 2020; 10:10771. [PMID: 32612270 PMCID: PMC7329839 DOI: 10.1038/s41598-020-67707-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/11/2020] [Indexed: 11/09/2022] Open
Abstract
Studies suggest that semen quality is declining globally, however, the debate remains open due to the possible effects of ethnic and geographical differences. This study aimed to explore whether semen quality of sperm donor candidates has changed in Henan Province, China from 2009 to 2019. In this retrospective study, we included 23,936 sperm donor candidates who were recruited by the Henan Human Sperm Bank of China between 2009 and 2019. To minimize intra-individual bias, we included only the first ejaculate provided by each sperm donor candidate. The following parameters were measured: volume, sperm concentration, total sperm count, progressive motility, and total motility. After adjustment for age, body mass index (BMI), and sexual abstinence duration, we evaluated changes in main semen parameters over time using multiple linear regression analyses. The sperm concentration decreased from 62.0 million/mL in 2009 to 32.0 million/mL in 2019 (P < 0.001), with an average annual rate of 3.9%. The total sperm count decreased from 160.0 million in 2009 to 80.0 million in 2019 (P < 0.001), with an average annual rate of 4.2%. The progressive motility decreased from 54.0% in 2009 to 40.0% in 2019 (P < 0.001), with an average annual rate of 2.5%. The total motility decreased from 60.0% in 2009 to 46.0% in 2019 (P < 0.001), with an average annual rate of 1.9%. Our results indicated that semen quality among sperm donor candidates had decreased during the study period in Henan Province, China.
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Affiliation(s)
- Junjie Liu
- Henan Human Sperm Bank, The Third Affiliated Hospital of Zhengzhou University, No. 7 Front Kangfu Street, Er'qi District, Zhengzhou, 450052, China
| | - Yanpeng Dai
- Department of Clinical Laboratory, The Third Affiliated Hospital of Zhengzhou University, No.7 Front Kangfu Street, Er'qi District, Zhengzhou, 450052, China
| | - Yushan Li
- Henan Human Sperm Bank, The Third Affiliated Hospital of Zhengzhou University, No. 7 Front Kangfu Street, Er'qi District, Zhengzhou, 450052, China.
| | - Enwu Yuan
- Department of Clinical Laboratory, The Third Affiliated Hospital of Zhengzhou University, No.7 Front Kangfu Street, Er'qi District, Zhengzhou, 450052, China.
| | - Quanxian Wang
- Henan Human Sperm Bank, The Third Affiliated Hospital of Zhengzhou University, No. 7 Front Kangfu Street, Er'qi District, Zhengzhou, 450052, China
| | - Xingling Wang
- Center for Reproductive Medicine, The Third Affiliated Hospital of Zhengzhou University, No.7 Front Kangfu Street, Er'qi District, Zhengzhou, 450052, China
| | - Yichun Guan
- Center for Reproductive Medicine, The Third Affiliated Hospital of Zhengzhou University, No.7 Front Kangfu Street, Er'qi District, Zhengzhou, 450052, China
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Albrethsen J, Johannsen TH, Jørgensen N, Frederiksen H, Sennels HP, Jørgensen HL, Fahrenkrug J, Petersen JH, Linneberg A, Nordkap L, Bang AK, Andersson AM, Juul A. Evaluation of Serum Insulin-like Factor 3 Quantification by LC-MS/MS as a Biomarker of Leydig Cell Function. J Clin Endocrinol Metab 2020; 105:5811414. [PMID: 32211773 DOI: 10.1210/clinem/dgaa145] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/23/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The peptide hormone insulin-like factor 3 (INSL3) is a marker for Leydig cell function and the clinical use of serum INSL3 measurements has been suggested by several groups. AIM (1) To establish a reference range for liquid chromatography-tandem mass spectrometry (LC-MS/MS) of serum INSL3 in healthy boys and men; and (2) to compare the associations of serum INSL3 and testosterone (T) to pubertal stage, lifestyle factors, diurnal variation, body composition, and human chorionic gonadotropin (hCG) stimulation. RESULTS In a reference range based on LC-MS/MS analysis of serum from 1073 boys and men, INSL3 increased from levels close to the detection limit (0.03 µg/L) in prepubertal boys to a maximum mean level of 1.3 µg/L (95% CI, 0.9-2.7) in young men (19-40 years of age) and decreased slightly in older men (0.1 µg/L per decade). Serum T, but not INSL3, was associated with body mass index or body fat percentage and with alcohol consumption. Smoking was positively associated with serum T, but negatively associated with INSL3. There were significant diurnal variations in both INSL3 and T in men (P < 0.001), but serum INSL3 varied substantially less, compared with serum T (± 11% vs ± 26%). Mean serum INSL3 increased after hCG stimulation, but less than T (+ 17% vs + 53%). In both healthy men and in patients suspected of testicular failure, baseline serum INSL3 was more closely associated to the hCG-induced increase in serum T than baseline T itself. CONCLUSION Measurement of serum INSL3 by LC-MS/MS has promise as a marker of testicular disorders.
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Affiliation(s)
- Jakob Albrethsen
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Centre for Research and Research Training in Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Trine Holm Johannsen
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Centre for Research and Research Training in Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Niels Jørgensen
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Centre for Research and Research Training in Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Frederiksen
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Centre for Research and Research Training in Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henriette P Sennels
- Department of Clinical Biochemistry, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Loevendahl Jørgensen
- Department of Clinical Biochemistry, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jan Fahrenkrug
- Department of Clinical Biochemistry, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Holm Petersen
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Biostatistics, University of Copenhagen, Denmark
| | - Allan Linneberg
- Center for Clinical Research and Disease Prevention, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Loa Nordkap
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Centre for Research and Research Training in Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anne Kirstine Bang
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Centre for Research and Research Training in Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna-Maria Andersson
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Centre for Research and Research Training in Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anders Juul
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Centre for Research and Research Training in Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Haervig KK, Høyer BB, Giwercman A, Hougaard KS, Ramlau-Hansen CH, Specht IO, Toft G, Bonde JP, Søgaard Tøttenborg S. Fetal exposure to paternal smoking and semen quality in the adult son. Andrology 2020; 8:1117-1125. [PMID: 32150347 DOI: 10.1111/andr.12782] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND The negative impact of maternal smoking during pregnancy on offspring semen quality is well established. Less is known about the impact of paternal smoking. METHODS We estimated differences in semen parameters and testicle size according to paternal smoking in 772 adult sons of women enrolled in the Danish National Birth Cohort when pregnant. Parents' smoking was reported around gestational week 16, and analyses were adjusted for parents' ages at conception, maternal pre-pregnancy body mass index, maternal alcohol and caffeine intake, family occupational status, ejaculatory abstinence time, clinic of semen analysis, and season. RESULTS Sons of smoking fathers and non-smoking mothers had a 10% (95% confidence interval: -24%, 7%) lower semen concentration and 11% (95% confidence interval: -27%, 8%) lower sperm count than sons of non-smoking parents. Having two smoking parents was associated with 19% reduction in sperm count (95% confidence interval: -37%, 3%). Paternal smoking was not associated with volume, motility, or morphology. Adjusting for maternal smoking, paternal smoking was associated with a 26% increased risk of small testicular volume (95% confidence interval: 0.89, 1.78). DISCUSSION Exclusion of sons with a history of testicular cancer, chemotherapy, orchiectomy, and with only one or no testicles may have caused us to underestimate associations if these men's reproductive health including semen quality are in fact more sensitive to paternal smoking. CONCLUSION The study provides limited support for slightly lower sperm concentration and total sperm concentration in sons of smoking fathers, but findings are also compatible with no association.
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Affiliation(s)
- Katia Keglberg Haervig
- Department of Occupational and Environmental Medicine, Bispebjerg & Frederiksberg Hospital, Copenhagen, Denmark.,Department of Public Health, The Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Birgit Bjerre Høyer
- Department of Occupational and Environmental Medicine, Bispebjerg & Frederiksberg Hospital, Copenhagen, Denmark.,Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Aleksander Giwercman
- Department of Translational Medicine, Molecular Reproductive Medicine, Lund University, Lund, Sweden
| | - Karin Sørig Hougaard
- Department of Public Health, The Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.,National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Ina Olmer Specht
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg Frederiksberg Hospital, Copenhagen, Denmark
| | - Gunnar Toft
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Peter Bonde
- Department of Occupational and Environmental Medicine, Bispebjerg & Frederiksberg Hospital, Copenhagen, Denmark.,Department of Public Health, The Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sandra Søgaard Tøttenborg
- Department of Occupational and Environmental Medicine, Bispebjerg & Frederiksberg Hospital, Copenhagen, Denmark
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Nassan FL, Jensen TK, Priskorn L, Halldorsson TI, Chavarro JE, Jørgensen N. Association of Dietary Patterns With Testicular Function in Young Danish Men. JAMA Netw Open 2020; 3:e1921610. [PMID: 32083688 PMCID: PMC7043196 DOI: 10.1001/jamanetworkopen.2019.21610] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Diet may play a role in testicular function, but data on how adherence to different diet patterns influences human testicular function are scarce. OBJECTIVE To determine whether adherence to specific dietary patterns is associated with testicular function in young men. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 2935 young Danish men unselected regarding fertility status who were enrolled from April 1, 2008, through May 31, 2017. Data were analyzed from July 1, 2017, to January 30, 2019. EXPOSURES Dietary patterns identified with principal component analysis based on responses to a validated food frequency questionnaire. MAIN OUTCOMES AND MEASURES Standard semen quality assessment; serum concentrations of testosterone, free testosterone, estradiol, inhibin B, follicle-stimulating hormone, luteinizing hormone, and sex hormone-binding globulin; and testicular volume measured with ultrasonography. RESULTS Among the 2935 participants included in the analysis, median age was 19 (interquartile range, 19-20) years and 2290 (78.0%) had normal body mass index. The 4 dietary patterns identified included Western, prudent, open-sandwich (a traditional Danish eating pattern), and vegetarianlike. The greatest adherence to the prudent pattern was associated with the highest total sperm count (median, 167 [95% CI, 146-183] million), followed by adherence to vegetarianlike (median, 151 [95% CI, 134-168] million) and open-sandwich (median, 146 [95% CI, 131-163] million) patterns. Adherence to the Western pattern was associated with the lowest total sperm count (median, 122 [95% CI, 109-138] million), which was significantly lower than sperm count in the other 3 diet patterns. After adjusting for confounders, the median total sperm count for men in the highest quintile of adherence to the Western pattern was 26 million lower (95% CI, -42 to -9 million) than for men in the lowest quintile of adherence to this pattern. Conversely, the median total sperm count of men in the highest quintile of adherence to the prudent pattern was 43 million (95% CI, 23-63 million) higher than that of men in the lowest quintile. Men with the highest adherence to the Western pattern had a lower median ratio of inhibin B to follicle-stimulating hormone (-12 [95% CI, -20 to -3]) and higher median ratio of free testosterone to luteinizing hormone (10 [95% CI, 2-19]) compared with men with lowest adherence to this pattern. CONCLUSIONS AND RELEVANCE In this cross-sectional study, adherence to generally healthy diet patterns was associated with better semen quality, with potentially more favorable fertility potential among adult men.
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Affiliation(s)
- Feiby L. Nassan
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Tina K. Jensen
- Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark
- Odense Patient Data Explorative Network (OPEN), Odense, Denmark
| | - Lærke Priskorn
- Department of Growth and Reproduction, International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thorhallur I. Halldorsson
- Centre for Foetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland, Reykjavík
| | - Jorge E. Chavarro
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
| | - Niels Jørgensen
- Department of Growth and Reproduction, International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Jensen TK, Priskorn L, Holmboe SA, Nassan FL, Andersson AM, Dalgård C, Petersen JH, Chavarro JE, Jørgensen N. Associations of Fish Oil Supplement Use With Testicular Function in Young Men. JAMA Netw Open 2020; 3:e1919462. [PMID: 31951274 PMCID: PMC6991322 DOI: 10.1001/jamanetworkopen.2019.19462] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
IMPORTANCE Many young men have poor semen quality, and the causes are often unknown. Supplement intake of ω-3 polyunsaturated fatty acid has been found to improve semen quality among men with infertility, but the association with semen quality among healthy men is unknown. OBJECTIVE To determine if intake of ω-3 fatty acid supplements is associated with testicular function as measured by semen quality and reproductive hormone levels among healthy men. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included young Danish men from the general population recruited between January 1, 2012, and December 31, 2017, at compulsory examinations to determine their fitness for military service. Young unselected men were approached after the examination and invited to participate in a study of reproductive function, regardless of their fitness for military service. Data analysis was conducted from September 1, 2018, to June 30, 2019. EXPOSURES Intake of supplements, including fish oil, during the past 3 months. MAIN OUTCOMES AND MEASURES Semen quality, measured as volume, concentration, total sperm count, percentage of morphologically normal spermatozoa, and motility, and serum reproductive hormone levels, measured as follicle-stimulating hormone, luteinizing hormone, testosterone, free testosterone, and inhibin B levels. RESULTS Among 1679 young Danish men (median [interquartile range] age, 18.9 [18.7-19.4] years) recruited to participate, 98 men (5.8%) reported use of fish oil supplements during the past 3 months, of whom 53 (54.1%) reported intake on 60 or more days. After adjustment and compared with men with no supplement intake, men with fish oil supplement intake on fewer than 60 days had semen volume that was 0.38 (95% CI, -0.03 to 0.80) mL higher, and men with fish oil supplement intake on 60 or more days had semen volume that was 0.64 (95% CI, 0.15 to 1.12) mL higher (P for trend < .001). Similarly, testicular size in men with supplement intake on fewer than 60 days was 0.8 (95% CI, -0.2 to 1.9) mL larger and in men with fish oil supplement intake on 60 or more days was 1.5 (95% CI, 0.2 to 2.8) mL larger compared with men with no supplement intake (P for trend = .007). After adjustment, men with fish oil supplement intake had a 20% (95% CI, 9%-31%) lower follicle-stimulating hormone level and 16% (95% CI, 8%-24%) lower luteinizing hormone level compared with men with no supplement intake. There were no associations of intake of other supplements with measures of testicular function. CONCLUSIONS AND RELEVANCE These findings suggest that intake of fish oil supplements was associated with better testicular function, which is less likely to be due to confounding by indication, as no associations of intake of other supplements with testicular function were found. This cross-sectional study did not examine the actual content of ω-3 fatty acids in the supplements; therefore, these findings need confirmation in well-designed randomized clinical trials among unselected men.
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Affiliation(s)
- Tina Kold Jensen
- Department of Environmental Medicine, University of Southern Denmark, Odense, Denmark
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lærke Priskorn
- 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, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Stine A. Holmboe
- 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, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Feiby L. Nassan
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anna-Maria Andersson
- 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, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christine Dalgård
- Department of Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Jørgen Holm Petersen
- 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, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jorge E. Chavarro
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - 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, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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The current status and future of andrology: A consensus report from the Cairo workshop group. Andrology 2019; 8:27-52. [PMID: 31692249 DOI: 10.1111/andr.12720] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/24/2019] [Accepted: 10/24/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND In attempting to formulate potential WHO guidelines for the diagnosis of male infertility, the Evidence Synthesis Group noted a paucity of high-quality data on which to base key recommendations. As a result, a number of authors suggested that key areas of research/evidence gaps should be identified, so that appropriate funding and policy actions could be undertaken to help address key questions. OBJECTIVES The overall objective of this Consensus workshop was to clarify current knowledge and deficits in clinical laboratory andrology, so that clear paths for future development could be navigated. MATERIALS AND METHODS Following a detailed literature review, each author, prior to the face-to-face meeting, prepared a summary of their topic and submitted a PowerPoint presentation. The topics covered were (a) Diagnostic testing in male fertility and infertility, (b) Male fertility/infertility in the modern world, (c) Clinical management of male infertility, and (d) The overuse of ICSI. At the meeting in Cairo on February 18, 2019, the evidence was presented and discussed and a series of consensus points agreed. RESULTS The paper presents a background and summary of the evidence relating to these four topics and addresses key points of significance. Following discussion of the evidence, a total of 36 consensus points were agreed. DISCUSSION The Discussion section presents areas where there was further debate and key areas that were highlighted during the day. CONCLUSION The consensus points provide clear statements of evidence gaps and/or potential future research areas/topics. Appropriate funding streams addressing these can be prioritized and consequently, in the short and medium term, answers provided. By using this strategic approach, andrology can make the rapid progress necessary to address key scientific, clinical, and societal challenges that face our discipline now and in the near future.
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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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Kanakis GA, Nordkap L, Bang AK, Calogero AE, Bártfai G, Corona G, Forti G, Toppari J, Goulis DG, Jørgensen N. EAA clinical practice guidelines—gynecomastia evaluation and management. Andrology 2019; 7:778-793. [DOI: 10.1111/andr.12636] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022]
Affiliation(s)
- G. A. Kanakis
- First Department of Obstetrics and Gynecology, Unit of Reproductive Endocrinology Aristotle University of Thessaloniki Thessaloniki Greece
| | - L. Nordkap
- University Department of Growth and Reproduction, and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC) Rigshospitalet Copenhagen Denmark
| | - A. K. Bang
- University Department of Growth and Reproduction, and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC) Rigshospitalet Copenhagen Denmark
| | - A. E. Calogero
- Department of Clinical and Experimental Medicine University of Catania Catania Italy
| | - G. Bártfai
- Department of Obstetrics, Gynecology, and Andrology Albert Szent‐Györgyi Medical University Szeged Hungary
| | - G. Corona
- Medical Department, Endocrinology Unit Azienda Usl, Maggiore‐Bellaria Hospital Bologna Italy
| | - G. Forti
- Department of Experimental Clinical and Biomedical Sciences ‘Mario Serio’, Endocrine Unit University of Florence Florence Italy
| | - J. Toppari
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology Turku University Hospital Turku Finland
| | - D. G. Goulis
- First Department of Obstetrics and Gynecology, Unit of Reproductive Endocrinology Aristotle University of Thessaloniki Thessaloniki Greece
| | - N. Jørgensen
- University Department of Growth and Reproduction, and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC) Rigshospitalet Copenhagen Denmark
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Skovmand A, Jensen ACØ, Maurice C, Marchetti F, Lauvås AJ, Koponen IK, Jensen KA, Goericke-Pesch S, Vogel U, Hougaard KS. Effects of maternal inhalation of carbon black nanoparticles on reproductive and fertility parameters in a four-generation study of male mice. Part Fibre Toxicol 2019; 16:13. [PMID: 30879468 PMCID: PMC6421671 DOI: 10.1186/s12989-019-0295-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 02/21/2019] [Indexed: 03/06/2023] Open
Abstract
Background Previous findings indicate that in utero exposure to nanoparticles may affect the reproductive system in male offspring. Effects such as decreased sperm counts and testicular structural changes in F1 males have been reported following maternal airway exposure to carbon black during gestation. In addition, a previous study in our laboratory suggested that the effects of in utero exposure of nanoparticles may span further than the first generation, as sperm content per gram of testis was significantly lowered in F2 males. In the present study we assessed male fertility parameters following in utero inhalation exposure to carbon black in four generations of mice. Results Filter measurements demonstrated that the time-mated females were exposed to a mean total suspended particle mass concentration of 4.79 ± 1.86 or 33.87 ± 14.77 mg/m3 for the low and high exposure, respectively. The control exposure was below the detection limit (LOD 0.08 mg/m3). Exposure did not affect gestation and litter parameters in any generation. No significant changes were observed in body and reproductive organ weights, epididymal sperm parameters, daily sperm production, plasma testosterone or fertility. Conclusion In utero exposure to carbon black nanoparticles, at occupationally relevant exposure levels, via maternal whole body inhalation did not affect male-specific reproductive, fertility and litter parameters in four generations of mice.
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Affiliation(s)
- Astrid Skovmand
- The National Research Centre for the Working Environment, Copenhagen Ø, Denmark.,Department of Veterinary Clinical Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | | | - Clotilde Maurice
- Environmental Health Science Research Bureau, Health Canada, Ottawa, ON, Canada
| | - Francesco Marchetti
- Environmental Health Science Research Bureau, Health Canada, Ottawa, ON, Canada
| | - Anna J Lauvås
- Department of Veterinary Clinical Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Ismo K Koponen
- The National Research Centre for the Working Environment, Copenhagen Ø, Denmark
| | - Keld A Jensen
- The National Research Centre for the Working Environment, Copenhagen Ø, Denmark
| | - Sandra Goericke-Pesch
- Department of Veterinary Clinical Sciences, University of Copenhagen, Frederiksberg C, Denmark.,Reproductive Unit of the Clinics - Clinic for Small Animals, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Ulla Vogel
- The National Research Centre for the Working Environment, Copenhagen Ø, Denmark.,Department of Micro- and Nanotechnology, Technical University of Denmark, Lyngby, Denmark
| | - Karin S Hougaard
- The National Research Centre for the Working Environment, Copenhagen Ø, Denmark. .,Institute of Public Health, University of Copenhagen, Copenhagen K, Denmark.
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Vaughan DA, Sakkas D. Sperm selection methods in the 21st century. Biol Reprod 2019; 101:1076-1082. [DOI: 10.1093/biolre/ioz032] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/05/2019] [Accepted: 02/21/2019] [Indexed: 12/30/2022] Open
Abstract
Abstract
Natural sperm selection in humans is a rigorous process resulting in the highest quality sperm reaching, and having an opportunity to fertilize, the oocyte. Relative to other mammalian species, the human ejaculate consists of a heterogeneous pool of sperm, varying in characteristics such as shape, size, and motility. Semen preparation in assisted reproductive technologies (ART) has long been performed using either a simple swim-up method or density gradients. Both methodologies provide highly motile sperm populations; however neither replicates the complex selection processes seen in nature. A number of methods have now been developed to mimic some of the natural selection processes that exist in the female reproductive tract. These methods attempt to select a better individual, or population of, spermatozoa when compared to classical methods of preparation. Of the approaches already tested, platforms based upon sperm membrane markers, such as hyaluronan or annexin V, have been used to either select or deselect sperm with varied success. One technology that utilizes the size, motility, and other characteristics of sperm to improve both semen analysis and sperm selection is microfluidics. Here, we sought to review the efficacy of both available and emerging techniques that aim to improve the quality of the sperm pool available for use in ART.
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Affiliation(s)
- Denis A Vaughan
- Boston IVF, Waltham, Massachusetts, USA
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
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Priskorn L, Bang AK, Nordkap L, Krause M, Mendiola J, Jensen TK, Juul A, Skakkebaek NE, Swan SH, Jørgensen N. Anogenital distance is associated with semen quality but not reproductive hormones in 1106 young men from the general population. Hum Reprod 2019; 34:12-24. [PMID: 30452659 PMCID: PMC6295959 DOI: 10.1093/humrep/dey326] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/01/2018] [Accepted: 10/16/2018] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is anogenital distance (AGD) associated with semen quality and reproductive hormones in men from the general population? SUMMARY ANSWER Short AGD measured from the anus to the base of scrotum (AGDAS) was associated with reduced sperm counts and morphology but not with sperm motility or reproductive hormones. WHAT IS KNOWN ALREADY AGD is longer in males than in females. In rodents, AGD is a well-established and sensitive marker of disruption during the masculinization programming window in utero and it has been suggested to be so in humans as well. Therefore, the average AGD would be expected to be shorter in men with poor semen quality, which some studies have confirmed while others have not. STUDY DESIGN, SIZE, DURATION This cross-sectional population-based study was of 1106 men included between 2012 and 2016. PARTICIPANTS/MATERIALS, SETTING, METHODS Men from the general Danish population (median age 19 years), unselected with regard to fertility status and semen quality, delivered a semen sample, had a blood sample drawn, which was analyzed for concentrations of reproductive hormones, and answered a comprehensive questionnaire. They also had a physical examination performed including determination of AGD measured as the distance between anus and scrotum (AGDAS) and penis (AGDAP). Odds ratios (OR) and 95% CI were estimated for a man having abnormal semen parameters according to the World Health Organization's reference values or a low/high concentration of reproductive hormones (defined as the lowest or highest 10%) depending on AGD. AGD was categorized in four strata: ≤10th percentile, 10th-30th percentile, 30th-50th percentile and >50th percentile. MAIN RESULTS AND THE ROLE OF CHANCE Men with the 10% shortest AGDAS had a more than doubled risk (OR: 2.19, 95% CI: 1.40-3.42) of being in the subfertile range for either sperm concentration (<15 million/mL) or sperm morphology (<4%) compared to men with AGDAS above the median (reference). Men in the 10th-30th percentile also had an increased OR of 1.48 (95% CI: 1.06-2.08) but not men in the 30th-50th percentile (OR: 1.14, 95% CI: 0.81-1.62). AGDAP was only weakly related to semen quality. AGD was not associated with testicular volume or any of the reproductive hormones. LIMITATIONS, REASONS FOR CAUTION Limitations include the potential non-differential misclassification of reproductive outcomes based on a single semen and blood sample and some between-examiner differences in AGD measurements which introduces noise and may result in an underestimation of observed associations. WIDER IMPLICATIONS OF THE FINDINGS Our study of men from the general population confirmed associations between AGD and semen quality, supporting the hypothesis that AGD in humans could be a marker of fetal testicular development. This suggests that the low semen quality in Danish men may partly be explained by prenatal factors. STUDY FUNDING/COMPETING INTEREST(S) The study has received financial support from the ReproUnion (L.P.); the Research fund of Rigshospitalet, Copenhagen University Hospital (N.J.); Grants R01ES016863-04 and R01ES016863-02S4; National Institute of Environmental Health Sciences (NIEHS) and National Institute of Environmental Health Sciences grant (P30ES023515) (S.S.); the European Union (Contract numbers BMH4-CT96-0314, QLK4-CT-1999-01422, QLK4-CT-2002-00603, FP7/2007-2013, DEER Grant agreement no. 212844); the Danish Ministry of Health; the Danish Environmental Protection Agency; A.P. Møller and wife Chastine McKinney Møllers foundation; and Svend Andersens Foundation. None of the funders had any role in the study design, collection, analysis or interpretation of data, writing of the paper or publication decisions. The authors have nothing to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- L Priskorn
- 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
| | - A K Bang
- 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
| | - L Nordkap
- 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
| | - M Krause
- 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
| | - J Mendiola
- Division of Preventive Medicine and Public Health, University of Murcia School of Medicine and Biomedical Research Institute of Murcia (IMIB-Arrixaca), Espinardo, Murcia, Spain
| | - T K Jensen
- 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
- Department of Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - A Juul
- 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
| | - N E Skakkebaek
- 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
| | - S H Swan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - N 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
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Mínguez-Alarcón L, Williams PL, Chiu YH, Gaskins AJ, Nassan FL, Dadd R, Petrozza J, Hauser R, Chavarro JE. Secular trends in semen parameters among men attending a fertility center between 2000 and 2017: Identifying potential predictors. ENVIRONMENT INTERNATIONAL 2018; 121:1297-1303. [PMID: 30389382 PMCID: PMC6279498 DOI: 10.1016/j.envint.2018.10.052] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/25/2018] [Accepted: 10/25/2018] [Indexed: 05/12/2023]
Abstract
BACKGROUND Multiple meta-analyses have shown sperm count declines in Western countries spanning eight decades. Secular trends in other parameters remain unclear, as are potential predictors of these trends. OBJECTIVE To analyze secular trends in semen quality and to evaluate whether factors previously found to be related to semen quality were responsible for these patterns. METHODS This is a prospective study including 936 men of couples seeking infertility treatment who provided 1618 semen samples at a single center (2000-2017). Self-reported demographic, nutritional and reproductive characteristics were collected using standardized questionnaires. Urinary concentrations of bisphenol A, parabens and phthalates were quantified by isotope-dilution tandem mass spectrometry. Semen samples were analyzed for volume, sperm concentration, count, motility and morphology following WHO guidelines. We estimated the differences in semen parameters over time by fitting generalized linear mixed models with random intercepts to account for repeated samples while adjusting for abstinence time. We also adjusted for demographic, nutritional and environmental factors to investigate these as potential predictors of time trends. RESULTS Sperm concentration and count declined by 2.62% per year (95% CI -3.84, -1.38) and 3.12% per year (95% CI: -4.42, -1.80), corresponding to an overall decline of 37% and 42%, respectively, between 2000 and 2017. Decreasing trends were also observed for total motility (per year: -0.44 percentage units, 95% CI -0.71, -0.17) and morphologically normal sperm (per year: -0.069 percentage units, 95% CI -0.116, -0.023). These decreases reflected relative percentage declines of 15% and 16% over the 17 year study period, respectively. When reproductive factors were included in the model, the downward trends in sperm concentration and sperm count were attenuated by 29% and 26%, respectively, while the trends in motility and morphology were attenuated by 54% and 53%, respectively. Also, the downward trends in both sperm concentration and sperm morphology over time were attenuated by 19% when including the DEHP and non-DEHP metabolites, respectively. CONCLUSIONS Sperm concentration, total count, motility and morphology significantly declined between 2000 and 2017 among subfertile men. These negative trends were attenuated when considering simultaneous changes in reproductive characteristics and urinary phthalates during the course of the study.
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Affiliation(s)
- Lidia Mínguez-Alarcón
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA.
| | - Paige L Williams
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Yu-Han Chiu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Audrey J Gaskins
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA; Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Feiby L Nassan
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Ramace Dadd
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
| | - John Petrozza
- Division of Reproductive Medicine and IVF, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA; Vincent Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jorge E Chavarro
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA; Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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