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Kamiński P, Baszyński J, Jerzak I, Kavanagh BP, Nowacka-Chiari E, Polanin M, Szymański M, Woźniak A, Kozera W. External and Genetic Conditions Determining Male Infertility. Int J Mol Sci 2020; 21:ijms21155274. [PMID: 32722328 PMCID: PMC7432692 DOI: 10.3390/ijms21155274] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 12/13/2022] Open
Abstract
We explain environmental and genetic factors determining male genetic conditions and infertility and evaluate the significance of environmental stressors in shaping defensive responses, which is used in the diagnosis and treatment of male infertility. This is done through the impact of external and internal stressors and their instability on sperm parameters and their contribution to immunogenetic disorders and hazardous DNA mutations. As chemical compounds and physical factors play an important role in the induction of immunogenetic disorders and affect the activity of enzymatic and non-enzymatic responses, causing oxidative stress, and leading to apoptosis, they downgrade semen quality. These factors are closely connected with male reproductive potential since genetic polymorphisms and mutations in chromosomes 7, X, and Y critically impact on spermatogenesis. Microdeletions in the Azoospermic Factor AZF region directly cause defective sperm production. Among mutations in chromosome 7, impairments in the cystic fibrosis transmembrane conductance regulator CFTR gene are destructive for fertility in cystic fibrosis, when spermatic ducts undergo complete obstruction. This problem was not previously analyzed in such a form. Alongside karyotype abnormalities AZF microdeletions are the reason of spermatogenic failure. Amongst AZF genes, the deleted in azoospermia DAZ gene family is reported as most frequently deleted AZF. Screening of AZF microdeletions is useful in explaining idiopathic cases of male infertility as well as in genetic consulting prior to assisted reproduction. Based on the current state of research we answer the following questions: (1) How do environmental stressors lessen the quality of sperm and reduce male fertility; (2) which chemical elements induce oxidative stress and immunogenetic changes in the male reproductive system; (3) how do polymorphisms correlate with changes in reproductive potential and pro-antioxidative mechanisms as markers of pathophysiological disturbances of the male reproductive condition; (4) how do environmental stressors of immunogenetic disorders accompany male infertility and responses; and (5) what is the distribution and prevalence of environmental and genetic risk factors.
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Affiliation(s)
- Piotr Kamiński
- Department of Biotechnology, Institute of Biological Sciences, University of Zielona Góra, Prof. Szafran St. 1, PL 65-516 Zielona Góra, Poland
- Department of Ecology and Environmental Protection, Department of Medical Biology and Biochemistry, Collegium Medicum in Bydgoszcz, Faculty of Medicine, Nicolaus Copernicus University in Toruń, M. Skłodowska-Curie St. 9, PL 85-094 Bydgoszcz, Poland;
- Correspondence:
| | - Jędrzej Baszyński
- Department of Ecology and Environmental Protection, Department of Medical Biology and Biochemistry, Collegium Medicum in Bydgoszcz, Faculty of Medicine, Nicolaus Copernicus University in Toruń, M. Skłodowska-Curie St. 9, PL 85-094 Bydgoszcz, Poland;
| | - Izabela Jerzak
- Department of Pharmacology and Toxicology, Collegium Medicum, University of Zielona Góra, Zyta St. 28, PL 65-046 Zielona Góra, Poland;
| | - Brendan P. Kavanagh
- RCSI Biology, Royal College of Surgeons in Ireland, 123 St. Stephen’s Green, Dublin 2, Ireland;
| | - Ewa Nowacka-Chiari
- Department of Sport Promotion, Institute of Biological Sciences, University of Zielona Góra, Prof. Szafran St. 1, PL 65-516 Zielona Góra, Poland;
| | - Mateusz Polanin
- Karol Marcinkowski University Hospital in Zielona Góra, Zyta St. 26, PL 65-045 Zielona Góra, Poland;
| | - Marek Szymański
- Female Pathology and Oncological Gynecology, Department of Obstetrics, Faculty of Medicine, University Hospital No. 2, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Ujejski St. 75, PL 85-168 Bydgoszcz, Poland;
- NZOZ Medical Center Co. Prof. dr. hab. med. Wiesław Szymański, Dr. hab. med. Marek Szymański, Waleniowa St. 24, PL 85-435 Bydgoszcz, Poland
| | - Alina Woźniak
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Karłowicz St. 24, PL 85-092 Bydgoszcz, Poland;
| | - Wojciech Kozera
- Department of Agricultural Chemistry, Faculty of Agriculture and Biotechnology, UTP University of Science and Technology in Bydgoszcz, Seminaryjna St. 5, PL 85-326 Bydgoszcz, Poland;
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Kumar S, Sharma A, Kshetrimayum C. Environmental & occupational exposure & female reproductive dysfunction. Indian J Med Res 2019; 150:532-545. [PMID: 32048617 PMCID: PMC7038808 DOI: 10.4103/ijmr.ijmr_1652_17] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Indexed: 01/08/2023] Open
Abstract
All individuals are exposed to certain chemical, physical, biological, environmental as well as occupational factors. The data pertaining to role of these factors on female reproduction are scanty as compared to male. The available data suggest the adverse effects of certain toxicants, viz., metals such as lead, cadmium and mercury, pesticides such as bis(4-chlorophenyl)-1,1,1-trichloroethane and organic solvent such as benzene, toluene and ionizing radiation on the female reproductive system affecting directly the organ system or impacting in directly through hormonal impairments, molecular alterations, oxidative stress and DNA methylation impairing fertility as well as pregnancy and its outcomes. Thus, there is a need for awareness and prevention programme about the adverse effects of these factors and deterioration of female reproductive health, pregnancy outcome and offspring development as some of these chemicals might affect the developing foetus at very low doses by endocrine disruptive mechanism.
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Affiliation(s)
- Sunil Kumar
- Division of Reproductive & Cyto-toxicology, ICMR-National Institute of Occupational Health, Ahmedabad, Gujarat, India
| | - Anupama Sharma
- Division of Reproductive & Cyto-toxicology, ICMR-National Institute of Occupational Health, Ahmedabad, Gujarat, India
| | - Chaoba Kshetrimayum
- Division of Reproductive & Cyto-toxicology, ICMR-National Institute of Occupational Health, Ahmedabad, Gujarat, India
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Shubina OS, Dudenkova NA. The effect of lead on the process of spermatogenesis in sex glands of male albino rats. Vet World 2016; 9:1129-1134. [PMID: 27847424 PMCID: PMC5104723 DOI: 10.14202/vetworld.2016.1129-1134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 08/27/2016] [Indexed: 11/22/2022] Open
Abstract
AIM The aim of this study was to investigate the morphological and functional features of the process of spermatogenesis in the testes of male albino rats when exposed to lead acetate. MATERIALS AND METHODS Using histological, morphometric and statistical methods explored the effects of lead acetate on the process of spermatogenesis in the testes of male albino rats. Investigations were carried out using a digital microscope Axio Imager. M2 and automatic cell counter Countess™. RESULTS It is shown that when exposed to lead acetate a decrease in the production of all populations of spermatogenic cells, decreased spermatogenesis index and an index of relaxation (tension spermatogenesis), the increase in the index of ripening, index meiotic activity and germinative index, which indicates a decrease in the functional activity of the testes. On preparations, it is possible to see that after the influence of acetate of lead the head of spermatozoa becomes more roundish, breaks of tails observed. CONCLUSION Lead acetate reduces the productivity of the seminal glands, which leads to the decrease of the concentration of spermatozoa, and their viability. The results of the studies suggest a negative impact of lead acetate in the course of the process of spermatogenesis in the testes of male white rats.
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Affiliation(s)
- Olga Sergeevna Shubina
- Federal State Budgetary Educational Institution of Higher Education, M. E. Evseviev Mordovian State Pedagogical Institute, Saransk, Russia
| | - Natalia Anatolievna Dudenkova
- Federal State Budgetary Educational Institution of Higher Education, M. E. Evseviev Mordovian State Pedagogical Institute, Saransk, Russia
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Chen C, Wang N, Nie X, Han B, Li Q, Chen Y, Zhai H, Zhu C, Chen Y, Xia F, Lu M, Lin D, Lu Y. Blood Cadmium Level Associates with Lower Testosterone and Sex Hormone-Binding Globulin in Chinese men: from SPECT-China Study, 2014. Biol Trace Elem Res 2016; 171:71-8. [PMID: 26434494 DOI: 10.1007/s12011-015-0526-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 09/25/2015] [Indexed: 12/16/2022]
Abstract
Cadmium is a widespread environmental pollutant. We aimed to determine whether blood cadmium level (BCL) associates with reproductive hormones in a cross-sectional study. Our data were from SPECT-China. We selected 5690 participants (2286 men and 3404 women), aged 18 years and older, among whom 1589 were postmenopausal women. BCL, blood lead level, total testosterone (TT), estradiol (E2), sex hormone-binding globulin (SHBG), luteinizing hormone, and follicle-stimulating hormone were measured. Results showed that BCL was significantly higher in men (median 1.90 μg/L) than that in women (median 1.56 μg/L). The median level of cadmium in postmenopausal women was 1.40 μg/L. In men, BCL was negatively correlated with TT (Spearmen coefficient = -0.057, P < 0.01) and SHBG (Spearmen coefficient = -0.098, P < 0.01), but in postmenopausal women, this correlation was not observed. In linear regression, after full adjustment for blood lead level, age, body mass index, residence area, economic status, and smoking, TT and SHBG were still negatively associated with BCL in men. Additionally, the association between BCL and TT levels was modified by BMI group (P for interaction = 0.041). However, from base model to fully adjusted model, BCL was not associated with TT and E2 in postmenopausal women. In conclusion, men had higher BCL than women in China, and BCL was associated with TT and SHBG in Chinese men, which may have important implications for male reproductive health. Concerted efforts are warranted to reduce adult cadmium exposure.
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Affiliation(s)
- Chi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiaomin Nie
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Bing Han
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Qin Li
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Hualing Zhai
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Chunfang Zhu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yingchao Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Fangzhen Xia
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Meng Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Dongping Lin
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
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Abstract
BACKGROUND Studies of couple fertility over time have often examined study populations with broad age ranges at a cross-section of time. An increase in fertility has been observed in studies that followed episodes of fertility events either prospectively among nulliparous women or retrospectively among parous women. Fertility has a biological effect on parity. If defined at a cross-section of time, parity will also be affected by year of birth, and thus becomes a collider. Conditioning (stratifying, restricting, or adjusting) on a collider may cause selection bias in the studied association. METHODS A study with prospective follow-up was taken as the model to assess the validity of fertility studies. We demonstrate the potential for selection bias using causal graphs and nationwide birth statistics and other demographic data. We tested the existence of parity-conditioning bias in data including both parous and nulliparous women. We also used a simulation approach to assess the strength of the bias in populations with prior at-risk cycles. Finally, we evaluated the potential for selection bias due to conditioning on parity in various sampling frames. RESULTS Analyses indicate that the observed increase in fertility over time can be entirely explained by selection bias due to parity-conditioning. CONCLUSION Heterogeneity in fertility and differential success in prior at-risk cycles are the ultimate factors behind the selection bias. The potential for selection bias due to parity-conditioning varies by sampling frame. A prospective multidecade study with representative sampling of birth cohorts and follow-up from menarche to menopause would bypass the described bias.
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Shedding light on the controversy surrounding the temporal decline in human sperm counts: a systematic review. ScientificWorldJournal 2014; 2014:365691. [PMID: 24672311 PMCID: PMC3929517 DOI: 10.1155/2014/365691] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 10/24/2013] [Indexed: 11/18/2022] Open
Abstract
We systematically examined the evidence of declining sperm counts and the hypothesis that an increased exposure to environmental pollutants is responsible for such decline. Search engines, including PUBMED, MEDLINE, EMBASE, BIOSIS, and Cochrane library, were used to identify epidemiologic studies published from 1985 to 2013. We concluded that there is no enough evidence to confirm a worldwide decline in sperm counts. Also, there seems to be no scientific truth of a causative role for endocrine disruptors in the temporal decline of sperm production. Such assumptions are based on few meta-analyses and retrospective studies, while other well-conducted researches could not confirm these findings. We acknowledge that difficult-to-control confounding factors in the highly variable nature of semen, selection criteria, and comparability of populations from different time periods in secular-trend studies, the quality of laboratory methods for counting sperm, and apparently geographic variations in semen quality are the main issues that complicate the interpretation of the available evidence. Owing to the importance of this subject and the uncertainties still prevailing, there is a need not only for continuing monitoring of semen quality, reproductive hormones, and xenobiotics, but also for a better definition of fecundity.
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Slama R, Ballester F, Casas M, Cordier S, Eggesbø M, Iniguez C, Nieuwenhuijsen M, Philippat C, Rey S, Vandentorren S, Vrijheid M. Epidemiologic tools to study the influence of environmental factors on fecundity and pregnancy-related outcomes. Epidemiol Rev 2013; 36:148-64. [PMID: 24363355 DOI: 10.1093/epirev/mxt011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Adverse pregnancy outcomes entail a large health burden for the mother and offspring; a part of it might be avoided by better understanding the role of environmental factors in their etiology. Our aims were to review the assessment tools to characterize fecundity troubles and pregnancy-related outcomes in human populations and their sensitivity to environmental factors. For each outcome, we reviewed the possible study designs, main sources of bias, and their suggested cures. In terms of study design, for most pregnancy outcomes, cohorts with recruitment early during or even before pregnancy allow efficient characterization of pregnancy-related events, time-varying confounders, and in utero exposures that may impact birth outcomes and child health. Studies on congenital anomalies require specific designs, assessment of anomalies in medical pregnancy terminations, and, for congenital anomalies diagnosed postnatally, follow-up during several months after birth. Statistical analyses should take into account environmental exposures during the relevant time windows; survival models are an appropriate approach for fecundity, fetal loss, and gestational duration/preterm delivery. Analysis of gestational duration could distinguish pregnancies according to delivery induction (and possibly pregnancy-related conditions). In conclusion, careful design and analysis are required to better characterize environmental effects on human reproduction.
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Affiliation(s)
- Rémy Slama
- Abbreviations: PROM, premature rupture of the fetal membranes; TTP, time to pregnancy
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Wang X, Wang M, Dong W, Li Y, Zheng X, Piao F, Li S. Subchronic exposure to lead acetate inhibits spermatogenesis and downregulates the expression of Ddx3y in testis of mice. Reprod Toxicol 2013; 42:242-50. [DOI: 10.1016/j.reprotox.2013.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 10/07/2013] [Accepted: 10/08/2013] [Indexed: 11/26/2022]
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9
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Buck Louis GM, Sundaram R, Schisterman EF, Sweeney AM, Lynch CD, Gore-Langton RE, Chen Z, Kim S, Caldwell K, Barr DB. Heavy metals and couple fecundity, the LIFE Study. CHEMOSPHERE 2012; 87:1201-7. [PMID: 22309709 PMCID: PMC3327819 DOI: 10.1016/j.chemosphere.2012.01.017] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 01/02/2012] [Accepted: 01/03/2012] [Indexed: 05/19/2023]
Abstract
The effect of heavy metals at environmentally relevant concentrations on couple fecundity has received limited study despite ubiquitous exposure. In 2005-2009, couples (n=501) desiring pregnancy and discontinuing contraception were recruited and asked to complete interviews and to provide blood specimens for the quantification of cadmium (μg L(-1)), lead (μg dL(-1)) and mercury (μg L(-1)) using inductively coupled plasma-mass spectrometry. Couples completed daily journals on lifestyle and intercourse along with menstruation and pregnancy testing for women. Couples were followed for 12 months or until pregnant. Fecundability odds ratios (FORs) and 95% confidence intervals (CIs) were estimated adjusting for age, body mass index, cotinine, and serum lipids in relation to female then male exposures. FORs <1 denote a longer time to pregnancy. In adjusted models, reduced FORs were observed for both female cadmium (0.78; 95% CI 0.63-0.97) and male lead (0.85; 95% CI 0.73-0.98) concentrations. When jointly modeling couples' exposures, only male lead concentration significantly reduced the FOR (0.82; 95% CI 0.68, 0.97), though the FOR remained <1 for female cadmium (0.80; 95% CI 0.64, 1.00). This prospective couple based cohort with longitudinal capture of time to pregnancy is suggestive of cadmium and lead's reproductive toxicity at environmentally relevant concentrations.
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Affiliation(s)
- Germaine M. Buck Louis
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd., Room 7B05, Rockville, Maryland 20852
| | - Rajeshwari Sundaram
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd., Room 7B05, Rockville, Maryland 20852
| | - Enrique F. Schisterman
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd., Room 7B05, Rockville, Maryland 20852
| | - Anne M. Sweeney
- Texas A & M Health Science Center, School of Rural Public Health
| | - Courtney D. Lynch
- Department of Obstetrics & Gynecology, The Ohio State University College of Medicine
| | | | - Zhen Chen
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd., Room 7B05, Rockville, Maryland 20852
| | - Sungduk Kim
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd., Room 7B05, Rockville, Maryland 20852
| | - Kathleen Caldwell
- Division of Laboratory Science, National Center for Environmental Health, Centers for Disease Control and Prevention
| | - Dana Boyd Barr
- Department of Environmental and Occupational Health, Rollins School of Public Health of Emory University
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Snijder CA, te Velde E, Roeleveld N, Burdorf A. Occupational exposure to chemical substances and time to pregnancy: a systematic review. Hum Reprod Update 2012; 18:284-300. [DOI: 10.1093/humupd/dms005] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tough SC, Siever JE, Jack M. Reproductive Assistance, Emotional Health, Obesity, and Time to Pregnancy Among Women Under 35 Years of Age. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:1153-1162. [DOI: 10.1016/s1701-2163(16)34739-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Cocuzza M, Sikka SC, Athayde KS, Agarwal A. Clinical relevance of oxidative stress and sperm chromatin damage in male infertility: an evidence based analysis. Int Braz J Urol 2007; 33:603-21. [DOI: 10.1590/s1677-55382007000500002] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2007] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Suresh C. Sikka
- Reproductive Research Center; Glickman Urological and Kidney Institute; Cleveland Clinic; Tulane University Health Sciences Center, USA
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Hodgson DC, Pintilie M, Gitterman L, Dewitt B, Buckley CA, Ahmed S, Smith K, Schwartz A, Tsang RW, Crump M, Wells W, Sun A, Gospodarowicz MK. Fertility among female hodgkin lymphoma survivors attempting pregnancy following ABVD chemotherapy. Hematol Oncol 2007; 25:11-5. [PMID: 17036376 DOI: 10.1002/hon.802] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) chemotherapy is infrequently associated with premature amenorrhea, little is known about the success rate of women attempting pregnancy following ABVD. In the present study females treated for HL with ABVD chemotherapy without pelvic radiation therapy (RT) and who were alive without relapse > or =3 years after treatment were identified from a clinical database and screened for inclusion. Using a standardized questionnaire, we determined the pregnancy rate (i.e. time-to-pregnancy, TTP) among survivors who had become pregnant, tried to become pregnant, or who had been sexually active for over 2 months without using contraception at any time following ABVD. The cumulative incidence of pregnancy was calculated using the Kaplan-Meier method. Cox proportional hazards models were constructed to compare the pregnancy rate among HL survivors to that reported by friend or sibling controls. Thirty-six female HL survivors, who had attempted pregnancy after ABVD treatment, and 29 controls, completed the survey. Eighteen patients (50%) received 2-4 cycles of ABVD, 16 (44%) received 4-6 cycles, and 2 (6%) received >6 cycles. The median TTP among both HL survivors and controls was 2.0 months. The 12-month pregnancy rates were 70% and 75%, respectively. The fertility ratio (FR) for HL survivors versus controls was 0.94 (95%CI = 0.53-1.66; p = 0.84) after adjusting for age and frequency of intercourse (where FR < 1 indicates subfertility). Age at treatment and the number of cycles of chemotherapy were not associated with pregnancy rate among HL survivors. Female HL patients who had survived without recurrence > or =3 years and who had attempted pregnancy after ABVD did not experience significant sub-fertility.
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Affiliation(s)
- David C Hodgson
- Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, Canada.
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Chang SH, Cheng BH, Lee SL, Chuang HY, Yang CY, Sung FC, Wu TN. Low blood lead concentration in association with infertility in women. ENVIRONMENTAL RESEARCH 2006; 101:380-6. [PMID: 16360143 DOI: 10.1016/j.envres.2005.10.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2005] [Revised: 09/30/2005] [Accepted: 10/06/2005] [Indexed: 05/04/2023]
Abstract
This study investigated the relationship between low-level lead exposure and risk of infertility in women. Study participants consisted of 64 cases recruited at a private infertility clinic and 83 control women from the postpartum clinic unit at a medical center in Kaohsiung, Taiwan. With informed consent, venous blood samples were obtained from subjects, during their early follicular phases (the 1st to 5th days of the menstrual cycle), for measuring concentrations of lead and hormones. Information on other potential risk factors associated with infertility, including reproductive history, Chinese herbal Medicine use, dairy product consumption, residential environment, and sociodemographic status, was obtained during an in-person interview. The mean blood lead level (BLL) in infertile women was significantly higher than that in controls (3.55 vs 2.78 microg/dL, P=0.007). Compared to women with BLL < or = 2.5 microg/dL, women with BLL>2.5 microg/dL were associated with a threefold increased risk for infertility (adjusted odds ratio=2.94, 95% confidence interval 1.18-7.34), after controlling for age, body mass index, smoking, Chinese herbal Medicine use, and irregular menstruation. Women's BLL was a significant predictor of the serum estradiol concentration also. These findings suggest an important role of very low BLL in the risk of infertility in women.
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Affiliation(s)
- Shu-Hao Chang
- Institute of Occupational Safety and Health, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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15
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Hooiveld M, Haveman W, Roskes K, Bretveld R, Burstyn I, Roeleveld N. Adverse reproductive outcomes among male painters with occupational exposure to organic solvents. Occup Environ Med 2006; 63:538-44. [PMID: 16757511 PMCID: PMC2078125 DOI: 10.1136/oem.2005.026013] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the risks of reproductive disorders and birth defects in offspring of male painters with exposure to organic solvents, and to determine the shape of the dose-response relationship. METHODS Random samples of painters and carpenters were drawn from workers affiliated with the Dutch Trade Union for Construction Workers, the Netherlands, 2001. Information on reproductive outcomes, occupational exposures, and lifestyle habits was retrospectively obtained through self-administered questionnaires filled in by 398 painters exposed to organic solvents in paints, thinners, and cleansers in the period of three months before the last pregnancy, and 302 carpenters with little or no exposure to solvents. A statistical model was used to estimate quantitative exposure measures. RESULTS Workers employed as painters at three months before pregnancy had an increased risk (odds ratio 6.2, 95% CI 1.4 to 27.9) of congenital malformations in offspring compared to carpenters. There was a positive exposure-response trend with increasing exposure to organic solvents based on quantitative model predicted exposure estimates using toluene as a marker. There was some indication of an increased risk of functional developmental disorders in offspring among painters with intermediate and high model predicted exposure. The risk of low birth weight children seemed to be slightly increased among painters as well. Results for other reproductive outcomes (time to pregnancy, spontaneous abortion, and preterm birth) did not show increased risks. CONCLUSION This study showed a positive association between paternal occupational exposure to organic solvents and congenital malformations in offspring. However, the small numbers of cases, especially when examining different exposure levels, as well as the self-reported nature of exposure and outcome variables, may hamper interpretation of the results.
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Affiliation(s)
- M Hooiveld
- Radboud University Nijmegen Medical Centre, Department of Epidemiology and Biostatistics, Nijmegen, Netherlands.
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Cole DC, Wainman B, Sanin LH, Weber JP, Muggah H, Ibrahim S. Environmental contaminant levels and fecundability among non-smoking couples. Reprod Toxicol 2006; 22:13-9. [PMID: 16439098 DOI: 10.1016/j.reprotox.2005.12.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2005] [Revised: 11/22/2005] [Accepted: 12/06/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the effects of low level maternal and paternal persistent contaminant exposures on fecundability among couples from the general population. METHODS About 41 couples having their first pregnancy completed questionnaires and provided blood samples for analysis of metals, organochlorine pesticides, and polychorinated biphenyls. Associations of personal consumption and contaminant measures for mothers, fathers, and couples overall were analyzed through fecundability odds ratios (fOR, probability of pregnancy per month in more versus less exposed) in multivariable analyses. FINDINGS Couples with higher reported caffeine consumption (couple consumption > or =111 drinks/month, fOR 0.25, 95% CI, 0.10, 0.63) and higher mercury concentrations in maternal blood (>1.2 microg/L or 0.24 ppm in hair, fOR 0.22, 95% CI, 0.07, 0.72) had lower fecundability, after adjustment for intercourse frequency. CONCLUSION Reduced fecundability at levels below the mercury reference dose warrants further research and prudent reduction in persistent toxic substances exposure among women and men of reproductive age.
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Affiliation(s)
- Donald C Cole
- Department of Public Health Sciences, University of Toronto, Toronto, Ont., Canada; Institute for Work and Health, Toronto, Ont., Canada
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17
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Abstract
This review focuses on the impacts of lead exposure on reproductive health and outcomes. High levels of paternal lead exposure (>40 microg/dl or >25 microg/dl for a period of years) appear to reduce fertility and to increase the risks of spontaneous abortion and reduced fetal growth (preterm delivery, low birth weight). Maternal blood lead levels of approximately 10 microg/dl have been linked to increased risks of pregnancy hypertension, spontaneous abortion, and reduced offspring neurobehavioral development. Somewhat higher maternal lead levels have been linked to reduced fetal growth. Some studies suggest a link between increased parental lead exposure and congenital malformations, although considerable uncertainty remains regarding the specific malformations and the dose-response relationships. Common methodological weaknesses of studies include potential exposure misclassifications due to the frequent unavailability of exposure biomarker measurements at biologically appropriate times and uncertainty regarding the best exposure biomarker(s) for the various outcomes. A special concern with regard to the pregnant woman is the possibility that a fetus might be exposed to lead mobilized from bone stores as a result of pregnancy-related metabolic changes, making fetal lead exposure the result of exposure to exogenous lead during pregnancy and exposure to endogenous lead accumulated by the woman prior to pregnancy. By reducing bone resorption, increased calcium intake during the second half of pregnancy might reduce the mobilization of lead from bone compartments, even at low blood lead levels. Subgroups of women who incurred substantial exposures to lead prior to pregnancy should be considered to be at increased risk.
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Affiliation(s)
- David C Bellinger
- Children's Hospital Boston, Harvard Medical School, Harvard School of Public Health, Farley Basement Box 127, 300 Longwood Avenue, Boston, MA 02115, USA.
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18
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Winker R, Rüdiger HW. Reproductive toxicology in occupational settings: an update. Int Arch Occup Environ Health 2005; 79:1-10. [PMID: 16010576 DOI: 10.1007/s00420-005-0011-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Accepted: 04/28/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This article mainly attempts to review the recent human literature on the adverse effects of occupational factors on fertility, developmental effects and genetic changes in the germ line, which lead to genetic malformations or to genetic disease. The secondary study aim is to answer whether occupational exposures are quantitative momentously for 15% involuntarily childless couples, 10-20% spontaneous abortions and 3% birth defects. METHODS A literature survey was conducted for publications on these subjects focusing on the latest publications. PubMed (Medline. 2005) was used for this literature search. RESULTS Publication bias and a large amount of confounding factors, which have to be controlled, make the design of human fertility studies difficult. Epidemiologic studies using time to conception techniques have been useful in identifying substances and exposure scenarios with proven toxic effect on fertility. The collected studies suggest that the exposure to the following substances or occupational settings may affect fertility function: lead, organic mercury compounds, manganese, carbon disulfide, 2-bromopropane and dibromochloropropane, welding, professional driving and working with heat. Concerning developmental effects even for methyl mercury, which was in group A of the German MAK list, to date no reliable evidence of the damaging effect on the human fetus under actual work conditions has been obtained. It is also difficult to classify substances according to their mutagenic potential for the germ cell, since no direct evidence of an association between exposure against a physical or chemical pollutant and the occurrence of a hereditary disorder has been found yet. CONCLUSION In conclusion there are only a few substances which may affect reproductive function in the workplace without a doubt. The decreasing fertility of women in Western countries can be explained by the increasing female reproduction age, rather than by occupational exposures. Also the rates for spontaneous abortions and birth defects cannot be explained by industrial exposures at the workplace.
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Affiliation(s)
- R Winker
- Division of Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Schütz A, Olsson M, Jensen A, Gerhardsson L, Börjesson J, Mattsson S, Skerfving S. Lead in finger bone, whole blood, plasma and urine in lead-smelter workers: extended exposure range. Int Arch Occup Environ Health 2005; 78:35-43. [PMID: 15750821 DOI: 10.1007/s00420-004-0559-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2004] [Accepted: 08/15/2004] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To assess the historical exposure and to study the relationships between lead concentrations in whole blood (B-Pb), plasma (P-Pb), urine (U-Pb), finger bone (Bone-Pb) and duration of employment in workers at a secondary lead smelter and to compare the relationships between B-Pb and P-Pb with results from previous studies of populations with a wide range of lead exposure. METHODS In 39 lead workers (29 active, ten retired), recruited from those with the highest exposure at a German secondary lead smelter, levels of B-Pb, P-Pb and U-Pb were determined by inductively coupled plasma mass spectrometry (ICP-MS). Bone-Pb was determined by in vivo X-ray fluorescence (XRF). Results were compared with data from a previous study on 90 workers (71 active, 19 retired) with lower exposure, from a Swedish secondary lead smelter, as well as with previously collected data from 42 active Russian lead workers and 34 Ecuadorian lead-exposed subjects. RESULTS The median values in the active/retired German lead workers were: age 44/59 years, duration of employment 20/38 years, Bone-Pb 71/150 microg/g, B-Pb 500/330 microg/l, P-Pb 2.7/1.1 microg/l, and U-Pb 25/13 micromol/mol creatinine. Bone-Pb increased with duration of employment by 4.2 microg/g per year and 1.6 microg/g per year in German and Swedish workers, respectively. The median Bone-Pb was three times higher in both active and retired German workers than in Swedish smelter workers with essentially the same age distribution and duration of employment. The linear regression equation between B-Pb and log P-Pb in the combined group of Ecuadorian, German, Russian and Swedish lead-exposed subjects (n=176) was B-Pb=545 x log[P-Pb] + 258 (r(s)=0.94; P<0.001). CONCLUSIONS The high Bone-Pb values recorded for the German smelters implied a historical lead exposure of considerable magnitude. The long-term high lead exposure also showed up in the B-Pb levels for both active and retired workers, leading to the implementation of necessary industrial safety measures in order to respond to biological threshold limits. The suggested equation describing the relationship between B-Pb and P-Pb in the combined group of subjects with a wide range of lead exposure can be useful in future cross-sectional and longitudinal studies of lead-exposed populations, relating, e.g., lead exposure to adverse health outcomes.
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Affiliation(s)
- Andrejs Schütz
- Department of Occupational and Environmental Medicine, Lund University Hospital, Lund, Sweden
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20
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Younglai EV, Holloway AC, Foster WG. Environmental and occupational factors affecting fertility and IVF success. Hum Reprod Update 2005; 11:43-57. [PMID: 15601728 DOI: 10.1093/humupd/dmh055] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Reproductive function has been shown to be sensitive to changes in the physical, psychosocial and chemical environments. Although reproductive effects of occupational exposure to hazardous chemicals have been well documented in the literature, the potential effects of chemical contaminants at levels representative of contemporary exposures in the general population are much less certain. Evidence for adverse effects of exposure to environmental contaminants is more conclusive among the lower animals than for humans where considerable controversy remains. In addition to potential reproductive hazards of exposure to environmental contaminants, there is also evidence for adverse reproductive effects of the physical and psychosocial environments. In this review we focus on the difficulties involved in linking exposure to putative hazardous substances in environmental and occupational settings to adverse reproductive outcomes, especially success of IVF procedures. We highlight the plausibility of adverse events through animal and cell studies and the application of these results to the interpretation of human data. We consider both the male and female partners since it is essentially their combined contributions of gametes which may be affected by chemicals, which lead to successful outcomes.
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Affiliation(s)
- Edward V Younglai
- Department of Obstetrics & Gynaecology, Reproductive Biology Division, McMaster University, Health Sciences Centre, Hamilton, Ontario, Canada.
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21
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Abstract
AIMS To investigate time to pregnancy (TTP) in male lead workers in order to determine the dose-response relation between blood lead and decreased fecundity. METHODS A total of 163 currently employed married male lead battery workers were classified into five categories of exposure based on questionnaire information and annual individual blood lead measurement. Information pertaining to the TTP was collected using personal interviews with 133 men and their spouses, with 280 valid pregnancies. The fecundability ratios (FRs) were calculated with the Cox discrete proportional hazard regression technique to evaluate the effects of lead exposure. RESULTS After other factors associated with TTP were controlled for, there was a dose-response relation between blood lead level and TTP. The measured FRs were 0.90 (95% CI 0.61 to 1.34), 0.72 (0.46 to 1.11), 0.52 (0.35 to 0.77), and 0.40 (0.27 to 0.59) for concurrent blood lead levels of <20, 20-29, 30-39, and > or =40 microg/dl, respectively. Paired self comparison was also performed for 41 couples that had pregnancies prior to lead exposure and pregnancies with male occupational lead exposure. The TTP was prolonged for 0.15 cycles by a 1 microg/dl increase in blood lead. CONCLUSIONS These results corroborate the hypothesis that a raised blood lead level affects fecundity. A blood lead level of less than 40 microg/dl may still significantly prolong TTP.
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Affiliation(s)
- C-Y Shiau
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
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22
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Slama R, Bouyer J, Remontet L, Spira A. Epidemiology of male reproductive function: a field searching for tools. Rev Epidemiol Sante Publique 2004; 52:221-42. [PMID: 15356436 DOI: 10.1016/s0398-7620(04)99048-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND An increase in the frequency of disorders of the male human reproductive organs has been described over recent decades. Neither its causes nor its consequences on fecundity, the ability of the couples to produce a live child, are clearly known. This lack of knowledge may partly be due to methodological difficulties specific to reproductive epidemiology. METHODS We discuss the relevance and limits of some markers of the male aspects of human reproduction, focusing on semen parameters and fecundability, a measure of the probability of pregnancy. RESULTS Semen parameters are associated with fecundability, although they have a relatively low sensitivity to detect couples with low fecundability. The study of semen parameters proved central to describe the influence of environmental factors on the male side of reproductive function. The main limitation of semen studies is low participation rates and the possible selection biases ensuing. Fecundability can be estimated by collecting waiting time to pregnancy. Its assessment in retrospective studies often excludes the least fecund, those couples remaining childless, which entails a bias and a decrease in statistical power. The prospective approach and an approach relying on the enrollment of a cross-sectional sample of the couples currently trying to obtain a pregnancy (current duration approach) do not have these limitations. Although it has never been used, the assessment of fecundability using the current duration approach is promising both for aetiologic research and monitoring. CONCLUSION Most of the potential markers of male reproductive function are not assessed in the general population of France, with the exception of the incidence rate of testis cancer, which is currently increasing. We present some alternatives for a monitoring system of reproductive function.
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Affiliation(s)
- R Slama
- Unité 569 Epidémiologie, Démographie et Sciences Sociales, INSERM, et INED, IFR69, 82, rue du Général-Leclerc, 94276 Le Kremlin-Bicêtre Cedex.
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23
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Joffe M, Bisanti L, Apostoli P, Kiss P, Dale A, Roeleveld N, Lindbohm ML, Sallmén M, Vanhoorne M, Bonde JP. Time To Pregnancy and occupational lead exposure. Occup Environ Med 2003. [PMID: 14504363 DOI: 10.1136/oem.60.10.752] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Lead exposure is known to be harmful to the male reproductive system, including impairment of fertility. However, it is unclear whether currently existing low levels of exposure have this effect. AIMS To study retrospectively current workers in lead using industries (battery manufacture, smelting, etc), and in non-lead using control industries, in four European countries, with Time To Pregnancy as the outcome variable, as part of the EU funded Asclepios Project. METHODS Exposure assessment was mainly by blood lead values, which were available from the late 1970s, supplemented by imputed values where necessary. Three exposure models were studied: (1) short term (recent) exposure; (2) total duration of work in a lead using industry; and (3) cumulative exposure. A Cox proportional hazards model with discrete ties was used for the statistical analysis, with covariates for both partners. RESULTS A total of 1104 subjects took part, of whom 638 were occupationally exposed to lead at the relevant time. Blood lead levels were mainly less than 50 microg/dl. No consistent association of Time To Pregnancy with lead exposure was found in any of the exposure models, although reduced fertility was observed in one category each in models (2) and (3). CONCLUSIONS This basically negative result is unlikely to be due to the misclassification of key variables, to insufficient statistical power, or to bias, for example, response bias. If any impairment of male reproductive function exists at the levels of occupational lead exposure now current, it does not appear to reduce biological fertility.
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Affiliation(s)
- M Joffe
- Imperial College Faculty of Medicine, Department of Epidemiology & Public Health, St Mary's Campus, Norfolk Place, London W2 1PG, UK.
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24
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Benoff S, Hurley IR, Millan C, Napolitano B, Centola GM. Seminal lead concentrations negatively affect outcomes of artificial insemination. Fertil Steril 2003; 80:517-25. [PMID: 12969691 DOI: 10.1016/s0015-0282(03)00981-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the relationships among seminal lead levels, acrosome status, and artificial insemination cycle fecundity (AI f) in semen donors. DESIGN Longitudinal analysis of seminal lead levels, sperm function testing, and fecundity. SETTING University medical center andrology and research laboratories. PATIENT(S) Semen donors (n = 15) participating in a therapeutic donor insemination program. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Seminal plasma lead levels, acrosome sensitivity to progesterone (P) and voltage-gated potassium channel inhibitors (e.g., charybdotoxin [CBTx]), and AI f. RESULT(S) Seminal plasma lead levels and AI f were strongly negatively correlated. Semen donors were divided into three groups by acrosome response to P: normal (CBTx sensitive [Rs] or CBTx resistant [Rr]: responders) and reduced (nonresponders [NR]) (Rs > Rr >> NR). Seminal lead differed among the three groups (NR > Rr > Rs). Comparison of 330 artificial insemination cycles from four Rs, four Rr, and two NR demonstrated that cycle AI f also differed significantly between groups (Rs >Rr >>NR). CONCLUSION(S) Measurements of seminal plasma lead, P-stimulated acrosome loss, and sensitivity to CBTx may provide prognostic information on the fertility status of potential donors as well as male infertility patients. Such evaluations may assist in donor acceptance, or in the case of patients, in selection of the appropriate treatment regimen.
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Affiliation(s)
- Susan Benoff
- Fertility Research Laboratories, North Shore-Long Island Jewish Research Institute, and Department of Obstetrics and Gynecology, North Shore University Hospital-New York University School of Medicine, Manhasset, New York, USA. sbenhoff@nshs,edu
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25
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Abstract
This review aims to give an overview of some of the biomarkers that have been used for the monitoring of human exposure to xenobiotics as well as to provide a summary of some of the recent epidemiological studies on male reproductive health of exposure to environmental and occupational toxicants. Possible molecular mechanisms on seminal quality change are also suggested. Studies using various biomarkers have no doubt enabled us to better characterize the effect of environmental pollutants on the male reproductive system. However, the sensitivity and specificity of these biomarkers have not been comprehensively validated. Furthermore, many epidemiological findings are difficult to replicate owing to the inherited methodological problems of male reproductive health investigations, such as the small number of study subjects, low compliance rate, substantial intra-individual variability in semen parameters, measurement techniques and misclassifications based on single assay. Oxidative damage, in particular DNA-damage caused by free radicals, generated either by xenobiotics, or endogenously, is now thought to be a key molecular mechanism associated with semen quality and sperm function. Laboratory studies and epidemiological findings have suggested that the male reproductive system is susceptible to reactive oxygen species (ROS). On the other hand, there is so far no single all-encompassing biomarker of reproductive capacity in men. A panel of biomarkers with specific goals should be considered. Collaborative multidisciplinary studies are also needed to overcome some of the issues mentioned here.
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Affiliation(s)
- Choon-Nam Ong
- Centre for Environmental and Occupational Health, Department of Community, Occupational and Family Medicine, National University of Singapore, 16, Medical Drive, 117597 Singapore, Singapore.
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26
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Hales BF, Robaire B. Paternal exposure to drugs and environmental chemicals: effects on progeny outcome. JOURNAL OF ANDROLOGY 2001; 22:927-36. [PMID: 11700855 DOI: 10.1002/j.1939-4640.2001.tb03431.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- B F Hales
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada.
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28
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Abstract
BACKGROUND Reports from a period spanning more than a century, and covering occupationally exposed women in several countries, support an increase in pregnancy loss from high maternal lead exposures. Nevertheless, most studies conducted among populations with low/moderate exposures have provided little evidence of an association with pregnancy loss, or in particular, spontaneous abortions. METHODS A critique of these low/moderate level studies reveals small sample sizes, problems in definition or ascertainment of outcome, lack of control for confounding, and/or deficiencies in the exposure assessment. For estimating exposure, either an ecologic measure was used, or individual biologic specimens were taken but attention was not paid to the timing of measurement of lead levels in these samples. A prospective study that overcame most of the deficiencies of previous studies enrolled pregnant women in Mexico City with low-to-moderate-level lead exposures, collected blood specimens during their first trimester, and ascertained spontaneous abortions by week 20. A key design element of this study was the use of incidence-density-matched controls in order to achieve comparable opportunity for the outcome and comparable timing of exposure measurements. The latter is especially important because blood lead levels are altered by pregnancy. RESULTS In the prospective Mexico City Study, a striking dose-response relation between blood lead and risk of spontaneous abortion was found: the odds ratio for spontaneous abortion was 1.8 (95% confidence interval = 1.1-3.1) for every 5 microg/dL increase in blood lead. CONCLUSIONS Low-to-moderate lead exposures may increase the risk for spontaneous abortion at exposures comparable to U.S. general population levels during the 1970s and to many populations worldwide today; these are far lower than exposures encountered in some occupations. Further research is needed to confirm the association, to delineate the role of maternal vs. paternal exposures, and to assess increases in menstrual variability as an explanation for this finding.
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Affiliation(s)
- I Hertz-Picciotto
- University of North Carolina, Chapel Hill, North Carolina 27599, USA.
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29
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Abstract
To assess whether paternal exposure to lead is associated with infertility, we performed a register-based study among married men biologically monitored for exposure to inorganic lead. We obtained information about the marriages and the wives of the men from the Finnish Central Population Register. Data on pregnancies were obtained from medical records. Paternal exposure to lead was assessed on the basis of blood lead measurements. We estimated the risk of infertility, defined as nonoccurrence of a marital pregnancy, by applying binomial regression. For the blood lead categories of 0.5-0.9, 1.0-1.4, 1.5-1.9, 2.0-2.4, and > or =2.5 micromol/L the relative risk of infertility, compared with the risk in the lowest exposure category (<0.5 micromol/L), was 1.27 (95% confidence interval 1.08-1.51), 1.35 (1.12-1.63), 1.37 (1.08-1.72), 1.50 (1.08-2.02), and 1.90 (1.30-2.59), respectively. The findings support the hypothesis that paternal exposure to lead increases the risk of infertility at low occupational exposure levels. We applied proportional hazards regression to the analysis of pregnancy delay. A delay was observed among the wives of men exposed to lead. Exposure to lead was not clearly associated with delayed pregnancy, however, when the analysis was restricted to couples with at least one pregnancy. This finding suggests that the restriction of the study on time to pregnancy to fertile couples may introduce a bias toward no association.
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Affiliation(s)
- M Sallmén
- Finnish Institute of Occupational Health, Department of Epidemiology and Biostatistics, Helsinki
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30
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