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Marín-Martínez FM, Arense-Gonzalo JJ, Artes MA, Bobadilla Romero ER, García Porcel VJ, Alcon Cerro P, Suárez-Pineda MC, Guzmán Martínez-Valls PL, Mendiola J. Anogenital distance, a biomarker of fetal androgen exposure and the risk of prostate cancer: A case-control study. Urologia 2023; 90:715-719. [PMID: 37606191 DOI: 10.1177/03915603231192736] [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] [Indexed: 08/23/2023]
Abstract
OBJECTIVE Evaluate the association between AGD and the risk of PCa. METHODS Incident case-control study, conducted on 153 patients. All patients underwent prostate biopsy for abnormal digital rectal exam and/or prostate antigen elevation. Two variants of AGD [anus to scrotum base (AGDas) and anus to dorsal insertion of penis (AGDap) were measured. Student's t-test was used to analyze continuous variables and chi-square for discrete variables. Differences in AGD (raw and adjusted) measures between cases and controls were assessed using the ANCOVA test. RESULTS There is significant association between the diagnose of PCa and both AGD, patients diagnosed with PCa had both AGD measures shortened, in the crude and the full adjusted models. CONCLUSIONS This research suggests that the same gestational environmental exposures, could represent a weak androgen signaling and may also have an increased risk of prostate cancer.
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Affiliation(s)
| | - Julian J Arense-Gonzalo
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, Faculty of Medicine of the University of Murcia, Murcia, Spain
- Biomedical Research Institute of Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Miriam Artes Artes
- Urology Department, General Hospital Santa Lucía of Cartagena, Cartagena, Spain
| | | | | | | | | | | | - Jaime Mendiola
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, Faculty of Medicine of the University of Murcia, Murcia, Spain
- Biomedical Research Institute of Murcia, IMIB-Arrixaca, Murcia, Spain
- Biomedical Research Consortium in Epidemiology and Public Health (CIBER Epidemiology and Public Health, CIBERESP), Carlos III Health Institute, Madrid, Spain
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Taşkınlar H, Elvan Ö, İsbir C, Kıllı İ, Naycı A. Anogenital distance and anal position index in cadaveric human fetuses. Anat Sci Int 2023; 98:155-163. [PMID: 36018443 DOI: 10.1007/s12565-022-00680-9] [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: 02/02/2022] [Accepted: 08/16/2022] [Indexed: 02/07/2023]
Abstract
The aim of this study is to contribute to the determination of the normal values of human anogenital distance (AGD) and anal position index (API) in the antenatal period. 59 formalin-fixed human fetuses were examined. AGD was measured by the distance between the center of the anus and the posterior fourchette in females, and the distance between the center of the anus and the posterior scrotal raphe in males. API in female fetuses was determined with the formula API = fourchette-center of anus/fourchette-coccyx formula, and API = posterior scrotal raphe-center of anus/posterior scrotal raphe-coccyx in males. The mean AGDs of the female and male fetuses in the second trimester were 5.60 ± 1.60 mm and 9.64 ± 2.75 mm and 12.88 ± 4.14 mm and 17.26 ± 5.55 mm in the third trimester, respectively. The AGD values were found to be significantly higher in the males (p = 0.002). While the API values detected in the female and male fetuses were 0.43 ± 0.085 and 0.55 ± 0.072 in the second trimester, they were 0.46 ± 0.079 and 0.55 ± 0.058 in the third trimester. The API values were found to be significantly higher in the male fetuses (p < 0.001). When the distribution of API values of the fetuses in the second and third trimesters was examined, no significant difference was found (p = 0.499). In addition, no significant correlation was found between API and AGD values and percentile groups of fetuses (p ˃ 0.05). The AGD and API differed significantly between female and male fetuses starting from the antenatal second trimester, and the difference was preserved independently of the fetal percentile in the later stages of pregnancy.
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Affiliation(s)
- Hakan Taşkınlar
- School of Medicine, Department of Pediatric Surgery, Çiftlikköy Campus, Mersin University, 33116, Yenişehir, Mersin, Turkey.
| | - Özlem Elvan
- School of Health, Department of Anatomy, Mersin University, Çiftlikköy Campus, 33116, Yenişehir, Mersin, Turkey
| | - Caner İsbir
- School of Medicine, Department of Pediatric Surgery, Çiftlikköy Campus, Mersin University, 33116, Yenişehir, Mersin, Turkey
| | - İsa Kıllı
- School of Medicine, Department of Pediatric Surgery, Çiftlikköy Campus, Mersin University, 33116, Yenişehir, Mersin, Turkey
| | - Ali Naycı
- School of Medicine, Department of Pediatric Surgery, Çiftlikköy Campus, Mersin University, 33116, Yenişehir, Mersin, Turkey
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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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Androgens and the masculinization programming window: human-rodent differences. Biochem Soc Trans 2021; 48:1725-1735. [PMID: 32779695 PMCID: PMC7458408 DOI: 10.1042/bst20200200] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 01/08/2023]
Abstract
Human male reproductive disorders are common and may have a fetal origin - the testicular dysgenesis syndrome (TDS) hypothesis. In rats, experimentally induced TDS disorders result from disruption of fetal androgen production/action specifically in the masculinization programming window (MPW). MPW androgen action also programs longer anogenital distance (AGD) in male versus female rats; shorter male AGD is correlated with risk and severity of induced TDS disorders. AGD thus provides a lifelong, calibrated readout of MPW androgen exposure and predicts likelihood of reproductive dysfunction. Pregnant rat exposure to environmental chemicals, notably certain phthalates (e.g. diethyl hexl phthalate, DEHP; dibutyl phthalate, DBP), pesticides or paracetamol, can reduce fetal testis testosterone and AGD and induce TDS disorders, provided exposure includes the MPW. In humans, AGD is longer in males than females and the presumptive MPW is 8-14 weeks' gestation. Some, but not all, epidemiological studies of maternal DEHP (or pesticides) exposure reported shorter AGD in sons, but this occurred at DEHP exposure levels several thousand-fold lower than are effective in rats. In fetal human testis culture/xenografts, DEHP/DBP do not reduce testosterone production, whereas therapeutic paracetamol exposure does. In humans, androgen production in the MPW is controlled differently (human chorionic gonadotrophin-driven) than in rats (paracrine controlled), and other organs (placenta, liver, adrenals) contribute to MPW androgens, essential for normal masculinization, via the 'backdoor pathway'. Consequently, early placental dysfunction, which is affected by maternal lifestyle and diet, and maternal painkiller use, may be more important than environmental chemical exposures in the origin of TDS in humans.
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Pedersen MRV, Osther PJ, Rafaelsen SR. Shorter anogenital distance is observed in patients with testicular microlithiasis using magnetic resonance imaging. Insights Imaging 2021; 12:46. [PMID: 33846876 PMCID: PMC8042061 DOI: 10.1186/s13244-021-00989-5] [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: 01/29/2021] [Accepted: 03/19/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To investigate the anogenital distance in patients with and without testicular microlithiasis (TML). METHODS A total of 101 patients underwent a conventional standard clinical B-mode scrotal ultrasonography and scrotal MRI. The patients were divided into two groups: patients with TML and non-TML. The latter served as control group. The anogenital distance was measured by a straight line from center of the anus to the posterior base of scrotum using MRI. RESULTS In the TML group, mean AGD was 5.4 (± 1.07) cm (range 29-79 mm), and in non-TML 5.9 (± 1.03) cm (range 35-85 mm) (p = 0.04). CONCLUSION MRI is a useful tool to measure the AGD. It is easy to perform without any discomfort to patients. We found AGD to be lower in patients with TML.
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Affiliation(s)
- Malene Roland Vils Pedersen
- Department of Radiology, Vejle Hospital, University of Southern Denmark, Beriderbakken 4, Vejle, Denmark. .,Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, Odense, Denmark.
| | - Palle Jørn Osther
- Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, Odense, Denmark.,Urological Research Center, Department of Urology, Vejle Hospital, University of Southern Denmark, Beriderbakken 4, Vejle, Denmark
| | - Søren Rafael Rafaelsen
- Department of Radiology, Vejle Hospital, University of Southern Denmark, Beriderbakken 4, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, Odense, Denmark
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Dural O, Kurbanova T, Yasa C, Ugurlucan FG, Selvi E, Ozdemir PK, Akhan SE. Idiopathic primary ovarian insufficiency is associated with anogenital distance, a marker for prenatal environment. Eur J Obstet Gynecol Reprod Biol 2021; 258:304-308. [PMID: 33498004 DOI: 10.1016/j.ejogrb.2021.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 01/04/2021] [Accepted: 01/10/2021] [Indexed: 12/09/2022]
Abstract
OBJECTIVE In a significant number of women diagnosed with primary ovarian insufficiency (POI), the underlying cause cannot be found. On the other hand, the ovarian reserve set prenatally has been shown to be affected by intrauterine nutrition, environmental and hormonal factors. We aimed to evaluate the relationship between anogenital distance (AGD), which is considered as a biomarker for prenatal hormonal environment, and idiopathic POI in adolescents and young women. STUDY DESIGN This case control study was conducted between September 2018 and December 2019. The study group consisted of patients between the ages of 15-30, who developed POI following menarche without any identified genetic or iatrogenic cause. Controls were patients of the same age range who were having regular menstrual periods and were not diagnosed with polycystic ovary syndrome or endometriosis. Patients were excluded from the study if they were pregnant, had vaginal delivery or genital surgery. Distance between the anterior clitoral surface and the upper verge of the anus (AGDAC), and between the posterior fourchette and the upper verge of the anus (AGDAF) were measured in all subjects. RESULTS In total, 37 POI patients and 44 controls were included in the study. Two groups were similar for demographic parameters such as age and body mass index (BMI). Shorter AGDAC and AGDAF measurements were found to be associated with idiopathic POI. CONCLUSION Our results provide the first evidence of a strong association between shorter AGD measurements and the presence of idiopathic POI suggesting that prenatal environment may have role in the development of POI.
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Affiliation(s)
- Ozlem Dural
- Istanbul University Faculty of Medicine, Department of Obstetrics and Gynecology, Fatih, 34390, Istanbul, Turkey.
| | - Turkane Kurbanova
- Istanbul University Faculty of Medicine, Department of Obstetrics and Gynecology, Fatih, 34390, Istanbul, Turkey
| | - Cenk Yasa
- Istanbul University Faculty of Medicine, Department of Obstetrics and Gynecology, Fatih, 34390, Istanbul, Turkey
| | - Funda Gungor Ugurlucan
- Istanbul University Faculty of Medicine, Department of Obstetrics and Gynecology, Fatih, 34390, Istanbul, Turkey
| | - Esra Selvi
- Istanbul University Faculty of Medicine, Department of Obstetrics and Gynecology, Fatih, 34390, Istanbul, Turkey
| | - Pelin Kundakci Ozdemir
- Istanbul University Faculty of Medicine, Department of Obstetrics and Gynecology, Fatih, 34390, Istanbul, Turkey
| | - Suleyman Engin Akhan
- Istanbul University Faculty of Medicine, Department of Obstetrics and Gynecology, Fatih, 34390, Istanbul, Turkey
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Slade AD, Christiansen AR, Keihani S, Brant WO, Hotaling JM. Stretched penile length and its associations with testosterone and infertility. Transl Androl Urol 2021; 10:49-55. [PMID: 33532295 PMCID: PMC7844491 DOI: 10.21037/tau-20-788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Male infertility can be associated with secondary sexual characteristics, hypogonadism, and several findings in the examination of external genitalia. We sought to identify if stretched penile length (SPL) is associated with infertility or baseline testosterone. Methods We performed a retrospective review of all males age 18–59 presenting to a Men’s health clinic from 2014 to 2017. SPL of patients with infertility were compared to patients with any other complaint. Patients with Peyronie’s disease, prior penile surgery, prostatectomy, on testosterone replacement, clomiphene or β-hCG were excluded from our study. Baseline characteristics were compared between the two groups (infertile vs. other). Linear regression was used to assess the association between infertility and testosterone with SPL after adjusting for patient age, BMI, and race. Scatterplot was used for correlation between testosterone and SPL. Results Six hundred and sixty-four men were included in our study (161 infertile, 503 other). The unadjusted mean SPL in the infertile group was 12.3 cm compared to 13.4 cm in the other group (P<0.001). The significance remained when adjusted for age, BMI, testosterone and race (12.4 vs. 13.3, P<0.001). Mean total testosterone in the infertile group was not significantly different than the other group (414 vs. 422, P=0.68). Infertile men were younger than the other group (33.2 vs. 42.1 years, P<0.001). BMI did not significantly differ (28.9 vs. 28.9 kg/m2, P=0.57). There was a weak positive correlation between testosterone and penile size in both the infertile group (r=0.20, P=0.01) and the other group (r=0.24, P<0.001). Conclusions Though SPL differed amongst our groups, adult testosterone levels did not. If developmental levels of testosterone exposure accounted for some of the differences in SPL between our two groups, these variations did not persist into adulthood. It remains unknown if reduced length is a result of genetic or congenital factors associated with infertility. Further investigation is needed to better understand the association of shorter SPL with male infertility.
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Affiliation(s)
- Austen D Slade
- Department of Surgery, Division of Urology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Andrew R Christiansen
- Department of Surgery, Division of Urology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sorena Keihani
- Department of Surgery, Division of Urology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - William O Brant
- Department of Surgery, Division of Urology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - James M Hotaling
- Department of Surgery, Division of Urology, University of Utah School of Medicine, Salt Lake City, UT, USA
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Sanches ESAM, Tsuzuki F, Joinhas F, Figueiras GB, Moreira EG, Salles MJS. Paternal exposure to bupropion affects postnatal development in the offspring. Reprod Fertil Dev 2020; 31:1539-1544. [PMID: 31270008 DOI: 10.1071/rd18403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 05/02/2019] [Indexed: 01/06/2023] Open
Abstract
The aim of this study was to evaluate whether paternal exposure to bupropion hydrochloride (BUP), an inhibitor of dopamine and noradrenaline reuptake, would affect the postnatal development of offspring. Male mice were divided into a BUP-treated (40mgkg-1day-1 by gavage, 45 days) or control (saline by gavage, 45 days) group (n=20 in each group). From Day 35 to Day 45 of treatment, males were allowed to mate with drug-naïve female mice. Postnatal development of the offspring (both sexes) was evaluated from Postnatal day (PND) 1 to PND60. Physical development parameters (weight gain, body length, incisor eruption, pinna detachment), anogenital distance, vaginal opening, reflexes (palmar grasp, surface righting, negative geotaxis and adult gait) and some behavioural parameters (locomotor activity and anxiety-like behaviour) were altered in the offspring of BUP-treated males. The results demonstrate that paternal exposure to BUP induces long-lasting changes in the postnatal development of the offspring.
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Affiliation(s)
- E S A M Sanches
- Department of Biology, Universidade Estadual de Londrina, PR 445Km 380, 86057-970, Londrina, Parana, Brazil; and Department of General Pathology, Universidade Estadual de Londrina, PR 445Km 380, 86057-970, Londrina, Parana, Brazil
| | - F Tsuzuki
- Department of Biology, Universidade Estadual de Londrina, PR 445Km 380, 86057-970, Londrina, Parana, Brazil
| | - F Joinhas
- Department of Biology, Universidade Estadual de Londrina, PR 445Km 380, 86057-970, Londrina, Parana, Brazil
| | - G B Figueiras
- Department of General Psychology and Behavioral Analysis, Universidade Estadual de Londrina, PR 445Km 380, 86057-970, Londrina, Parana, Brazil
| | - E G Moreira
- Department of Physiological Sciences, Universidade Estadual de Londrina, PR 445Km 380, 86057-970, Londrina, Parana, Brazil
| | - M J S Salles
- Department of Biology, Universidade Estadual de Londrina, PR 445Km 380, 86057-970, Londrina, Parana, Brazil; and Corresponding author.
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Sánchez-Ferrer ML, Arense-Gonzalo JJ, Prieto-Sánchez MT, Alfosea-Marhuenda E, Gómez-Carrascosa I, Iniesta MA, Mendiola J, Torres-Cantero AM. Does the anogenital distance change across pregnancy? Reprod Biomed Online 2020; 41:527-533. [PMID: 32586732 DOI: 10.1016/j.rbmo.2020.05.009] [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: 01/17/2020] [Revised: 04/28/2020] [Accepted: 05/11/2020] [Indexed: 01/03/2023]
Abstract
RESEARCH QUESTION Does the length of the anogenital distance (AGD), an anthropometric biomarker of fetal androgen exposure, change across pregnancy? It has been suggested that AGD remains stable during adulthood with no changes across the menstrual cycle. No studies, however, have been carried out during pregnancy, during which women are exposed to important hormonal and anthropometric variations. DESIGN A cohort study of 186 singleton pregnant women recruited in the first trimester of pregnancy. Measurements from the anterior clitoral surface to the upper verge of the anus (AGDAC), and from the posterior fourchette to the upper verge of the anus (AGDAF) and body mass index (BMI) were obtained in each trimester. Generalized linear model for repeated measures was carried out to assess differences in AGDs and BMI across the three trimesters of the pregnancy. RESULTS In crude analyses, AGDAC was progressively and significantly longer as the pregnancy developed (first trimester: 87.69 ± 13.14mm; second trimester: 89.69 ± 13.47mm; third trimester: 91.95 ± 13.25 mm; P < 0.001), whereas AGDAF did not significantly change throughout pregnancy (first trimester: 28.37 ± 6.94 mm; second trimester: 28.09 ± 7.66 mm; third trimester: 28.94 ± 6.7 mm). In the multivariable mixed-effect models for fixed effect (trimester) and time-covariate (BMI), AGDs did not show significant associations with trimesters of pregnancy when BMI was included in the model. CONCLUSIONS Our results suggest that AGDAF and AGDAC, when adjusted by BMI, do not change throughout gestation despite maternal anthropometric variations during pregnancy. AGDAF may be a meaningful measurement at any time during pregnancy without considering BMI. Therefore, maternal AGDAF may be used as a prenatal biomarker of the mother's in-uteru hormonal exposure even during pregnancy.
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Affiliation(s)
- María L Sánchez-Ferrer
- Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain; Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar Mucia 30120, Spain
| | - Julian J Arense-Gonzalo
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar Mucia 30120, Spain; Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, Espinardo Murcia 30100, Spain
| | - María T Prieto-Sánchez
- Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain; Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar Mucia 30120, Spain.
| | - Emilia Alfosea-Marhuenda
- Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain
| | - Inmaculada Gómez-Carrascosa
- Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain
| | - Miguel A Iniesta
- Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, El Palmar Murcia 30120, Spain
| | - Jaime Mendiola
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar Mucia 30120, Spain; Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, Espinardo Murcia 30100, Spain
| | - Alberto M Torres-Cantero
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar Mucia 30120, Spain; Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, Espinardo Murcia 30100, Spain; Department of Preventive Medicine, 'Virgen de la Arrixaca' University Clinical l Hospital, Murcia Murcia 30003, Spain; Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
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10
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Toprak T, Tokat E. Does anogenital distance change with age? Andrologia 2019; 51:e13431. [DOI: 10.1111/and.13431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/21/2019] [Accepted: 08/29/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Tuncay Toprak
- Department of Urology Fatih Sultan Mehmet Training and Research Hospital Istanbul Turkey
| | - Eda Tokat
- Department of Urology Hakkari State Hospital Hakkari Turkey
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11
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Najdi N, Safi F, Hashemi-Dizaji S, Sahraian G, Jand Y. First trimester determination of fetal gender by ultrasonographic measurement of anogenital distance: A cross-sectional study. Int J Reprod Biomed 2019; 17. [PMID: 31435579 PMCID: PMC6652156 DOI: 10.18502/ijrm.v17i1.3820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 05/03/2018] [Accepted: 07/28/2018] [Indexed: 12/15/2022] Open
Abstract
Background In some patients with a family history of the gender-linked disease, determination of the fetal gender in the first trimester of pregnancy is of importance. In X-linked recessive inherited diseases, only the male embryos are involved, while in some conditions, such as congenital adrenal hyperplasia, female embryos are affected; hence early determination of fetal gender is important. Objective The aim of the current study was to predict the gender of the fetus based on the accurate measurement of the fetal anogenital distance (AGD) by ultrasound in the first trimester. Materials and Methods To determine the AGD and crown-rump length in this cross-sectional study, 316 women with singleton pregnancies were exposed to ultrasonography. The results were then compared with definitive gender of the embryos after birth. Results The best cut-off for 11 wk to 11 wk, 6 days of pregnancy was 4.5 mm, for 12 wk to 12 wk, 6 days was 4.9 mm, and for 13 wk to 13 wk, 6 days was 4.8 mm. Conclusion AGD is helpful as an ultrasonographic marker that can determine fetal gender in the first trimester, especially after 12 wks.
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Affiliation(s)
- Nazila Najdi
- Department of Gynecology and Obstetrics, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Fatemeh Safi
- Department of Gynecology and Obstetrics, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Shahrzad Hashemi-Dizaji
- Department of Gynecology and Obstetrics, Shahid Akbarabadi Hospital, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ghazal Sahraian
- Department of Gynecology and Obstetrics, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Yahya Jand
- Departement of Pharmacology, School of Medicine, Tehran University of Medical Science, Tehran, Iran
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12
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Freire C, Ocón-Hernández O, Dávila-Arias C, Pérez-Lobato R, Calvente I, Ramos R, Olea N, Fernández MF. Anogenital distance and reproductive outcomes in 9- to 11-year-old boys: the INMA-Granada cohort study. Andrology 2018; 6:874-881. [PMID: 30113141 DOI: 10.1111/andr.12544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/26/2018] [Accepted: 07/24/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Studies examining the association of anogenital distance (AGD), a biomarker of prenatal androgen exposure, with sexual development in children are lacking. OBJECTIVE To assess the association between AGD measures and reproductive outcomes, including puberty onset, testicular volume, reproductive hormone levels, and urogenital malformations in boys aged 9-11 years. MATERIALS AND METHODS A cross-sectional study was conducted among children belonging to the Spanish Environment and Childhood (INMA) Project, a population-based birth cohort study. The present sample included 279 boys for whom data were available on AGD, pubertal stage, testicular volume, and relevant covariates. Out of the boys with AGD data, 187 provided a blood sample for hormone analysis. AGD was measured from the center of the anus to the base of the scrotum. Pubertal development was assessed according to Tanner stage of genital development (G1-G5), and testicular volume was measured with an orchidometer. RESULTS After adjusting for potential confounders, logistic regression analysis showed that AGD was positively associated with testicular volume but not with Tanner stage (>G1 vs. G1), serum hormone levels, or undescended testis. Regardless of their age, body mass index, and Tanner stage (G1 or >G1), boys with longer AGD showed increased odds of a testicular volume >3 mL (OR = 1.06, 95%CI = 1.00-1.19 per 10% increment in AGD; and OR = 3.14, 95%CI = 0.99-9.94 for AGD >42 mm vs. <33 mm). DISCUSSION Longer AGD was associated with testicular growth, an indicator of gonadarche, but not with other reproductive outcomes. CONCLUSIONS Although AGD was positively associated with testicular volume, it remains unclear whether AGD predicts testis size at puberty or is related to puberty onset.
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Affiliation(s)
- C Freire
- Health Research Institute of Granada (ibs.GRANADA), Granada, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Granada, Spain
| | - O Ocón-Hernández
- Health Research Institute of Granada (ibs.GRANADA), Granada, Spain.,Obstetrics and Gynecology Service, San Cecilio University Hospital, Granada, Spain
| | - C Dávila-Arias
- Radiology Unit, Health Science Technological Park University Hospital, Granada, Spain
| | - R Pérez-Lobato
- Health Research Institute of Granada (ibs.GRANADA), Granada, Spain.,Psychology Clinic ISEP, Granada, Spain
| | - I Calvente
- Health Research Institute of Granada (ibs.GRANADA), Granada, Spain
| | - R Ramos
- Health Research Institute of Granada (ibs.GRANADA), Granada, Spain
| | - N Olea
- Health Research Institute of Granada (ibs.GRANADA), Granada, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Granada, Spain.,Department of Radiology, School of Medicine, Center for Biomedical Research, University of Granada, Granada, Spain
| | - M F Fernández
- Health Research Institute of Granada (ibs.GRANADA), Granada, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Granada, Spain.,Department of Radiology, School of Medicine, Center for Biomedical Research, University of Granada, Granada, Spain
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13
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Sipahi M, Tokgöz VY, Alanya Tosun Ş. An appropriate way to predict fetal gender at first trimester: anogenital distance. J Matern Fetal Neonatal Med 2018; 32:2012-2016. [PMID: 29298531 DOI: 10.1080/14767058.2018.1424131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Using anogenital distance to determine fetal sex is a new method. There is only one study in the literature. We predict that it will pass through the literature as a new method that can be used in determining fetal sex especially in first trimester. INTRODUCTION Determination of fetal gender before birth has been a matter of curiosity for both the family and the clinician. In the presence of gender-linked genetic disease, it becomes an obligation instead of an interest. The aim of this study was to determine the fetal gender accurately at first trimester with anogenital distance (AGD) and to investigate the correlations of nuchal translucency (NT), fetal heart rate (FHR), and crown-rump length (CRL) with AGD. MATERIALS AND METHODS In this prospective cross-sectional study, AGD measurement was performed in 111 patients with singleton pregnancy from 11 to 13 weeks and 6 days (CRL 45-84 mm). Measurements of AGD ≥4.8 mm were identified for males, and AGD <4.8 mm for females. RESULTS Genders were demonstrated accurately for males as 76.7% and for females as 97.1%. The mean value of AGD was 3.6 mm for females and 5.1 mm for males. There were no relations between fetal gender and FHR and also NT. CONCLUSIONS Gender can be detected with great accuracy in gestations between 11 to 13 weeks and 6 days by using AGD. CRL and gestational week (GW) were determined as nonsignificant predictors of fetal gender by AGD measurement. In order to obtain more accurate results with AGD, consideration of further studies with larger series in different races is recommended.
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Affiliation(s)
- Mehmet Sipahi
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Giresun University , Giresun , Turkey
| | - Vehbi Yavuz Tokgöz
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Giresun University , Giresun , Turkey
| | - Şebnem Alanya Tosun
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Giresun University , Giresun , Turkey
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14
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Anogenital distance: A longitudinal evaluation of its variants and indices in boys and girls of Sonora, Mexico. Reprod Toxicol 2017; 73:167-174. [DOI: 10.1016/j.reprotox.2017.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 04/25/2017] [Accepted: 08/16/2017] [Indexed: 11/20/2022]
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15
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Wainstock T, Shoham-Vardi I, Sheiner E, Walfisch A. Fertility and anogenital distance in women. Reprod Toxicol 2017; 73:345-349. [PMID: 28743560 DOI: 10.1016/j.reprotox.2017.07.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/14/2017] [Accepted: 07/18/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Human and animal studies have found an association between prenatal androgen exposure and the anogenital distance (AGD). The aims of this study were to study the association between female AGD, reproductive health and background characteristics. METHODS This was a cross sectional study, in which AGD were measured in 300 pregnant women who were recruited early during the first stage of labor. Demographic and health characteristics were collected and studied in association with AGD measurements. RESULTS AGD presented with normal distribution (mean 40.3mm±10.7) and was positively associated with maternal age (beta=0.032, 95%CI 0.007-0.05, p=0.01) and negatively associated with infertility treatments (beta=-1.06, 95%CI -1.99 to -0.12, p=0.03). AGD was not associated with parity, ethnicity, height and other characteristics. CONCLUSIONS Adult females AGD is associated with age and fertility problems. Adult female AGD, used as a marker of early life exposure to EDCs, is possibly associated with reproductive characteristics.
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Affiliation(s)
- Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, POB 653, Beer-Sheva, Israel.
| | - Ilana Shoham-Vardi
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, POB 653, Beer-Sheva, Israel.
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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16
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Wu Y, Zhong G, Chen S, Zheng C, Liao D, Xie M. Polycystic ovary syndrome is associated with anogenital distance, a marker of prenatal androgen exposure. Hum Reprod 2017; 32:937-943. [DOI: 10.1093/humrep/dex042] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 02/25/2017] [Indexed: 12/31/2022] Open
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17
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Thankamony A, Pasterski V, Ong KK, Acerini CL, Hughes IA. Anogenital distance as a marker of androgen exposure in humans. Andrology 2016; 4:616-25. [PMID: 26846869 PMCID: PMC6225986 DOI: 10.1111/andr.12156] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/06/2015] [Accepted: 12/09/2015] [Indexed: 12/20/2022]
Abstract
Abnormal foetal testis development has been proposed to underlie common disorders of the male reproductive system such as cryptorchidism, hypospadias, reduced semen quality and testicular germ cell tumour, which are regarded as components of a 'testicular dysgenesis syndrome'. The increasing trends and geographical variation in their incidence have been suggested to result from in utero exposure to environmental chemicals acting as endocrine disruptors. In rodents, the anogenital distance (AGD), measured from the anus to the base of genital tubercle, is a sensitive biomarker of androgen exposure during a critical embryonic window of testis development. In humans, several epidemiological studies have shown alterations in AGD associated with prenatal exposure to several chemicals with potential endocrine disrupting activity. However, the link between AGD and androgen exposure in humans is not well-defined. This review focuses on the current evidence for such a relationship. As in rodents, a clear gender difference is detected during foetal development of the AGD in humans which is maintained thereafter. Reduced AGD in association with clinically relevant outcomes of potential environmental exposures, such as cryptorchidism or hypospadias, is in keeping with AGD as a marker of foetal testicular function. Furthermore, AGD may reflect variations in prenatal androgen exposure in healthy children as shorter AGD at birth is associated with reduced masculine play behaviour in preschool boys. Several studies provide evidence linking shorter AGD with lower fertility, semen quality and testosterone levels in selected groups of adults attending andrology clinics. Overall, the observational data in humans are consistent with experimental studies in animals and support the use of AGD as a biomarker of foetal androgen exposure. Future studies evaluating AGD in relation to reproductive hormones in both infants and adults, and to gene polymorphisms, will help to further delineate the effect of prenatal and postnatal androgen exposures on AGD.
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Affiliation(s)
- Ajay Thankamony
- Department of Paediatrics, Addenbrooke’s Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Vickie Pasterski
- Department of Paediatrics, Addenbrooke’s Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
- Department of Psychology, University of Cambridge, Cambridge, CB2 3RQ, UK
| | - Ken K Ong
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Carlo L Acerini
- Department of Paediatrics, Addenbrooke’s Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Ieuan A Hughes
- Department of Paediatrics, Addenbrooke’s Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
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18
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Arfi A, Cohen J, Canlorbe G, Bendifallah S, Thomassin-Naggara I, Darai E, Benachi A, Arfi JS. First-trimester determination of fetal gender by ultrasound: measurement of the ano-genital distance. Eur J Obstet Gynecol Reprod Biol 2016; 203:177-81. [PMID: 27323318 DOI: 10.1016/j.ejogrb.2016.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Early ultrasound fetal sex determination is of obvious interest, particularly in the context of X-linked diseases. In the human, the anogenital distance, i.e., the distance between the caudal end and the base of the genital tubercule is sexually dimorphic. This difference is apparent from 11 weeks of gestation. The aim of this prospective study was to evaluate the accuracy of anogenital distance measurement during the first trimester ultrasound in the early determination of fetal gender. MATERIALS AND METHODS Fetal gender was assessed by ultrasound in 310 singleton pregnancies at 11-14 weeks of gestation. The optimal cut-off was determined by the minimal p-value technic and validated using bootstrap simulation. RESULTS 310 women were included. A cut-off of 4.8mm was determined to predict male (≥4.8mm) or female (<4.8mm) fetuses. Sex was correctly determined for 87% of the males and 89% of the females. The inter-observer variability was excellent. CONCLUSION This study presents a new sonographic sign for early fetal sex determination that has not been previously explored. It appears to be an accurate tool but it requires further validation in larger series.
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Affiliation(s)
- A Arfi
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie Paris 6, GRC 6-UPMC Centre Expert en Endométriose (C3E), France.
| | - J Cohen
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie Paris 6, GRC 6-UPMC Centre Expert en Endométriose (C3E), France
| | - G Canlorbe
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie Paris 6, GRC 6-UPMC Centre Expert en Endométriose (C3E), France
| | - S Bendifallah
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie Paris 6, GRC 6-UPMC Centre Expert en Endométriose (C3E), France; ISERM UMRS 707, « Epidemiology, Information systems, Modeling », University Pierre and Marie Curie, Paris, France
| | - I Thomassin-Naggara
- Department of Radiology, Tenon Hospital, AP-HP, Paris, France; GRC6-UPMC: Centre expert en Endométriose (C3E), Paris, France; UMR_S938 Université Pierre et Marie Curie Paris 6, Paris, France
| | - E Darai
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie Paris 6, GRC 6-UPMC Centre Expert en Endométriose (C3E), France
| | - A Benachi
- Department of Obstetrics, Gynecology and Reproductive Medicine and Centre Maladies Rares, Hernie de Coupole Diaphragmatique, Hôpital Antoine Béclère, APHP, Université Paris Sud, Clamart, France
| | - J S Arfi
- Department of Obstetrics and gynecology, Hôpital Armand Trousseau, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie Paris 6, France
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Zhou N, Sun L, Yang H, Chen Q, Wang X, Yang H, Tan L, Chen H, Zhang G, Ling X, Huang L, Zou P, Peng K, Liu T, Liu J, Ao L, Zhou Z, Cui Z, Cao J. Anogenital distance is associated with serum reproductive hormones, but not with semen quality in young men. Hum Reprod 2016; 31:958-67. [PMID: 27052617 DOI: 10.1093/humrep/dew052] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/26/2016] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Is anogenital distance associated with semen parameters and serum reproductive hormone levels in males? SUMMARY ANSWER Anogenital distance is associated with serum reproductive hormones, but not with semen quality. WHAT IS KNOWN ALREADY Epidemiological studies have suggested that anogenital distance (AGD) may be associated with testicular dysfunction in adult men. However, the role of AGD in estimating male reproductive function remains unclear. STUDY DESIGN, SIZE, DURATION We examined the associations between AGD and semen parameters and reproductive hormones levels in 656 young college students in a Male Reproductive Health in Chongqing College Students (MARHCSs) cohort study in June of 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS In this study, two variants of AGD (AGDAP and AGDAS) were measured in 656 university students. Serum levels of testosterone (T), estradiol (E2), progesterone (P), prolactin (PRL), luteinizing hormone (LH), follicle-stimulating hormone (FSH), sex hormone-binding globulin (SHBG) and inhibin-B; and semen quality outcomes, including semen volume, sperm concentration, total sperm number, sperm progressive motility, total motility and morphology, were assessed. The associations between AGD and semen parameters/reproductive hormones levels were analyzed using multiple regression analysis. MAIN RESULTS AND THE ROLE OF CHANCE Both AGDAS and AGDAP were not associated with any semen parameters. In the non-parametric correlation analysis, AGDAP were correlated with sperm progressive motility and reproductive hormones of E2, testosterone, SHBG and the testosterone/LH ratio. However, body mass index (BMI) also significantly correlated with serum testosterone ( ITALIC! r = -0.216, ITALIC! P = <0.0001) and SHBG ( ITALIC! r = -0.229, ITALIC! P = <0.001). In the multiple regression models, AGDAP was negatively associated with the serum E2 level (95% CI, -0.198 to -0.043; ITALIC! P = 0.002) and positively associated with the ratio of T/E2 (95% CI, 0.004-0.011; ITALIC! P = 0.001) after an adjustment for BMI and other confounders. LIMITATIONS, REASONS FOR CAUTION Using only a single semen sample to predict male reproductive function over a longer period is a potential limitation of the present study. The other limitation is the cross-sectional nature of the study design. Longitudinal data from an extended follow-up on a large cohort would be more definitive. WIDER IMPLICATIONS OF THE FINDINGS Our results do not support previous studies where AGD is associated with male semen quality. The utility of AGD in predicting reproductive outcomes in adult males should thus be considered prudently. STUDY FUNDING/COMPETING INTERESTS This study was supported by the Key Program of Natural Science Funding of China (no. 81130051), Young Scientist Program of NSFC (no. 81502788) and the National Scientific and Technological Support Program of China (no. 2013BAI12B02). None of authors had any competing interests to declare.
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Affiliation(s)
- Niya Zhou
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing, PR China
| | - Lei Sun
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing, PR China
| | - Huan Yang
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing, PR China
| | - Qing Chen
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing, PR China
| | - Xiaogang Wang
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing, PR China
| | - Hao Yang
- Chongqing Institute of Science and Technology for Population and Family Planning, Chongqing, PR China
| | - Lu Tan
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing, PR China
| | - Hongqiang Chen
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing, PR China
| | - Guowei Zhang
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing, PR China
| | - Xi Ling
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing, PR China
| | - Linping Huang
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing, PR China
| | - Peng Zou
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing, PR China
| | - Kaige Peng
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing, PR China
| | - Taixiu Liu
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing, PR China
| | - Jinyi Liu
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing, PR China
| | - Lin Ao
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing, PR China
| | - Ziyuan Zhou
- Department of Environmental Health, College of Preventive Medicine, Third Military Medical University, Chongqing, PR China
| | - Zhihong Cui
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing, PR China
| | - Jia Cao
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing, PR China
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Anogenital distance as a measure of human male fertility. J Assist Reprod Genet 2014; 32:479-84. [PMID: 25533333 DOI: 10.1007/s10815-014-0410-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 12/11/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE In humans, recent studies have correlated anogenital distance (AGD) in adult men to testicular function. While studies of a group of men suggest an association, the utility of AGD in an infertility evaluation remains uncertain. We sought to determine the utility of AGD to predict male fertility. METHODS Between 2010 and 2011, men were recruited at a urology clinic to participate. AGD was measured using digital calipers in men being evaluated at a urology clinic. ANOVA and ROC analyses were used to determine correlations between AGD, fatherhood status, and semen parameters. RESULTS In all, 473 men were included in the analysis with a mean age of 43 ± 13 years. Anogenital distance was significantly longer in men with higher sperm concentration, total sperm count, and total motile sperm count. In order to evaluate the discriminating ability of AGD, ROC curves were created comparing AGD and total testis volume. The area under the curve (AUC) was significantly larger for total testis volume compared to AGD when evaluating fertility (0.71 vs 0.63, p = 0.02). Similarly, there was a trend towards a higher AUC for testis volume compared to AGD for sperm concentration and total sperm count. Stratification of men with long/short AGD and large/small testes also did not improve the predictive value of AGD. CONCLUSIONS While AGD is associated with sperm production on a population level, at the individual level the distinction based AGD alone cannot accurately estimate the efficiency of spermatogenesis.
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Gilboa Y, Kivilevitch Z, Oren M, Cohen YP, Katorza E, Achiron R. Anogenital distance in male and female fetuses at 20 to 35 weeks of gestation: centile charts and reference ranges. Prenat Diagn 2014; 34:946-51. [DOI: 10.1002/pd.4399] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/21/2014] [Accepted: 04/27/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Yinon Gilboa
- Department of Obstetrics and Gynecology; Sheba Medical Center; Ramat Gan Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Zvi Kivilevitch
- Department of Obstetrics and Gynecology; Sheba Medical Center; Ramat Gan Israel
| | - Meri Oren
- Department of Obstetrics and Gynecology; Sheba Medical Center; Ramat Gan Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Yisca Pazit Cohen
- Department of Obstetrics and Gynecology; Sheba Medical Center; Ramat Gan Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Eldad Katorza
- Department of Obstetrics and Gynecology; Sheba Medical Center; Ramat Gan Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Reuven Achiron
- Department of Obstetrics and Gynecology; Sheba Medical Center; Ramat Gan Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
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Liu C, Xu X, Huo X. Anogenital distance and its application in environmental health research. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2014; 21:5457-64. [PMID: 24474565 DOI: 10.1007/s11356-014-2570-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 01/16/2014] [Indexed: 02/05/2023]
Abstract
Anogenital distance (AGD), a useful anthropometric measurement for genital development in both animals and humans, was originally found by reproductive toxicologists in rodent experiments. As an easy-to-measure and sensitive marker, AGD has become a bioassay of fetal androgen action and a well-established reproductive toxicity endpoint in animals. It is generally accepted that AGD is sexually dimorphic in many mammals, with males having longer AGD than females. Exposure to proposed endocrine disruptors may result in reduced AGD; thus, it has been used to measure health effects of compounds with endocrine-altering properties or endocrine-disrupting chemicals (EDCs) in environmental toxicology. Moreover, AGD is an important clinical measure to address endocrine-sensitive endpoints in the first year of life and to assess the adverse impact of in utero exposure to environmental EDCs. Recently, AGD has been identified as one of the endpoints in the US Environmental Protection Agency guidelines for reproductive toxicity studies in humans, but use of AGD in human studies is still rare, and the results remain mixed and inconclusive due to many reasons. In order to achieve a breakthrough, researchers are endeavoring to standardize the measurement of AGD, normalize age-specific population data in different ethnic groups, and conduct more in-depth human researches in this field.
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Affiliation(s)
- Chunhua Liu
- Laboratory of Environmental Medicine and Developmental Toxicology, Shantou University Medical College, 22 Xinling Rd., Shantou, 515041, China
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Mira-Escolano MP, Mendiola J, Mínguez-Alarcón L, Melgarejo M, Cutillas-Tolín A, Roca M, López-Espín JJ, Noguera-Velasco JA, Torres-Cantero AM. Longer anogenital distance is associated with higher testosterone levels in women: a cross-sectional study. BJOG 2014; 121:1359-64. [DOI: 10.1111/1471-0528.12627] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2013] [Indexed: 11/28/2022]
Affiliation(s)
- MP Mira-Escolano
- Division of Preventive Medicine and Public Health; Department of Health and Social Sciences; University of Murcia School of Medicine; Espinardo (Murcia) Spain
| | - J Mendiola
- Division of Preventive Medicine and Public Health; Department of Health and Social Sciences; University of Murcia School of Medicine; Espinardo (Murcia) Spain
- Fertilidad Roca; Gestión Clínica Avanzada SLU; Murcia Spain
| | - L Mínguez-Alarcón
- Division of Preventive Medicine and Public Health; Department of Health and Social Sciences; University of Murcia School of Medicine; Espinardo (Murcia) Spain
| | - M Melgarejo
- Department of Laboratory Medicine; ‘Virgen de la Arrixaca’ University Hospital; Murcia Spain
| | - A Cutillas-Tolín
- Division of Preventive Medicine and Public Health; Department of Health and Social Sciences; University of Murcia School of Medicine; Espinardo (Murcia) Spain
| | - M Roca
- Fertilidad Roca; Gestión Clínica Avanzada SLU; Murcia Spain
| | - JJ López-Espín
- Centre of Operations Research; Miguel Hernandez University; Elche Spain
| | - JA Noguera-Velasco
- Department of Laboratory Medicine; ‘Virgen de la Arrixaca’ University Hospital; Murcia Spain
| | - AM Torres-Cantero
- Division of Preventive Medicine and Public Health; Department of Health and Social Sciences; University of Murcia School of Medicine; Espinardo (Murcia) Spain
- Regional Campus of International Excellence ‘Campus Mare Nostrum’; University of Murcia; Murcia Spain
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Dean A, Sharpe RM. Clinical review: Anogenital distance or digit length ratio as measures of fetal androgen exposure: relationship to male reproductive development and its disorders. J Clin Endocrinol Metab 2013; 98:2230-8. [PMID: 23569219 DOI: 10.1210/jc.2012-4057] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Male reproductive disorders evident at birth or in young adulthood are remarkably common. They are hypothesized to comprise a testicular dysgenesis syndrome (TDS), with a fetal origin involving mild androgen deficiency. EVIDENCE ACQUISITION Testing this hypothesis requires "seeing back in time." Two ways have been proposed: measurement of anogenital distance (AGD), or measurement of the 2:4 digit length ratio. This review assesses the evidence that they reflect fetal androgen exposure and might be used to provide insight into the origin of TDS disorders. EVIDENCE SYNTHESIS Supporting evidence for AGD derives from rat experimental studies that identified a fetal masculinization programming window, within which androgen action determines adult reproductive organ size, TDS disorders, and AGD. In humans, AGD is positively correlated to testis size, sperm count/fertility, penis length, and T levels, consistent with rat experimental data. The 2:4 digit ratio also shows associations with these parameters, but inconsistently between studies; evidence that the 2:4 digit ratio accurately reflects fetal androgen exposure is also equivocal. CONCLUSIONS AGD appears to provide a reliable guide to fetal androgen exposure, although available data are limited. The next steps are to: standardize AGD measurement; obtain age-specific population data; and use AGD to evaluate the importance of fetal androgens in determining reproductive disorders and variation in testis/penis size and sperm count in the normal population. These studies should identify what, if any, clinical applications of AGD measurement are feasible--for example, its ability to predict adult-onset reproductive function and disorders.
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Affiliation(s)
- Afshan Dean
- Queen's Medical Research Institute, Medical Research Council/University of Edinburgh Centre for Reproductive Health, 47 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4TJ, United Kingdom
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