Childhood thyroid radioiodine exposure and subsequent infertility in the intermountain fallout cohort

Environmental and occupational factors and higher risk of couple infertility: a systematic review study

Background

Infertility is a global health problem that represents an increasing trend due to new lifestyles following technological advances since individuals are facing more risk factors than before. The present systematic review study aimed to investigate the impact of environmental and occupational factors on reproductive parameters and increased risk of couple infertility.

Main body

Scopus, PubMed, SID, and Web of Science databases were searched for the available observational (i.e., cohort, case-control, and cross-sectional) systematic review, meta-analysis, and clinical trial studies between 2007 and 2019. To this end, keywords such as ‘Environmental exposure’, ‘Occupational exposure’, ‘Environmental pollutants’, ‘Environmental pollution’, ‘Couple infertility’, ‘Sterility’, and ‘Sub-fertility’ were used. The retrieved investigations examined the impact of environmental and occupational risk factors on reproductive indices and increased infertility risk. Totally, 66 out of 9519 papers were evaluated after considering the inclusion and exclusion criteria. The reported risk factors in the reviewed studies were heavy metals, cigarette smoking, and exposure to chemicals through consumer goods, urban life, and proximity to main roads. In addition, occupational factors included heavy physical activity, prolonged sitting, exposure to a hot environment, contact with formaldehyde, pesticides, insecticides, mechanical vibration, and contact with ionizing radiation, all of which affected the reproductive parameters. However, some researchers found no significant associations in this regard.

Short conclusion

In general, individuals with known impairments in reproductive parameters were more exposed to risk factors. Nonetheless, more studies are needed to determine the risk of infertility in the population.

Effects of Radioactive Iodine Therapy on Ovarian Reserve: A Prospective Pilot Study

Background: Thyroid carcinoma is the most common endocrine malignancy. Surgery is the standard therapeutic approach for patients with differentiated thyroid carcinoma (DTC), followed by radioiodine (RAI) therapy if indicated. For women with DTC, the effects of RAI therapy on gonadal and reproductive function are an important consideration. This study aimed to evaluate the effects of RAI therapy on ovarian function. Methods: A total of 33 premenopausal women were enrolled in this study. Serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and anti-Müllerian hormone (AMH) levels during the early follicular phase were measured before and 3, 6, and 12 months after RAI therapy. The Friedman and Wilcoxon tests were used to detect changes in FSH, AMH, LH, and estradiol levels induced by RAI therapy over time. Results: The patients' ages ranged from 21 to 38 years, with a mean age of 31.15 ± 4.83 years. The median follow-up was 19 months (range 4-26 months). The median AMH levels were 3.25 ng/mL (range 0.32-17.42 ng/mL), 1 ng/mL (range 0.01-3.93 ng/mL), 1.13 ng/mL (range 0.08-6.12 ng/mL), and 1.37 ng/mL (range 0.09-6.1 ng/mL) before and at 3, 6, and 12 months after RAI therapy, respectively. The median FSH levels were 6.6 mIU/mL (range 3.78-15.5 mIU/mL), 5.83 mIU/mL (range 4.19-35.36 mIU/mL), 7.71 mIU/mL (range 4.24-16.25 mIU/mL), and 7.04 mIU/mL (range 4.93-19.96 mIU/mL) before and at 3, 6, and 12 months after RAI therapy, respectively. The AMH levels were higher before than after RAI therapy (p = 0.001). The AMH levels did not differ significantly between the three time points (p > 0.05). The FSH, LH, and estradiol levels were similar before and after RAI therapy (p > 0.05). Conclusion: AMH is considered an important marker of ovarian reserve. Ovarian reserve decreased after RAI therapy. More attention may be needed when considering RAI therapy for patients with reduced ovarian reserve.

Anti-Müllerian hormone in pre-menopausal females after ablative radioiodine treatment for differentiated thyroid cancer

PURPOSE

In recent years, anti-Mullerian hormone (AMH) has been considered a reliable index of ovarian reserve. There are few data on AMH values in thyroid cancer. The aim of this study was to evaluate AMH levels in pre-menopausal women with a history of low-risk thyroid cancer.

METHODS

Thirty-four women (aged 40.7 ± 6.7 years) were studied 7.1 ± 0.9 years after surgery and at least one RAI treatment. A group of 23 thyroid cancer women (41.6 ± 7.4 years) who had undergone only thyroidectomy served as controls. AMH, follicle-stimulating hormone (FSH) and estradiol were assayed on days 2-3, and prolactin and progesterone levels on days 21-24 of the menstrual cycle.

RESULTS

Pregnancy (RAI group 62%; control group 61%) and miscarriage rates (18% and 26%) were similar. AMH levels were similar in the RAI (10.7 ± 1.7 pmol/l) and control (17.5 ± 4.7 pmol/l) groups. Regular menses were reported in 41% and 52% of RAI and control subjects, respectively. Non-ovulatory cycles were noted in 26% and 35% of RAI and control women, respectively. AMH levels were found to be negatively correlated with age (RAI group P = 0.0003; control group P = 0.0001) and FSH, and positively correlated with progesterone, but not with the other hormonal parameters.

CONCLUSIONS

AMH should replace FSH in the evaluation of gonadal reserve in pre-menopausal thyroid cancer women. At present, age is the only predictor of AMH levels. About one out of two women with a history of thyroid cancer suffers from menstrual dysregulation, but infertility must be considered a low risk.

Radioactively contaminated areas: Bioindicator species and biomarkers of effect in an early warning scheme for a preliminary risk assessment

Concerns about the impacts on public health and on the natural environment have been raised regarding the full range of operational activities related to uranium mining and the rest of the nuclear fuel cycle (including nuclear accidents), nuclear tests and depleted uranium from military ammunitions. However, the environmental impacts of such activities, as well as their ecotoxicological/toxicological profile, are still poorly studied. Herein, it is discussed if organisms can be used as bioindicators of human health effects, posed by lifetime exposure to radioactively contaminated areas. To do so, information was gathered from several studies performed on vertebrates, invertebrate species and humans, living in these contaminated areas. The retrieved information was compared, to determine which are the most used bioindicators and biomarkers and also the similarities between human and non-human biota responses. The data evaluated are used to support the proposal for an early warning scheme, based on bioindicator species and on the most sensitive and commonly shared biomarkers, to perform a screening evaluation of radioactively contaminated sites. This scheme could be used to support decision-making for a deeper evaluation of risks to human health, making it possible to screen a large number of areas, without disturbing and alarming local populations.

Detection of mutations in the CYP21A2 gene: genotype-phenotype correlation in Slovenian couples with conceiving problems

The objective of this study was to compare the CYP 21A2 genetic profiles of couples with unexplained fertility problems (UFP) with genetic profiles of healthy controls (HCs). Furthermore, we analyzed associations between mutations in the CYP21A2 gene and various clinical and laboratory parameters. Allele-specific polymerase chain reaction (PCR) was used in 638 probands with UFP and 200 HCs. Statistic analysis with χ² was used to study the association of mutations with infertility. The effect of mutations on particular clinical and laboratory parameters was assessed with the analysis of variance (ANOVA) test. With regard to the CYP21A2 gene, 0.6% of probands with UFP and 0.5% of HCs were positive for the c.290-13A/C>G mutation; 0.6% of probands with UFP and 1.5% of HCs were positive for the p.I172N mutation; there were no probands with UFP positive for the p.P30L mutation, whereas 0.5% of HCs were; and 0.2% of probands with UFP and 0.5% of HCs were found to have the p.V281L mutation. We found a significant association between c.290-13A/C>G mutation and the frequency of significant hormone deviations (χ² = 6.997, p = 0.008). Similar association was also observed between the c.29013A/C>G mutation and the frequency of polycystic ovary syndrome (PCOS) (χ² = 16.775, p = 0.000). Our findings indicate that no significant difference in the prevalence of CYP 21A2 mutations can be found in probands with UFP when compared with HCs without infertility history. The results also imply the significant association of the c.290-13A/ C>G mutation in the CYP21A2 gene, not only with the frequency of PCOS, but also with the frequency of significant hormone deviations.

Sorption and desorption studies of radioiodine onto silver chloride via batch equilibration with its aqueous media

The uncontrolled spread out of radioiodine (especially (1)(3)(1)I) produced from nuclear activities or accidents, due to its high volatility, to the biosphere represents an environmental impact because of its concentration in the thyroid gland and accumulation on soil surface. This work represents a simple method for isolation of radioiodine from aqueous solution in the form of insoluble solid compound and further recovery of it in aqueous phase for any further controlled use. Crystalline silver chloride was prepared and characterized. Batch sorption of (131)I onto the prepared AgCl was studied from different aqueous media (H2O and NaOH of different concentrations) and at different I(-):Ag molar ratios (from alkaline media) for different times at 25 °C. It was found that the sorption yield of (131)I from 2.5 M NaOH solution (at I(-):Ag and S2O3(2-):I(-) molar ratios of 0.025 and 2, respectively) reached 97.7% after 6 h and only slightly increased to 98.6% after 16 h of contact time. The presence of H2O2 adversely affected the batch sorption process. The included REDOX and precipitation reactions were discussed. Batch desorption of the sorbed (131)I from AgCl into aqueous phase was studied with NaOCl solutions of different concentrations and different contact times at 25 °C. Desorption yield of (131)I was found to be 94.5% with 10 mL of 0.5 M NaOCl solution after contact time of 16 h. Kinetic analysis has been performed for both batch sorption and desorption processes.

Development and initial validation of a fertility experiences questionnaire

Background

Many women throughout the world have history of subfertility (resolved or unresolved), but much remains unknown about services and treatments chosen.

Methods

We developed a mixed-mode fertility experiences questionnaire (FEQ) in 2009 through literature review and iterative pilot work to optimize question format and mode of administration. The focus of the FEQ is to collect data retrospectively on time at risk for pregnancy, fertility treatments received and declined, pregnancy, time to pregnancy and pregnancy outcomes. We conducted a validation of key elements of the FEQ with comparison to medical records in 2009 and 2010. The validation sample was selected from women initially seen at a specialized fertility treatment center in Utah in 2004.

Results

The FEQ was optimized with two components: 1) written (paper or web-based), self-administered, followed by 2) telephone- administered questions. In 63 patients analyzed, high levels of correlation were identified between patient self-report and medical records for the use of intrauterine insemination and assisted reproductive technology, pregnancy and live birth histories, time at risk for pregnancy and time to pregnancy. There was low correlation between medical records and self-report for the use of oral ovulation drugs and injectable ovulation drugs. Compared to the medical record, the FEQ was over 90 % sensitive for all elements, except injectable ovulation drugs (70 % sensitivity).

Conclusions

The FEQ accurately captured elements of fertility treatment history at 5–6 years after the first visit to a specialty clinic.

Electronic supplementary material

The online version of this article (doi:10.1186/s12978-015-0054-3) contains supplementary material, which is available to authorized users.