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Vincens N, Persson Waye K. Occupational and environmental noise exposure during pregnancy and rare health outcomes of offspring: a scoping review focusing on congenital anomalies and perinatal mortality. REVIEWS ON ENVIRONMENTAL HEALTH 2023; 38:423-438. [PMID: 35503245 DOI: 10.1515/reveh-2021-0166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/08/2022] [Indexed: 06/14/2023]
Abstract
As environmental and occupational noise can be health hazards, recent studies have investigated the effects of noise exposure during pregnancy. Despite biological plausibility and animal studies supporting an association, studies focusing on congenital anomalies and perinatal mortality as outcomes of noise exposure are still scarce. We performed a scoping review to collect, summarise, and discuss the existing scientific research about the relationships between noise exposure during pregnancy and congenital anomalies and/or perinatal mortality. We searched electronic databases for papers published between 1970 and March 2021. We included 16 studies (seven on congenital anomalies, three on perinatal mortality, and two on both congenital anomalies and perinatal mortality). We assessed four studies on congenital hearing dysfunction as the definition of congenital anomalies includes functional anomalies. We found few studies on this topic and no studies on the combined effects of occupational and environmental noise exposures. Evidence suggests a small increase in the risk of congenital anomalies in relation to occupational and to a lesser extent environmental noise exposure. In addition, few studies investigated perinatal mortality and the ones that did, used different outcome definitions, so no conclusions could be made. However, a recent big cross-sectional study demonstrated an association between road traffic noise and stillbirth. A few studies suggest a possible association between congenital hearing dysfunction and occupational noise exposure during pregnancy. Future studies with larger samples, better exposure assessments, and better statistical modelling strategies are needed to investigate these relationships further.
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Affiliation(s)
- Natalia Vincens
- Department of Public Health and Community Medicine at Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Kerstin Persson Waye
- Department of Public Health and Community Medicine at Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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Mai H, Ke J, Li M, He M, Qu Y, Jiang F, Cai S, Xu Y, Fu L, Pi L, Zhou H, Yu H, Che D, Gu X, Zhang J, Zuo L. Association of living environmental and occupational factors with semen quality in chinese men: a cross-sectional study. Sci Rep 2023; 13:15671. [PMID: 37735181 PMCID: PMC10514289 DOI: 10.1038/s41598-023-42927-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/16/2023] [Indexed: 09/23/2023] Open
Abstract
Sperm quality can be easily influenced by living environmental and occupational factors. This study aimed to discover potential semen quality related living environmental and occupational factors, expand knowledge of risk factors for semen quality, strengthen men's awareness of protecting their own fertility and assist the clinicians to judge the patient's fertility. 465 men without obese or underweight (18.5 < BMI < 28.5 kg/m2), long-term medical history and history of drug use, were recruited between June 2020 to July 2021, they are in reproductive age (25 < age < 45 years). We have collected their semen analysis results and clinical information. Logistic regression was applied to evaluate the association of semen quality with different factors. We found that living environment close to high voltage line (283.4 × 106/ml vs 219.8 × 106/ml, Cohen d = 0.116, P = 0.030) and substation (309.1 × 106/ml vs 222.4 × 106/ml, Cohen d = 0.085, P = 0.015) will influence sperm count. Experienced decoration in the past 6 months was a significant factor to sperm count (194.2 × 106/ml vs 261.0 × 106/ml, Cohen d = 0.120, P = 0.025). Living close to chemical plant will affect semen PH (7.5 vs 7.2, Cohen d = 0.181, P = 0.001). Domicile close to a power distribution room will affect progressive sperm motility (37.0% vs 34.0%, F = 4.773, Cohen d = 0.033, P = 0.030). Using computers will affect both progressive motility sperm (36.0% vs 28.1%, t = 2.762, Cohen d = 0.033, P = 0.006) and sperm total motility (57.0% vs 41.0%, Cohen d = 0.178, P = 0.009). After adjust for potential confounding factors (age and BMI), our regression model reveals that living close to high voltage line is a risk factor for sperm concentration (Adjusted OR 4.03, 95% CI 1.15-14.18, R2 = 0.048, P = 0.030), living close to Chemical plants is a protective factor for sperm concentration (Adjusted OR 0.15, 95% CI 0.05-0.46, R2 = 0.048, P = 0.001) and total sperm count (Adjusted OR 0.36, 95% CI 0.13-0.99, R2 = 0.026, P = 0.049). Time spends on computer will affect sperm total motility (Adjusted OR 2.29, 95% CI 1.11-4.73, R2 = 0.041, P = 0.025). Sum up, our results suggested that computer using, living and working surroundings (voltage line, substation and chemical plants, transformer room), and housing decoration may association with low semen quality. Suggesting that some easily ignored factors may affect male reproductive ability. Couples trying to become pregnant should try to avoid exposure to associated risk factors. The specific mechanism of risk factors affecting male reproductive ability remains to be elucidated.
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Affiliation(s)
- Hanran Mai
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
- Department of Andrology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, Guangdong, China
| | - Junyi Ke
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
- Department of Andrology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, Guangdong, China
| | - Miaomiao Li
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
- Department of Andrology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, Guangdong, China
| | - Menghua He
- Department of Laboratory, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, China
| | - Yanxia Qu
- Department of Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Fan Jiang
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, Guangdong, China
| | - Simian Cai
- Department of Science, Education and Data Management, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, Guangdong, China
| | - Yufen Xu
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Lanyan Fu
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Lei Pi
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Huazhong Zhou
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Hongyan Yu
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Di Che
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Xiaoqiong Gu
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Jinxin Zhang
- Department of Medical Statistics, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Liandong Zuo
- Department of Andrology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, Guangdong, China.
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Zhao QC, Zhang Z, Zhao LM, Deng ZF, Gao JM, Zhang HL, Lin HC, Liu DF, Mao JM, Zhang HT, Chen YL, Tang WH, Jiang H. A retrospective cohort study of geographic differences in the semen of 1,012 sperm donors in China. Transl Androl Urol 2023; 12:187-196. [PMID: 36915889 PMCID: PMC10006001 DOI: 10.21037/tau-22-578] [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: 08/09/2022] [Accepted: 12/02/2022] [Indexed: 02/09/2023] Open
Abstract
Background Male reproductive health has become a serious public health concern, and semen quality is essential to male reproduction. We aimed to investigate geographical differences in the semen quality of sperm donors from northern and southern China by enrolling donors across the country. Methods A total of 1,012 sperm donors were enrolled in this study between 2015 and 2019. Donors were first divided into two parts based on their birthplace according to the "Qinling-Huaihe" line, and secondly, by their residential latitude. Finally, donors were re-classified into two groups (typically north and south) which contained 667 samples. Results Statistically significant differences in sperm concentration were observed among men from different latitudes in China (P=0.04). The sperm concentrations of males from 18° to 27° north latitude were significantly lower than those from 36° to 45° and 45° to 54° [median 131, 134, and 146, respectively, P=0.021 (18° to 27° vs. 36° to 45°) and P=0.01 (18° to 27° vs. 45° to 54°)]. Conclusion We hypothesize environmental pollution and mental stress due to the increased population size may be the main factors underlying differences in the sperm quality of men in northern and southern China.
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Affiliation(s)
- Qian-Cheng Zhao
- Department of Human Sperm Bank, Peking University Third Hospital, Beijing, China
| | - Zhe Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Lian-Ming Zhao
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Zhen-Feng Deng
- Department of Natural Medicine, Peking University School of Pharmaceutical Sciences, Beijing, China
| | - Jiang-Man Gao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Hong-Liang Zhang
- Department of Human Sperm Bank, Peking University Third Hospital, Beijing, China
| | - Hao-Cheng Lin
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - De-Feng Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Jia-Ming Mao
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Hai-Tao Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Yu-Long Chen
- Department of Urban and Rural Planning, Peking University, Beijing, China
| | - Wen-Hao Tang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Hui Jiang
- Department of Urology, Peking University Third Hospital, Beijing, China
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Amorim MCP, Vieira M, Meireles G, Novais SC, Lemos MFL, Modesto T, Alves D, Zuazu A, Lopes AF, Matos AB, Fonseca PJ. Boat noise impacts Lusitanian toadfish breeding males and reproductive outcome. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 830:154735. [PMID: 35337882 DOI: 10.1016/j.scitotenv.2022.154735] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
Anthropogenic noise is a growing threat to marine organisms, including fish. Yet very few studies have addressed the impact of anthropogenic noise on fish reproduction, especially in situ. In this study, we investigated the impacts of boat noise exposure in the reproductive success of wild Lusitanian toadfish (Halobatrachus didactylus), a species that relies on advertisement calls for mate attraction, using behavioural, physiological and reproductive endpoints. Two sets of artificial nests were deployed in the Tagus estuary and exposed to either ambient sound or boat noise during their breeding season. Toadfish males spontaneously used these nests to breed. We inspected nests for occupation and the presence of eggs in six spring low tides (in two years) and assessed male vocal activity and stress responses. Boat noise did not affect nest occupation by males but impacted reproductive success by decreasing the likelihood of receiving eggs, decreasing the number of live eggs and increasing the number of dead eggs, compared to control males. Treatment males also showed depressed vocal activity and slightly higher cortisol levels. The assessment of oxidative stress and energy metabolism-related biomarkers revealed no oxidative damage in noise exposed males despite having lower antioxidant responses and pointed towards a decrease in the activity levels of energy metabolism-related biomarkers. These results suggest that males exposed to boat noise depressed their metabolism and their activity (such as parental care and mate attraction) to cope with an acoustic stressor, consistent with a freezing defensive response/behaviour. Together, our study demonstrates that boat noise has severe impacts on reproductive fitness in Lusitanian toadfish. We argue that, at least fishes that cannot easily avoid noise sources due to their dependence on specific spawning sites, may incur in significant direct fitness costs due to chronic noise exposure.
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Affiliation(s)
- M Clara P Amorim
- MARE - Marine and Environmental Sciences Centre, ISPA, Instituto Universitário, Lisbon, Portugal; Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal.
| | - Manuel Vieira
- MARE - Marine and Environmental Sciences Centre, ISPA, Instituto Universitário, Lisbon, Portugal; Departamento de Biologia Animal and cE3c_Centre for Ecology, Evolution and Environmental Changes, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Gabriela Meireles
- MARE-Marine and Environmental Sciences Centre, ESTM, Politécnico de Leiria, 2050-641 Peniche, Portugal
| | - Sara C Novais
- MARE-Marine and Environmental Sciences Centre, ESTM, Politécnico de Leiria, 2050-641 Peniche, Portugal
| | - Marco F L Lemos
- MARE-Marine and Environmental Sciences Centre, ESTM, Politécnico de Leiria, 2050-641 Peniche, Portugal
| | - Teresa Modesto
- Centro de Ciências do Mar, Universidade do Algarve, Campus de Gambelas, 8000-810 Faro, Portugal
| | - Daniel Alves
- Departamento de Biologia Animal and cE3c_Centre for Ecology, Evolution and Environmental Changes, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Zuazu
- Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Ana F Lopes
- MARE - Marine and Environmental Sciences Centre, ISPA, Instituto Universitário, Lisbon, Portugal
| | - André B Matos
- MARE - Marine and Environmental Sciences Centre, ISPA, Instituto Universitário, Lisbon, Portugal; Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Paulo J Fonseca
- Departamento de Biologia Animal and cE3c_Centre for Ecology, Evolution and Environmental Changes, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
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Jang WS, Yoon YE, Lee TH, Lee SR, Lee JH, Kim DK. External validation of karyotype nomogram to predict karyotype abnormalities in oligospermic men. Andrologia 2022; 54:e14446. [PMID: 35470445 DOI: 10.1111/and.14446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/21/2022] [Accepted: 04/03/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Won Sik Jang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Eun Yoon
- Department of Urology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Tae Ho Lee
- Department of Urology, Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea
| | - Seung-Ryeol Lee
- Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Jae Ho Lee
- Department of Biomedical Science, College of Life Science, CHA University, Pochen, Republic of Korea
| | - Dae Keun Kim
- Department of Urology, CHA Fertility Center Seoul Station, CHA University School of Medicine, Seoul, Republic of Korea
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Wu LM, Jiang XH, Bai S, Dou XC, Qi HL, Zhu YS, Zhang YT, Liu YX, Hu XC, Cao C, Tong XH, Xu B. Association between semen collection time and semen parameters: an observational study. Asian J Androl 2022; 25:339-344. [PMID: 36254888 DOI: 10.4103/aja202268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The process of semen collection plays a key role in the quality of semen specimens. However, the association between semen collection time and semen quality is still unclear. In this study, ejaculates by masturbation from 746 subfertile men or healthy men who underwent semen analysis were examined. The median (interquartile range) semen collection time for all participants was 7.0 (5.0-11.0) min, and the median time taken for semen collection was lower in healthy men than that in subfertile men (6.0 min vs 7.0 min). An increase in the time required to produce semen samples was associated with poorer semen quality. Among those undergoing assisted reproductive technology (ART), the miscarriage rate was positively correlated with the semen collection time. After adjusting for confounders, the highest quartile (Q4) of collection time was negatively associated with semen volume and sperm concentration. A longer time to produce semen samples (Q3 and Q4) was negatively correlated with progressive and total sperm motility. In addition, there was a significant negative linear association between the semen collection time and the sperm morphology. Higher risks of asthenozoospermia (adjusted odds ratio [OR] = 2.06, 95% confidence interval [CI]: 1.31-3.25, P = 0.002) and teratozoospermia (adjusted OR = 1.98, 95% CI: 1.10-3.55, P = 0.02) were observed in Q3 than those in Q1. Our results indicate that a higher risk of abnormal semen parameter values was associated with an increase in time for semen collection, which may be related to male fertility through its association with semen quality.
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Choe SA, Kim S, Im C, Kim SY, Wellenius G, Kim YS, Yoon TK, Kim DK. Land use and semen quality: A fertility center cohort study. PLoS One 2021; 16:e0255985. [PMID: 34383845 PMCID: PMC8360504 DOI: 10.1371/journal.pone.0255985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/28/2021] [Indexed: 11/24/2022] Open
Abstract
This study explored the association between built environment and semen parameters among men who sought fertility evaluation. We used a data of 5,886 men living in the Seoul capital area whose semen was tested at a single fertility center during 2016–2018. Distance to fresh water, the coast, major roadways, and neighborhood greenness measured by Normalized Difference Vegetation Index (NDVI) were evaluated. Outcome indicators were semen volume, sperm concentration, percentage of progressive motility, vitality, normal morphology, and total motile sperm count. Linear regression models were fitted to standardized values of six semen indicators. Majority of men were white-collar, clerical, and service workers. Linear associations between built environment features and semen quality indicators were not evident except for NDVI within 500 m and sperm vitality (β = 0.05; 95% confidence interval (CI): 0.01, 0.09). The 2nd quartile of distance to fresh water was associated with lower progressive motility compared to the 1st quartile (β = −0.10; 95% CI: −0.17, −0.03). Proportion of vitality was higher among men in the 2nd quartile of distance to roadways than those in the 1st quartile (0.08; 95% CI: 0.01, 0.15). Men in the 2nd quartile of NDVI had higher total motile sperm count (0.09; 95% CI: 0.01, 0.17). In the multi-exposure model, the positive association between NDVI and vitality remained (0.03; 95% CI: 0.00, 0.06). We observed potential evidence regarding the impact of built environment on male fertility, specifically a positive association between residential greenness and sperm vitality among men with a history of infertility.
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Affiliation(s)
- Seung-Ah Choe
- Department of Preventive Medicine, Korea University Medical College, Seoul, South Korea
| | - Seulgi Kim
- Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Changmin Im
- Department of Geography, Korea University, Seoul, South Korea
| | - Sun-Young Kim
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si, Gyunggi-do, South Korea
| | - Gregory Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
| | - You Shin Kim
- Department of Obstetrics and Gynecology, CHA Fertility Center Seoul Station, CHA University School of Medicine, Seoul, South Korea
| | - Tae Ki Yoon
- Department of Obstetrics and Gynecology, CHA Fertility Center Seoul Station, CHA University School of Medicine, Seoul, South Korea
| | - Dae Keun Kim
- Department of Urology, CHA Fertility Center Seoul Station, CHA University School of Medicine, Seoul, South Korea
- * E-mail:
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Zhou Y, Yao W, Zhang D, Yu Y, Chen S, Lu H, Jiang W, Jiang C. Effectiveness of acupuncture for asthenozoospermia: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25711. [PMID: 33907155 PMCID: PMC8084068 DOI: 10.1097/md.0000000000025711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND According to the World Health Organization, the global incidence of infertility is about 15%, and more than 50% of infertility cases are caused by male infertility. Asthenozoospermia is caused by male fertility decline and male infertility. Due to work pressure, environmental pollution, sexual diseases, and other factors, the number of patients with asthenozoospermia has increased in recent years. It has been confirmed that acupuncture has a certain effect on patients with asthenozoospermia. Acupuncture and moxibustion can be an adjuvant treatment plan for the treatment of asthenozoospermia in addition to drug treatment. METHODS Randomized controlled trials of acupuncture for asthenozoospermia will be searched in the relevant database, including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Biomedical Literature Database (CBM), and Chinese Scientific Journal Database (VIP database). The studies of electronic searches will be exported to EndNote V.9.1 software. We will run meta-analyses using the Review Manager (RevMan) V.5.3 software. Any disagreements will be solved in consultation with a third reviewer. RESULTS Our study aims to explore the efficacy of acupuncture for asthenozoospermia and to provide up-to-date evidence for clinical of asthenozoospermia. CONCLUSION This study will perform a comprehensive systematic review and meta-analysis on the efficacy of acupuncture for asthenozoospermia, making up for the lack of relevant evidence of the clinical use of acupuncture. INPLASY REGISTRATION NUMBER INPLASY 202140032.
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