Urinary concentrations of bisphenol A, parabens and benzophenone-type ultra violet light filters in relation to sperm DNA fragmentation in young men: A chemical mixtures approach

People are daily exposed to multiple endocrine disruptor compounds (EDCs) that may interfere with different molecular and cellular processes, promoting a potential estrogenic, androgenic, or anti-androgenic state. However, most epidemiological studies attempting to establish relationships between EDCs exposure and health effects are still considering individual compounds. A few studies have shown associations between exposure to individual non-persistent EDCs and sperm DNA fragmentation (SDF) in different male populations. Thus, the aim of this study was to investigate associations between combined exposure to non-persistent EDCs and SDF index in young men. A cross-sectional study was conducted with 158 healthy university students from Southeaster Spain. The participants provided spot urine and semen samples on the same day. The concentrations of urinary bisphenol A (BPA), benzophenones [2,4-dihydroxybenzophenone (BP-1); 2,2',4,4'-tetrahydroxybenzophenone (BP-2), 2-hydroxy-4-methoxybenzophenone (BP-3), 2,2'-dihydroxy-4-methoxybenzophenone (BP-8), 4-hydroxybenzophenone (4OHBP)], and parabens (methylparaben, ethylparaben, propylparaben, butylparaben) were measured by dispersive liquid-liquid microextraction and ultrahigh-performance liquid chromatography with tandem mass spectrometry detection. SDF was analysed using a Sperm Chromatin Dispersion test. Statistical analyses were carried out using Bayesian Kernel Machine Regression models to evaluate associations between combined exposure to these compounds and SDF index while adjusting by relevant covariates. The increase in urinary concentration of 4OHBP was found to be the most important contributor to the negative association between urinary EDCs concentrations and SDF index, being of -5.5 % [95 % CI: -10.7, -0.3] for those in percentile 50, and - 5.4 % [95 % CI: -10.8, -0.1] for those in percentile 75. No significant associations were observed between other EDCs and SDF index. Our findings show that urinary 4OHBP levels may be associated with a decrease in the SDF index. Nonetheless, the effects we observed were likely to be small and of uncertain clinical significance. Further research is needed to replicate our findings in other male populations.

The Spanish version of the reflective functioning questionnaire: Validity data in the general population and individuals with personality disorders

INTRODUCTION

Mentalization or reflective functioning (RF) is the capacity to interpret oneself or the others in terms of internal mental states. Its failures have been linked to several mental disorders and interventions improving RF have a therapeutic effect. Mentalizing capacity of the parents influences the children's attachment. The Reflective Functioning Questionnaire (RFQ-8) is a widely used tool for the assessment of RF. No instrument is available to assess general RF in Spanish-speaking samples. The aim of this study is to develop a Spanish version of the RFQ-8 and to evaluate its reliability and validity in the general population and in individuals with personality disorders.

METHODS

602 non-clinical and 41 personality disordered participants completed a Spanish translation of the RFQ and a battery of self-reported questionnaires assessing several RF related constructs (alexithymia, perspective taking, identity diffusion and mindfulness), psychopathology (general and specific) and interpersonal problems. Temporal stability was tested in a non-clinical sub-sample of 113 participants.

RESULTS

Exploratory and confirmatory factor analyses suggested a one-factor structure in the Spanish version of the RFQ-8. RFQ-8 understood as a single scale was tested, with low scorings reflecting genuine mentalizing, and high scorings uncertainty. The questionnaire showed good internal consistence in both samples and moderate temporal stability in non-clinical sample. RFQ correlated significantly with identity diffusion, alexithymia, and general psychopathology in both samples; and with mindfulness, perspective taking, and interpersonal problems in clinical sample. Mean values of the scale were significantly higher in the clinical group.

DISCUSSION

This study provides evidence that the Spanish version of the RFQ-8, understood as a single scale, has an adequate reliability and validity assessing failures in reflective functioning (i.e., hypomentalization) in general population and personality disorders.

Maternal urinary concentrations of bisphenol A during pregnancy are associated with global DNA methylation in cord blood of newborns in the "NELA" birth cohort

Endocrine disrupting chemicals (EDCs) set a public health risk through disruption of normal physiological processes. The toxicoepigenetic mechanisms of developmental exposure to common EDCs, such as bisphenol A (BPA), are poorly known. The present study aimed to evaluate associations between perinatal maternal urinary concentrations of BPA, bisphenol S (BPS) and bisphenol F (BPF) and LINE-1 (long interspersed nuclear elements) and Alu (short interspersed nuclear elements, SINEs) DNA methylation levels in newborns, as surrogate markers of global DNA methylation. Data come from 318 mother-child pairs of the `Nutrition in Early Life and Asthma´ (NELA) birth cohort. Urinary bisphenol concentration was measured by dispersive liquid-liquid microextraction and ultrahigh performance liquid chromatography with tandem mass spectrometry detection. DNA methylation was quantitatively assessed by bisulphite pyrosequencing on 3 LINEs and 5 SINEs. Unadjusted linear regression analyses showed that higher concentration of maternal urinary BPA in 24th week's pregnancy was associated with an increase in LINE-1 methylation in all newborns (p = 0.01) and, particularly, in male newborns (p = 0.03). These associations remained in full adjusted models [beta = 0.09 (95 % CI = 0.03; 0.14) for all newborns; and beta = 0.10 (95 % CI = 0.03; 0.17) for males], including a non-linear association for female newborns as well (p-trend = 0.003). No associations were found between maternal concentrations of bisphenol and Alu sequences. Our results suggest that exposure to environmental levels of BPA may be associated with a modest increase in LINE-1 methylation -as a relevant marker of epigenomic stability- during human fetal development. However, any effects on global DNA methylation are likely to be small, and of uncertain biological significance.

Risk factors for admission to ICU among COVID-19 patients: A 6-month observational study in Spain

Background

Admission to the Intensive Care Unit (ICU) is one of the most used indicators to estimate the magnitude of the current COVID-19 pandemic. This study was performed to assess the relationship between demographic, lifestyles and comorbidity factors on the severity of patients with SARS-CoV2 infection.

Methods

An observational study including data from the regional surveillance dataset on acute respiratory infections from September 2020 to February 2021 in one large tertiary hospital in Murcia, Spain. Demographic, clinical and lifestyle factors were collected. A descriptive analysis was carried out using SPSS. Chi-square tests were performed to assess the relationship between comorbidities and lifestyle factors. Binary logistic regression was calculated to estimate the probability of being admitted to ICU. Analysis were adjusted by sex, age, and lifestyle factors.

Results

Overall, 906 patients with COVID-19 were identified. The mean age was 64.3 years (SD = 16.5 years), and 523 of the patients were male (57.7%). A total of 104 (11.5%) patients required admission to ICU and 142 (15.7%) died during the hospitalisation process. The average length of stay at the hospital was 8 days (SD = 6). Acute renal failure (OR = 7.7; 95% CI: 1.7-33.0), being a smoker (OR = 7.02; 95% CI: 2.7-19, 0) and suffering from obesity (OR = 3.5; 95% CI: 1.2-10.3) were the main risk factors associated with admission to ICU.

Conclusions

Acute renal failure, obesity, and smoking were strongly associated with both severity and admission to intensive care among patients with COVID-19 infection. More research needs to be done to assess the role of these underlying factors in the severity of COVID-19 infections.

Key messages

The design of predictive models for ICU admission during the COVID-19 pandemic should be promoted. Features associated to vulnerability in COVID-19 patients must be identified.

Analysis and Reliability of Anthropometric Measurements during Pregnancy: A Prospective Cohort Study in 208 Pregnant Women

Anthropometric assessment during pregnancy is a widely used, low-technology procedure that has not been rigorously evaluated. Our objective is to investigate fat mass distribution during pregnancy by examining changes in anthropometrics measures, in order to evaluate the reliability of these measures. An observational, longitudinal, prospective cohort study was performed in 208 pregnant women. Anthropometric measurements were taken following the ISAK protocol during the three trimesters and a generalized linear model for repeated measures was used to evaluate differences. Variability was assessed using the coefficient of variation, and Propagated Error (PE) was used to sum of skinfold thicknesses (SFT). SFT showed a general increase in fat mass during the three trimesters of pregnancy (∑SFT7 p = 0.003), and was observed in specific anatomical locations as well: arms (∑Arm SFT, p = 0.046), trunk (∑Trunk SFT, p = 0.019), legs (∑Leg SFT, p = 0.001) and appendicular (∑Appendicular SFT, p = 0.001). Anthropometric measures for skinfold thickness were taken individually during pregnancy and were reliable and reproducible during the three trimesters, which could help to prevent adverse pregnancy outcomes.

Fat intake pattern in women with polycystic ovary syndrome

RESEARCH QUESTION

Do women with polycystic ovary syndrome (PCOS) have a different fat intake pattern to women without PCOS?

DESIGN

Case-control study of 276 women between 20 and 35 years old from the Murcia region of Spain. Cases (n = 121) attended the Department of Gynaecology and Obstetrics of the University Clinical Hospital and were diagnosed with PCOS using Rotterdam criteria. Controls (n = 155) were women without PCOS attending the gynaecological outpatient clinic for routine gynaecological examinations. Data from clinical, gynaecological and analytical examinations were collected, including a food frequency questionnaire. Associations between fat intake and presence of PCOS and its phenotypes were examined using multiple logistic regression, adjusting for potential confounding factors.

RESULTS

Although no association was found between fatty acid intake and PCOS, significant associations were observed for some PCOS phenotypes. The PCOS phenotype characterized by hyperandrogenism + oligo/amenorrhoea + polycystic ovarian morphology ('H+O+POM') was significantly associated with a higher intake of polyunsaturated fat (odds ratio [OR] 4.0; 95% confidence interval [CI] 1.1-14.2; fourth quartile of highest intake [Q4] versus lowest intake quartile as reference [Q1]) and omega-6 fatty acids (OR 3.5; 95% CI 1.01-12.4; Q3 versus Q1). The 'H+O' phenotype was positively associated with saturated fat intake (OR 6.9; 95% CI 1.1-41.6; Q4 versus Q1).

CONCLUSION

This exploratory study suggests that higher intakes of specific fatty acids are related to some PCOS phenotypes although no association was found for PCOS on a global basis. It is recommended that studies with larger sample size be performed to further explore these associations, thus contributing to establishing recommendations about fat intake adapted to different PCOS phenotypes.

Associations between urinary concentrations of bisphenol A and sperm DNA fragmentation in young men

BACKGROUND

Bisphenol A (BPA) is one of the most common endocrine disruptor compounds in our environment, promoting a xenoestrogenic state. Numerous studies have shown a relationship between exposure to BPA and male infertility problems. Spermatic DNA integrity is a critical factor for the correct transmission of paternal genetic material to the embryo. However, only a very few studies have investigated the association between urinary BPA concentrations and human sperm DNA fragmentation (SDF).

METHOD

Cross-sectional study conducted with 158 healthy university students (18-23 years), recruited between 2010 and 2011 in the Region of Murcia (Spain). The subjects provided urine and semen samples on a single day. Urinary BPA concentrations were measured by dispersive liquid-liquid microextraction and ultrahigh performance liquid chromatography with tandem mass spectrometry detection, and SDF analysed using the Sperm Chromatin Dispersion test. Statistical analyses were made using linear regression adjusting for potential covariates and confounding factors.

RESULTS

No association was found between urinary BPA concentrations and SDF index in the total group. However, in the subgroup of men with SDF index> 30%, significant positive associations across quartiles (p-trend=0.02) and as a continuous BPA levels were observed (β = 0.055, 95%, CI: 0.002; 0.108).

CONCLUSION

Our results show that, within the subgroup of men with relatively high SDF index, the higher the concentration of BPA the greater the SDF index. Nonetheless, more studies are required to confirm these results and draw conclusions in other male populations.

Associations between maternal circulating 25-hydroxyvitamin D concentration and birth outcomes-Mode of delivery and episiotomy rate: A prospective cohort study

AIM

The objective of this study was to evaluate associations between maternal concentrations of 25-hydroxyvitamin D (25(OHD)) and birth outcomes: mode of delivery and episiotomy rate.

DESIGN AND METHODS

One hundred and seventeen pregnant women were enrolled in an observational, longitudinal, prospective cohort study. Multivariable linear regression analyses were performed to assess relationships between maternal 25(OHD) concentrations and mode of delivery. To account for systematic temporal variation in 25(OHD), a cosinor model to the data was fitted.

RESULTS

No significant statistical associations were found between adjusted maternal 25(OHD) concentrations and risk of eutocic vaginal delivery, instrumented delivery (OR 1.05 [95% CI: 0.97-1.13]), primary Caesarean section (OR 0.99 [95% CI: 0.88-1.11]) or Caesarean section for any other causes (OR 1.04 [95% CI: 0.95-1.14]). High 25(OHD) levels tended to show a protective effect on performance of episiotomy, without reaching statistical significance (OR 0.36 [95% CI: 0.09, 1.37]).

Body Composition and Characterization of Skinfold Thicknesses from Polycystic Ovary Syndrome Phenotypes. A Preliminar Case-Control Study

To describe whether polycystic ovary syndrome (PCOS) phenotypes vary in their body composition and skinfold (SKF) thicknesses and if they differ from women without PCOS, a preiminar case-control study was performed. A total of 117 cases were diagnosed using the Rotterdam criteria. Gynecological examinations and transvaginal ultrasound were performed in all women (266 women). Anthropometric measurements including SKF thickness were taken according to the restricted profile protocol of the international standards for the anthropometric evaluation according to the International Society of the Advancement of Kinanthropometry (ISAK). Women with PCOS had higher body mass index and percentage of fat mass with respect to controls. The endomorphy component was also significantly higher in women with PCOS than in controls. Each PCOS phenotype displayed a different representation in the somatochart respect to the others phenotypes and also compared to controls. Women with PCOS had significantly higher ∑7 SKF (p = 0.013), ∑appendicular SKF (p = 0.017) and ∑arm SKF (p = 0.019) than controls. H-O-POM phenotype had higher 7∑ SKF (p = 0.003), ∑appendicular SKF (p = 0.01), ∑arm SKF (0.005), ∑leg SKF, and ∑trunk SKF (0.008) and also a higher fast mass percentage than controls (p = 0.011). In conclusion, body composition evaluated by ISAK protocol is different in women with PCOS, especially in the complete phenotype (H-O-POM). This could have relevant implications in terms of clinical evaluation and follow-up of these women, although more researches in this field are needed.

Asociación entre el cociente del segundo y cuarto dedo y el riesgo de cáncer de próstata: Un estudio de casos y controles en población mediterránea

Objetivo Evaluar la asociación entre el cociente de los dedos segundo y cuarto (2D:4D), como un biomarcador de la exposición prenatal a andrógenos, y la presencia de cáncer de próstata (CaP).

Métodos Estudio de casos y controles con 260 hombres que consultaron en el Servicio de Urología del Hospital General Universitario Reina Sofía (Murcia, España). Los casos (n = 125) fueron pacientes diagnosticados de CaP por anatomía patológica a los que se les realizó una prostatectomía radical. Los controles (n = 135) fueron pacientes que consultaron en Urología por otro motivo y que no mostraron signos ni síntomas de patología prostática. La longitud del 2D y 4D de la mano derecha fue medida mediante un pie de rey digital y se calculó el cociente entre ambos (2D:4D). Para los análisis estadísticos se utilizaron modelos de regresión logística obteniendo Odds ratios (OR) crudas y ajustadas e intervalos de confianza al 95%.

Resultados Los casos presentaron un cociente 2D:4D significativamente menor que los controles. El cociente 2D:4D se relacionó significativamente con la presencia de CaP. Tras el ajuste multivariante, se observó que los varones que se encontraban en el primer tercil de distribución del cociente 2D:4D, presentaban casi el doble de riesgo de padecer CaP (OR 1,9: IC 95% 1,1–4,0; P-valor = 0,040) en comparación con los varones que se encontraban en el segundo y tercer tercil.

Conclusiones Una mayor exposición prenatal a andrógenos, reflejada por un cociente 2D:4D menor, podría estar asociado con riesgo aumentado de padecer CaP, pero más estudios son necesarios para corroborar esos hallazgos.

Adherence to diet quality indices in relation to semen quality and reproductive hormones in young men

STUDY QUESTION

Is adherence to an a priori defined diet quality indices [Alternate Healthy Index 2010 (AHEI-2010), relative Mediterranean diet score (rMED) or dietary approaches to stop hypertension (DASH)] associated with semen quality and reproductive hormone levels in young men?

SUMMARY ANSWER

Greater adherence to the DASH diet is related to higher sperm counts.

WHAT IS KNOWN ALREADY

Studies assessing the relationship between dietary intake and male reproductive function have mainly been focused on specific nutrients, food groups or data-driven dietary patterns, but the evidence on a priori defined dietary indices is still scarce.

STUDY DESIGN, SIZE, DURATION

Cross-sectional study of 209 male university students recruited from October 2010 to November 2011 in Murcia Region (Southern Spain).

PARTICIPANTS/MATERIALS, SETTING, METHODS

Healthy young men aged 18-23 years were included in this study. Diet was assessed using a validated food frequency questionnaire and three a priori-defined dietary indices (AHEI-2010, rMED and DASH) were calculated. Linear regression was used to analyze the relation between the three dietary indices and semen quality parameters and reproductive hormone levels accounting for potential confounders and covariates.

MAIN RESULTS AND THE ROLE OF CHANCE

We found statistically significant positive associations between the DASH index and sperm concentration (P, trend = 0.04), total sperm count (P, trend = 0.04) and total motile sperm count (P, trend = 0.02). No associations were observed for other semen parameters or male reproductive hormones.

LIMITATIONS, REASONS FOR CAUTION

Even though we adjusted for several known and suspected confounders we cannot exclude the possibility of residual or unmeasured confounding or chance findings. Subjects were blinded to the study outcomes thus reducing the potential influence on their report of diet. Our sample size may be too small to rule out associations with other semen parameters or reproductive hormones. Causal inference is limited, as usual with all observational studies.

WIDER IMPLICATIONS OF THE FINDINGS

The results suggest that greater adherence to the DASH may help improve sperm counts. This study was carried out on young men from the general population. However, results may differ among other populations (e.g. infertile men). Therefore, further research is needed to confirm these findings and extend these results to other populations.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by Fundación Séneca, grants No 08808/PI/08 and No 19443/PI/14; Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III (AES), grants No PI10/00985 and No PI13/01237; and grant P30DK046200 from the National Institutes of Health. Authors have no competing interests to declare.

Anogenital distance and anti-Müllerian hormone combined improves the diagnosis of polycystic ovary syndrome

The objective of this study was to assess the accuracy of the combination of anogenital distance (AGD) and anti-Müllerian hormone (AMH) in the diagnosis of polycystic ovary syndrome (PCOS). The study included women diagnosed with PCOS and a control group who attended the Clinical University Hospital 'Virgen de la Arrixaca' in Murcia (Spain). Serum concentrations of AMH were measured and two AGD measurements were obtained: (i) from the anterior clitoral surface to the upper verge of the anus (AGD_AC); and (ii) from the posterior fourchette to the upper verge of the anus (AGD_AF). Data were assessed by receiver operator characteristic (ROC) curves. Women with PCOS (n = 126) had significantly larger AGD_AC (80.5 ± 11.3 versus 76.0 ± 10.4 mm; p < 0.001) and higher AMH (7.2 ± 4.7 versus 3.1 ± 2.2; p < 0.001) compared to control women (n = 159). Women with serum AMH above 3.8 ng/mL (clinical cut-off used in PCOS) were 9.1 times more likely to have PCOS (95% CI: 5.1-16.2). The area under the ROC curve of combined model of AMH and AGD_AC was 0.87 (95% CI: 0.83-0.91). The combined model for predicting PCOS based on AMH and AGD_AC has better diagnostic accuracy than that of AMH or AGD_AC alone. This model could be useful for clinicians and improve diagnosis and clinical management of these women.

Health-related quality of life in women with polycystic ovary syndrome attending to a tertiary hospital in Southeastern Spain: a case-control study

BACKGROUND

Polycystic ovary syndrome (PCOS) is a chronic condition with symptoms affecting many women at reproductive age and evaluating their health-related quality of Life (HRQoL) is an important issue. Moreover, differences in the HRQoL between women with different PCOS phenotypes have never been analyzed. Therefore, the aim of our study was to compare the HRQoL between women with PCOS -and its phenotypes- and controls attending to a tertiary hospital.

METHODS

A group of 117 women with PCOS and 153 controls were studied between 2014 and 2016. Controls were women without PCOS attending the gynecological outpatient clinic for routine examinations. Cases were women attending the same setting and diagnosed with PCOS. PCOS diagnose was performed following the Rotterdam Criteria and women were further classified by anovulatory or ovulatory phenotypic subtype. Women underwent physical and gynecological exams and completed health questionnaires including the Short Form-12v2. Eight scales and two component summary scores [Physical (PCS) and Mental (MCS), respectively] were calculated. Bivariate and multivariate analyses were performed to assess differences in HRQoL between women with PCOS and controls.

RESULTS

All women with PCOS and anovulatory PCOS presented lower score in PCS compared to controls [mean (95%CI): 53.7 (52.5-54.9) and 52.9 (51.5-54.4) vs. 55.8 (54.8-56.8); p-values< 0.01], as well as lower scores for five out of the eight scales (p-values < 0.05) after adjusting by age, body mass index, infertility, educational level and current occupation. No significant differences were observed for the MCS between women with or without PCOS or its phenotypic subtypes.

CONCLUSIONS

HRQoL was significantly decreased in adult women with PCOS and its anovulatory phenotype compared to controls attending the outpatient clinic of a tertiary hospital. These results may have implications for the clinical practice and suggest the need for specific interventions in women with PCOS.

Does the anogenital distance change across pregnancy?

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 (AGD_AC), and from the posterior fourchette to the upper verge of the anus (AGD_AF) 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, AGD_AC 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 AGD_AF 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 AGD_AF and AGD_AC, when adjusted by BMI, do not change throughout gestation despite maternal anthropometric variations during pregnancy. AGD_AF may be a meaningful measurement at any time during pregnancy without considering BMI. Therefore, maternal AGD_AF may be used as a prenatal biomarker of the mother's in-uteru hormonal exposure even during pregnancy.

Stent graft deployment in haemodialysis fistula: patency rates in partially thrombosed aneurysm and residual thrombi

Background

Current evidence is insufficient to determine the contribution of stent grafts as treatment in partially thrombosed aneurysms or residual wall-adherent thrombi in arteriovenous fistulae (AVFs) for haemodialysis. The overall purpose of this study was to analyse patency rates of post-interventional covered stent deployment in those cases. We also assessed if patency rates differed when fistulas were punctured through the stent during dialysis sessions.

Methods

We conducted a retrospective study between 2006 and 2014 analysing post-intervention primary patency rates using the Kaplan-Meier log-rank test. Multivariate Cox proportional regression models were performed to determine if cannulation within the stent graft area was a potential risk factor for occlusion, by adjusted hazard ratio (HR).

Results

A total of 27 procedures were included in the study. Primary patency rates (%) after stent deployment at 3, 6, 12, 24, 36 and 72 months were, respectively: total 59, 32, 32, 21, 11 and 5; stent puncture 53, 21, 21, 16, 5 and 0; and no stent puncture 80, 80, 80, 40, 40 and 40. Cannulation through the stent graft was not significantly associated with increased risk of obstruction in multivariate analysis (HR = 3.01; P = 0.286).

Conclusion

Stent graft treatment may be a feasible procedure in partially thrombosed aneurysms and residual thrombi in AVF. Although fistulas punctured through the stent presented lower patency rates, this practice was not associated with a higher risk of obstruction. Giving the impossibility of comparing with similar approaches, further studies are needed to confirm or refute the advantages of this procedure.

Vitamin D status is not associated with reproductive parameters in young Spanish men

BACKGROUND

Relatively low sperm count was reported among young Spanish men in 2013. Several potential culprits have been suggested as explanations for reported trends in sperm counts in Western men, including lifestyles. Although controversial, some studies suggest that semen parameters, such as low sperm motility or abnormal morphology, may be associated with low serum vitamin D levels.

OBJECTIVES

To evaluate associations between semen parameters and reproductive hormones and serum 25-hydroxyvitamin D (25OHD) status in young Spanish men and to examine these associations in relation to dietary intake of vitamin D.

MATERIALS AND METHODS

This cross-sectional study includes 198 university students recruited in 2010-2011 in southern Spain, who provided samples of blood and semen and food frequencies. Semen quality was evaluated by measuring volume, concentration, sperm counts, motility, and morphology, according to the WHO guidelines. Serum samples were analyzed for total 25OHD and reproductive hormones, including FSH, LH, testosterone, inhibin B, and estradiol. Dietary vitamin D intake was assessed using a validated food frequency questionnaire. Associations with semen quality and reproductive hormones were examined using linear regression, adjusting for potential confounders.

RESULTS

Almost all men had adequate levels of serum vitamin D - only three men (1.5%) were vitamin D deficient (<30 nmol/L) and 17% were insufficient (<50 nmol/L). However, dietary vitamin D intakes were relatively low (below recommended 600 IU/day in 99% of men). Neither dietary intake nor serum vitamin D levels were associated with any sperm parameter or any reproductive hormone (all p ≥ 0.09).

DISCUSSION

We did not observe an association between vitamin D status and any reproductive parameter in our study population.

CONCLUSIONS

Our results suggest that serum vitamin D levels are sustained in Spanish men despite low dietary intake and therefore low vitamin D does not explain the poor semen quality previously observed in these young Spanish men.

[Study of anogenital distance as a diagnostic tool for prostate cancer]

INTRODUCTION AND OBJECTIVE

The distance from the genitals to the anus (anogenital distance [AGD]) reflects androgen concentration during prenatal development in mammals. At the present time, there is only one study suggesting the relationship between AGD and risk of prostate cancer (CaP). The goal of this study was to assess the performance and clinical utility of AGD, as a biomarker of prenatal androgenic milieu, and risk of CaP in a larger population, in CaP diagnosis.

MATERIAL AND METHODS

A case-control study was conducted on 260 men seen in a hospital outpatient clinic where underwent a physical and andrological examination and completed a brief questionnaire. CaP patients were confirmed by biopsy of the tumor. Controls were men without CaP seen in the urology outpatient clinic for routine examinations. Two variants of AGD (from the anus to the posterior base of the scrotum [AGD_AS] and to the cephalad insertion of the penis [AGD_AP]) were measured. Parametric and non-parametric tests and receiver operating characteristic (COR) analyses were used to determine relationships between AGD and presence of CaP.

RESULTS

The highest area under the curve (0.69; 95% CI 0.60 to 0.78 and 0.69; 95% CI 0.61 to 0.77) was obtained for the Gleason=7 subgroup with the AGD_AS and AGD_AP measurement, with a sensitivity and specificity of 83% and 55%, and 91% and 41%, the predictive positive value of 39% and 35% and negative value of 90% and 93% respectively.

CONCLUSION

AGD may be a useful clinical tool for the CaP diagnosis.

Are there differences in basal thrombophilias and C-reactive protein between women with or without PCOS?

RESEARCH QUESTION

Polycystic ovary syndrome (PCOS) women have increased cardiovascular risks, although it is unclear whether the haemostatic system and coagulation contribute to that increased risk.

DESIGN

Women attending the Gynecology Unit of the 'Virgen de la Arrixaca' University Hospital (Murcia, Spain) for routine gynaecological examinations between September 2014 and May 2016 were assessed for PCOS using the Rotterdam criteria (hyperandrogenism [H], oligo/amenorrhoea [O] and polycystic ovarian morphology [POM]) and were classified into four phenotypic. In total, 126 cases were identified and 159 control women were selected. All women underwent physical and gynaecological examinations, and blood tests between the second and fifth day of the menstrual cycle. Differences in hormonal, basal thrombophilia and metabolic parameters, and C-reactive protein (CRP) between PCOS and controls were analysed.

RESULTS

After adjusting by BMI and age, PCOS women had higher LH (P < 0.001), testosterone (P < 0.001), free testosterone (P = 0.01) and anti-Müllerian hormone (P < 0.001) and lower FSH (P = 0.03) compared with controls, whereas sex hormone-binding globulin was no different. Cases showed significantly higher protein S, glucose, insulin and insulin resistance (HOMA-IR) compared with controls (P < 0.05). There were no differences in protein C levels, antithrombin III, prothrombin time, homocysteine, D-dimer, factor V Leyden, prothrombin G20210A polymorphism or CRP. The H+O phenotype showed the poorest results for insulin and HOMA-IR (P = 0.04 and 0.05).

CONCLUSIONS

The results suggest that there are no differences in the basal thrombophilias between women with and without PCOS. However, PCOS with H+O shows the poorest metabolic profile.

[Prostate cancer is associated with the anogenital distance, a biomarker of prenatal androgen milieu.]

OBJECTIVE

To evaluate the associationbetween anogenital distance (AGD), as a biomarker ofprenatal androgen milieu, and risk of prostate cancer(PCa).

METHODS

A case-control study was conducted on260 men attending a university hospital where theyunderwent physical and andrological examination andcompleted a brief questionnaire. PCa patients were confirmedby biopsy of the tumor. Controls were men withoutPCa attending the urology outpatient clinic for routineexaminations. Two variants of AGD [from the anus to theposterior base of the scrotum (AGDAS) and to the cephaladinsertion of the penis (AGDAP)] were measured.Unconditional multiple logistic regression was used toestimate the association between AGD measurementsand presence of PCa, and Odds Ratios and 95% confidenceintervals (CI) were calculated.

RESULTS

Cases showed significantly shorter AGDAPand AGDAS than controls. Subjects with AGDAP andAGDAS in the lowest compared to the upper tertile were2.6 times (95% CI 1.2-5.6) and 3.2 times (95% CI 1.5-6.9) more likely to have PCa, respectively.

CONCLUSIONS

We found that shorter measurementsof both distances (AGDAS and AGDAP) were associatedwith higher risk of PCa. A previous study reportedsimilar results, showing that longer AGDAP was associatedwith lower risk of PCa, but this relationship was notfound for AGDAS, as it was in our study with a largersample size.

Accuracy of anogenital distance and anti-Müllerian hormone in the diagnosis of endometriosis without surgery

OBJECTIVE

To assess the predictive ability of a combination of anogenital distance (AGD) and anti-Müllerian hormone (AMH) to diagnosis the presence of endometriosis without surgery.

METHODS

The present study included women diagnosed with endometriosis and a control group who attended the "Virgen de la Arrixaca" University Hospital, Murcia, Spain, between September 1, 2014, and May 31, 2015. Serum concentrations of AMH were measured, and two AGD measurements were obtained: from the anterior clitoral surface to the upper verge of the anus (AGD_AC ), and from the posterior fourchette to the upper verge of the anus (AGD_AF ). Data were assessed by receiver operator characteristic (ROC) curves.

RESULTS

Women in the endometriosis group (n=57) had significantly shorter AGD_AF (22.8 ± 4.6 vs 27.2 ± 5.7 mm; P<0.001) and lower AMH (2.2 ± 2.5 vs 3.3 ± 1.9 ng/mL; P<0.003) compared with the control group (n=93). Women with serum AMH below the clinical cut-off (1 ng/mL) were 17.40-times more likely to have endometriosis (95% confidence interval [CI] 5.64-53.82). The area under the ROC curve of combined AMH and AGD_AF was 0.77 (95% CI 0.70-0.85).

CONCLUSION

The model for predicting endometriosis on the basis of AMH and AGD could be useful for clinicians and epidemiologists to improve diagnosis and prognosis of this condition.

Assessment of anogenital distance as a diagnostic tool in polycystic ovary syndrome

RESEARCH QUESTION

Is anogenital distance (AGD) a useful clinical tool for predicting polycystic ovarian syndrome (PCOS) and its main National Institutes of Health (NIH) phenotypes?

DESIGN

Case-control study conducted between September 2014 and May 2016 at the Department of Obstetrics and Gynecology of the University Clinical Hospital 'Virgen de la Arrixaca' in the Murcia region (south-eastern Spain). One hundred and twenty-six cases of PCOS and 159 controls without PCOS were included. AGD measurements were taken from the anterior clitoral surface to the upper verge of the anus (AGD_AC), and from the posterior fourchette to the upper verge of the anus (AGD_AF). Parametric and non-parametric tests and receiver operating characteristic (ROC) curves were used to assess associations between AGD and the presence of PCOS and its phenotypes.

RESULTS

AGD_AC, but not AGD_AF, was associated with PCOS and all its phenotypes (P-values < 0.001 to 0.048). The highest area under the curve (0.62; 95% confidence interval 0.55 to 0.71) was obtained for all PCOS with AGD_AC with a sensitivity and specificity of 50.0% and 73.0%, and positive and negative predictive value of 59.0% and 64.4%, respectively.

CONCLUSIONS

AGD_AC could moderately discriminate the presence of PCOS and may be a useful clinical tool.

Patency rates of dysfunctional central hemodialysis venous catheter: Comparison between catheter exchange alone and catheter exchange with fibrin sheath angioplasty

PURPOSE

The purpose of this study was to compare patency rates and risk of obstruction of catheter exchange (CE) with that of CE with fibrin sheath angioplasty (CE+FSA) in dysfunctional tunneled central hemodialysis venous catheter (CHVC).

MATERIALS AND METHODS

A total of 107 consecutive patients with dysfunctional CHVC were retrospectively included. There were 66 men and 41 women with a mean age of 67.8±12.5 (SD) years (range: 23.0-86.0 years). Seventy-three of 107 patients (68.2%) underwent CE procedure and 34 of 107 (31.8%) underwent CE+FSA. Kaplan-Meier log-rank test and multivariate Cox regression analyses were performed to determine patency rates and risk of obstruction according to type of endovascular procedure.

RESULTS

Patency rates after endovascular procedures at 3, 6, 12, 24 and 36 months follow up were 75%, 75%, 65%, 65% and 65% in CE+FSA group and 70%, 65%, 62%, 30% and 0% in CE group. Mean time until obstruction of CHVC was 778.4 days after CE+FSA and 497 days after CE (P=0.211). Endovascular procedure was unrelated to risk of obstruction in adjusted model (HR=1.34; P=0.515).

CONCLUSIONS

Our findings suggest that both techniques are equivalent in terms of patency and safety results, so other aspects as cost assessment should be considered when choosing between both techniques.

Anogenital Distance and Perineal Measurements of the Pelvic Organ Prolapse (POP) Quantification System

Anogenital distance (AGD) is a sexually dimorphic attribute, twice longer in males than in females, and a marker of intrauterine hormonal environment. Interest in AGD measurements is increasing due to mounting evidence on their potential clinical implications. A parallel set of perineal measurements, the Pelvic Organ Prolapse Quantification System (POP-Q), include similar, but not exactly the same, landmarks: the perineal body (PB) and the genital hiatus (GH) lengths. However, clinical reproducibility of both perineal measurements and their usefulness to describe perineal anthropometry needs to be elucidated. To our knowledge, there is no publication in video format showing the methodology of these measurements. The main objective of this work is to show how to properly perform perineal anthropometry, including measurements of the AGD in its two variants [anoclitoral (AGDAC) and anofourchette (AGDAF)], genital hiatus (GH) and perineal body (PB). Moreover, we explored if there were differences in these measurements in women with and without Pelvic Organ Prolapse (POP). We research whether the anthropometric characteristics of the perineum, such as AGD (which is determined prenatally), may be altered in these women and be an independent etiological factor for pelvic floor dysfunction. We show two different ways of measuring perineal lengths, as they might be quite comparable. Our suggestion is that unifying perineal measurements could be useful for clinical and biomedical investigation. More studies are needed in order to compare GH and PB measurements and its AGD counterparts to analyze which procedures are more reproducible with less intra and interobserver variability.

Urinary concentrations of parabens and reproductive parameters in young men

Parabens are a group of alkyl esters of p-hydroxybenzoic acid that are commonly added to personal care products, cosmetics, pharmaceuticals and beverage and food processing as antimicrobial preservatives. Parabens have been reported to show estrogenic effects and affect male reproduction function in animal models, but human epidemiologic studies are still scarce. The objective of this study was to examine associations between urinary concentrations of parabens and semen quality and reproductive hormone levels. This was a cross-sectional study with 215 young university students (18-23years old) recruited between 2010 and 2011 in Southern Spain (Murcia Region). All men provided a urine, blood and semen sample on a single day. Urinary paraben concentrations (methylparaben, ethylparaben, propylparaben and butylparaben) were measured by dispersive liquid-liquid microextraction and ultra-high performance liquid chromatography with tandem mass spectrometry detection. Semen quality was evaluated by measuring volume, sperm concentration, total sperm count (TSC), motility and morphology following WHO guidelines. Serum samples were analyzed for reproductive hormones, including follicle-stimulating hormone, luteinizing hormone, testosterone, inhibin B and estradiol using immunoassays. Associations between urinary concentrations of parabens and semen quality parameters and reproductive hormone levels were examined using linear regression, adjusting for potential covariates. Ninety-four percent of the men had detectable urinary concentrations of parabens. After taking into account important covariates, urinary concentrations of parabens or their molar sum were not significantly associated with any semen parameters or any of the reproductive hormone levels. Relative to men in the lowest quartile of sum of urinary paraben concentrations, the adjusted difference (95% CI) of TSC (millions) for men in the 2nd, 3rd, and 4th quartiles were 4.1% (-37.1;45.3), -1.6% (-41.9;38.8), and -9.8% (-52.5;32.8), respectively (P-trend=0.55). Our results suggest that, in young men, urinary parabens may not adversely impact reproductive function, but further research is warranted to confirm these findings in other male populations.

Urinary bisphenol A concentrations are associated with reproductive parameters in young men

Bisphenol A (BPA) is a pervasive environmental toxicant with known reproductive effects on sperm parameters and hormone levels. Several observational studies have investigated the associations between BPA exposure and male reproductive function, but findings are inconsistent. The objective of this study was to assess the associations between urinary BPA concentrations and semen quality and reproductive hormone levels in a cross-sectional study with 215 healthy young university students (18-23 years old), investigated between 2010 and 2011 in Southern Spain (Murcia Region). All subjects provided urine, blood serum and semen samples on a single day. Urinary BPA concentrations were measured by dispersive liquid-liquid microextraction and ultra-high performance liquid chromatography with tandem mass spectrometry detection. Semen quality was evaluated by measuring volume, concentration, motility, morphology and total sperm count (TSC). Serum samples were analyzed for reproductive hormones, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, inhibin B and estradiol. Relationships between urinary BPA concentrations and semen quality parameters and reproductive hormone levels were examined using linear regression, adjusting for potential confounders and covariates. Ninety-five percent of the men had detectable urinary BPA concentrations with unadjusted median (5th-95th) of 2.8 (0.16-11.5) ng/mL. After adjustment for important covariates, there was a significant positive association between urinary BPA concentrations and serum LH levels (β = 0.07, 95%CI: 0.02;0.12, p-value < 0.01). Urinary BPA concentration was also significantly and inversely associated with sperm concentration (β = - 0.04, 95%CI: - 0.07;- 0.02, p-value < 0.01) and TSC (β = - 0.05, 95%CI: - 0.08;- 0.02, p-value < 0.01). No significant associations were found between BPA and other semen parameters or reproductive hormone levels. Our results support the hypothesis that BPA exposure may be associated with a reduction in Leydig cell capacity (increased LH levels) and decreased sperm counts in young men.

Anogenital distance and variability in semen parameters

The purpose of this study was to analyze whether the anogenital distance (AGD) was associated with variability in semen parameters. Semen parameters analyzed following the WHO guidelines and sperm DNA fragmentation were evaluated in 160 semen samples obtained over a period of a year from 16 healthy male volunteers. Two types of AGD measurements from the anus to the rear base of the scrotum (AGD_AS) and to the cephalic insertion of the penis (AGD_AP) were taken in each individual. The association between AGDs and semen parameters were studied using three statistical tools: a) general coefficient of variation (CV) and intra-individual coefficient of variation (CV_i), b) general linear models for repeated measures, and c) mixed model fixed effects panel data. Men with shortened AGD_AP have significantly greater intra-individual variability in sperm concentration, total sperm count, and normal sperm morphology. Conversely, greater total sperm motility was observed in men with long AGD_AS. Shortened AGD_AS was associated with less intra-individual variability of total sperm motility (progressive and non-progressive). AGD measurements were associated with the variability in semen parameters. AGD may be useful to determine intra-individual variability in semen parameters.

ABBREVIATIONS

AGD: anogenital distance; AGD_AP: anogenital distance from the anus to the cephalic insertion of the penis; AGD_AS: anogenital distance from the anus to the rear base of the scrotum; AIC: Akaike information criteria; BMI: body mass index; CV: general coefficient of variation; CV_i: intra-individual coefficient of variation; GLM: generalized linear model; PR+NP: total sperm motility.

Anogenital Distance, a Biomarker of Prenatal Androgen Exposure Is Associated With Prostate Cancer Severity

BACKGROUND

Anogenital distance (AGD), the distance from the centre of the anus to the genitals, is a sexually dimorphic phenotype in mammals. Experimental studies have shown that AGD is a biomarker of prenatal androgen exposure during the masculinisation period of development. The aim of this study is to assess the relationship between anogenital distance (AGD), as an indirect marker of prenatal hormonal environment, and prostate cancer (PCa) severity.

MATERIALS

We conducted a cross-sectional study with a total of 120 PCa patients with confirmed biopsy of the tumour from April 2007 to July 2015. Two variants of the anogenital distance were assessed, from the anus to the posterior base of the scrotum (AGD_AS ) and to the cephalad insertion of the penis (AGD_AP ). We compared differences in groups to evaluate the association between AGD measurements and severity of the preoperative biopsy and clinical scores.

RESULTS

Longer AGD_AS was significantly associated with the highest Gleason score (P = 0.015) and D'Amico nomogram (P = 0.048). In contrast, no statistical differences were found in the AGD_AP and severity of the preoperative biopsy.

CONCLUSIONS

These findings are consistent with the hypothesis that a higher prenatal androgen exposure is associated with higher severity of PCa. Prostate 77: 406-411, 2017. © 2016 Wiley Periodicals, Inc.

Fatty acid intake in relation to reproductive hormones and testicular volume among young healthy men

Emerging evidence suggests that dietary fats may influence testicular function. However, most of the published literature on this field has used semen quality parameters as the only proxy for testicular function. We examined the association of fat intake with circulating reproductive hormone levels and testicular volume among healthy young Spanish men. This is a cross-sectional study among 209 healthy male volunteers conducted between October 2010 and November 2011 in Murcia Region of Spain. Participants completed questionnaires on lifestyle, diet, and smoking, and each underwent a physical examination, and provided a blood sample. Linear regression was used to examine the association between each fatty acid type and reproductive hormone levels and testicular volumes. Monounsaturated fatty acids intake was inversely associated with serum blood levels of calculated free testosterone, total testosterone, and inhibin B. A positive association was observed between the intake of polyunsaturated fatty acids, particularly of omega-6 polyunsaturated fatty acids, and luteinizing hormone concentrations. In addition, the intake of trans fatty acids was associated with lower total testosterone and calculated free testosterone concentrations (P trend = 0.01 and 0.02, respectively). The intake of omega-3 polyunsaturated fatty acids was positively related to testicular volume while the intake of omega-6 polyunsaturated fatty acids and trans fatty acids was inversely related to testicular volume. These data suggest that fat intake, and particularly intake of omega 3, omega 6, and trans fatty acids, may influence testicular function.

Investigation of anogenital distance as a diagnostic tool in endometriosis

An association between anogenital distance (AGD) and endometriosis has been reported, suggesting that AGD may be a useful clinical tool in endometriosis. The predictive ability of AGD of women in discriminating presence and type of endometriosis was examined. A case-control study was conducted at the University Hospital 'Virgen de la Arrixaca', Murcia, Spain, between 2014 and 2015. A total of 114 participants diagnosed with endometriosis using ultrasound findings and 105 controls were recruited. Two AGD measurements were obtained: one from the anterior clitoral surface to the upper verge of the anus (AGD_AC), and another one from the posterior fourchette to the upper verge of the anus (AGD_AF). Parametric and non-parametric tests andreceiver operator characterstic analyses were used to determine relationships between AGD and presence of endometriosis and subgroups (ovarian endometriomas or deep infiltrating endometriosis [DIE]). The AGD_AF, but not AGD_AC, was associated with presence of endometriomas, DIE (P-values, <0.001-0.02), or both. The highest area under curve (0.91; 95% CI 0.84 to 0.97) was obtained for the DIE subgroup with the AGD_AF measurement, with a sensitivity and specificity of 84.4% and 91.4%, respectively. AGD_AF can therefore efficiently discriminate the presence of DIE and may be a useful clinical tool.

Endometriomas and deep infiltrating endometriosis in adulthood are strongly associated with anogenital distance, a biomarker for prenatal hormonal environment

STUDY QUESTION

Is the length of the anogenital distance (AGD), a biomarker of the in-utero prenatal hormonal environment, associated with the presence of endometriomas and deep infiltrating endometriosis (DIE)?

SUMMARY ANSWER

Shorter AGD is associated with presence of endometriomas and DIE.

WHAT IS KNOWN ALREADY

It is debated whether hormonal exposure to estrogens in utero may be a risk factor for endometriosis in adulthood. AGD is a biomarker of prenatal hormonal environment and observational studies have shown an association between AGD and reproductive parameters in both sexes.

STUDY DESIGN, SIZE, DURATION

This case–control study of 114 women with endometriosis (endometriomas and/or DIE) and 105 controls was conducted between September 2014 and May 2015.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Cases were attending the Endometriosis Unit of the Hospital. Prevalent as well as incident cases, diagnosed by transvaginal ultrasound (TVUS), were included. Controls were women without endometriosis attending the gynecological outpatient clinic for routine gynecological exams. Participants completed health questionnaires, followed physical and gynecological examinations, including TVUS. Measurements from the anterior clitoral surface to the upper verge of the anus (AGD_AC), and from the posterior fourchette to the upper verge of the anus (AGD_AF) were obtained in all subjects. Unconditional multiple logistic regression was used to estimate the association between AGD measurements and presence of endometriomas and/or DIE while accounting for important confounders and covariates, including age, body mass index, vaginal delivery or episiotomy.

MAIN RESULTS AND THE ROLE OF CHANCE

AGD_AF was related to presence of endometriomas and/or DIE. For all cases of endometriosis (endometriomas and DIE), women in the lowest tertile of the AGD_AF distribution, compared with the upper tertile, were 7.6-times (95% CI 2.8–21.0; P-trend < 0.001) more likely to have endometriosis. With regard to DIE, women with AGD_AF below the median, compared with those with AGD_AF above the median, were 41.6-times (95% CI 3.9–438; P-value = 0.002) more likely to have endometriosis.

LIMITATIONS, REASONS FOR CAUTION

In case–control studies, information and selection bias has to be ruled out. Physicians conducting the measurement were blind to the status of the patients. Controls came from the same population as the cases. We adjusted for known and suspected confounders and covariates, but the possibility of residual confounding or chance findings should always be considered. As with all observational studies, causal inference is limited.

WIDER IMPLICATIONS OF THE FINDINGS

This study suggests that endometriosis, especially the DIE, might have a prenatal origin that may be traced back to the hormonal milieu in which the fetus develops.

STUDY FUNDING/COMPETING INTEREST

This work was supported by the Ministry of Economy and Competitiveness, ISCIII (AES), grant no. PI13/01237 and the Seneca Foundation, Murcia Regional Agency of Science and Technology, grant no. 19443/PI/14. The authors have no competing interests to declare.

TRIAL REGISTRATION NUMBER

Not applicable.

Mediterranean and western dietary patterns are related to markers of testicular function among healthy men

STUDY QUESTION

Are there any associations of dietary patterns with semen quality, reproductive hormone levels, and testicular volume, as markers of testicular function?

SUMMARY ANSWER

These results suggest that traditional Mediterranean diets may have a positive impact on male reproductive potential.

WHAT IS KNOWN ALREADY

The Mediterranean diet has been related to lower risk of multiple chronic diseases, but its effects on reproduction potential are unclear.

STUDY DESIGN, SIZE, DURATION

Cross-sectional sample of 215 male university students recruited from October 2010 to November 2011 in Murcia Region (Spain).

PARTICIPANTS/MATERIALS, SETTING, METHODS

Two hundred and nine healthy men aged 18-23 years were finally included in this analysis. Diet was assessed using a validated food frequency questionnaire, and dietary patterns were identified by factor analysis. Linear regression was used to analyze the relation between diet patterns with semen quality parameters, reproductive hormone levels and testicular volume adjusting for potential confounders.

MAIN RESULTS AND THE ROLE OF CHANCE

We identified two dietary patterns: a Mediterranean (characterized by high intakes of vegetables, fruits and seafood) and a Western pattern (characterized by high intakes of processed meats, French fries and snacks). The Mediterranean pattern was positively associated with total sperm count (P, trend = 0.04). The Western pattern was positively related to the percentage of morphologically normal sperm (P, trend = 0.008). We found an inverse association between adherence to the Western pattern and sperm concentration among overweight or obese men (P, trend = 0.04).

LIMITATIONS, REASONS FOR CAUTION

As with all cross-sectional studies, causal inference is limited. However, participants were blinded to the study outcomes thus reducing the potential influenced their report of diet. Although we adjusted for a large number of known and suspected confounders, we cannot exclude the possibility of residual confounding or chance findings.

WIDER IMPLICATIONS OF THE FINDINGS

This study was carried out on healthy and young men, so it is difficult to predict whether and how the observed differences in semen quality translate into reproductive success for men in couples trying to conceive. These results suggest that traditional Mediterranean diets may have a positive impact on male reproductive potential.

Associations between urinary organophosphate pesticide metabolite levels and reproductive parameters in men from an infertility clinic

Organophosphate (OP) pesticides are compounds used for pest control at home or in agriculture activities. Almost all OP pesticides are metabolized to at least one of six possible dialkylphosphates (DAPs). Despite wide use, their potential effects on human reproductive health have not yet been fully characterized. The aim of this study was to evaluate the associations between urinary concentrations of six DAP metabolites and reproductive parameters in men. All men were attended an infertility clinic and provided urine, serum and semen samples on the same day. Six DAP metabolites were measured in urine (dimethylphosphate [DMP], dimethylthiophosphate [DMTP], dimethyldithiophosphate [DMDTP], diethylphosphate [DEP], diethylthiophosphate [DETP], and diethyldithiophosphate [DEDTP]). Sperm quality was assessed by measuring volume, concentration, total sperm count (TSC), motility and morphology, and serum samples were analyzed for reproductive hormones, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, prolactin and estradiol. Pearson correlations were used for unadjusted analyses, and multiple linear regression analysis was performed controlling for appropriate covariates. All men presented detectable concentrations of at least one urinary OP metabolite. After adjustment by important covariates, there was a significant positive association between DEDTP concentrations and LH [(β)=11.4; 95% CI 0.81-22.1] as well as FSH levels [(β)=3.2; 95% CI 0.08-6.2]. Sperm concentration and TSC were both significantly inversely associated with DMP, DMDP, DMDTP and ∑DAP in multivariate analysis. Besides, there was a significant inverse association between percentage of motile sperm and DMTP, DMDTP and DEP metabolite concentrations. Our results suggest that exposure to OP pesticides may be associated with decreased sperm counts and motility and altered reproductive hormone levels in male partners of couples seeking for infertility treatment. However, further studies are warranted to confirm and extent these findings.

Physical activity is not related to semen quality in young healthy men

OBJECTIVE

To study the relationship of physical activity with semen quality among healthy young men from Spain.

DESIGN

Cross-sectional study.

SETTING

University and college campuses of Murcia Region, Spain.

PATIENT(S)

Healthy young men with untested fertility (n = 215).

INTERVENTION(S)

A physical examination, blood and semen samples, and completion of a questionnaire.

MAIN OUTCOME MEASURE(S)

Semen quality parameters.

RESULT(S)

Physical activity was not related to semen quality parameters. The adjusted percentage differences (95% confidence interval) in semen parameters comparing men in the top quartile of moderate-to-vigorous physical activity (≥9.5 h/wk) with men in the bottom quartile (≤3 h/wk) were 4.3% (-30.2%, 38.9%) for total sperm count, 7.2% (-30.6%, 45.1%) for sperm concentration, -2.42% (-6.53%, 1.69%) for sperm motility, and 12.6% (-12.0%, 37.2%) for sperm morphology.

CONCLUSION(S)

In contrast to previous research among athletes, these data suggest that physical activity is not deleterious to testicular function, as captured by semen quality parameters in this population of healthy young men in Spain.

Trans fatty acid intake is inversely related to total sperm count in young healthy men

STUDY QUESTION

Is intake of fatty acids related to semen quality among young men?

SUMMARY ANSWER

The intake of trans fatty acids is inversely related to total sperm count in healthy young men.

WHAT IS KNOWN ALREADY

Spain has seen an increase in the proportion of calories consumed as fat over the same period that a downward trend in semen quality has been observed. In addition, rodent models suggest that trans fat intake may severely affect testicular function.

STUDY DESIGN, SIZE, DURATION

Cross-sectional study of 209 men recruited between October 2010 and November 2011.

PARTICIPANTS/MATERIALS, SETTING, METHODS

A group of 209 healthy young university students 18-23 years of age provided a semen sample and completed a previously validated food frequency questionnaire. The association between intake of fatty acids with semen quality parameters (sperm concentration, motility, morphology and total count) was assessed using multivariate linear regression.

MAIN RESULTS AND THE ROLE OF THE CHANCE

Trans fatty acid intake was inversely related to total sperm count after adjusting for potential confounders (P, trend = 0.03). The multivariate adjusted mean (95% confidence interval) total sperm count in increasing quartiles of trans fat intake was 144 (110-190), 113 (87-148), 100 (18-130) and 89 (69-117). There also was an inverse association between cholesterol intake and ejaculate volume (P, trend = 0.04). No other statistically significant relations were observed.

LIMITATIONS, REASONS FOR CAUTION

The cross-sectional design of the study limits causal inference, we cannot exclude the possibility of unmeasured confounding and there was insufficient statistical power to identify modest associations.

WIDER IMPLICATIONS OF THE FINDINGS

The results of this study, together with previous experimental work in rodents and biomarker studies among infertility patients, suggest that intake of trans fatty acids may be related to lower semen quality. Although the data provide further evidence that diet is a modifiable factor that could impact male fertility, it is not known whether the observed differences in sperm count translate into differences in fertility.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by The Seneca Foundation, Regional Agency of Science and Technology, grant no 00694/PI/04, Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III (FIS), grant no PI10/00985, and grant P30 DK46200 from the National Institutes of Health. The authors have no competing interests to declare.

Sperm counts may have declined in young university students in Southern Spain

Several studies have investigated temporal trends in semen quality in Northern Europe, but none has examined this question in Southern Europe. A prior study conducted in Almeria Province (Southern Spain) reported higher sperm count and concentration among Spanish young men recruited from 2001 to 2002 compared with young men from Northern Europe. The aim of this new study was to examine whether semen quality has changed among Spanish young men in the last decade. In this cross-sectional study, questionnaires and semen samples were collected from 215 healthy young university students from Murcia Region between 2010 and 2011. The 273 men from the Almeria study previously studied were included in a trend analysis of the two populations from Southern Spain. Descriptive statistics were calculated for the Murcia study population and these and semen variables for the Murcia and Almeria study populations were compared. Study methods and population characteristics were similar across the two studies. Therefore, we used multiple linear regression analyses on the combined population (controlling for study centre, age, ejaculation abstinence time, season, smoking, medication during the last 3 months, Body mass index (BMI), presence of varicocoele and prenatal exposure to tobacco) to look for a birth-cohort effect over the combined study period (2001-2011). Sperm concentration and total sperm count declined significantly with year of birth in the pooled analysis (β = -0.04 and β = -0.06, respectively, both p < 0.01). Sperm counts were significantly lower in Murcia study subjects than in the Almeria participants; sperm concentration median (5th-95th) = 44.0 (8.9-129) million/mL vs. 51.0 (5.0-206) million/mL; p < 0.01 and total sperm count = 121 (17.8-400) million vs. 149 (8.0-599) million; p < 0.01. Other semen variables did not differ significantly between the two studies. Our study suggests that total sperm count and sperm concentration may have declined in young Spanish men over the last decade.

Anogenital distance is related to ovarian follicular number in young Spanish women: a cross-sectional study

BACKGROUND

In animals, anogenital distance (AGD) at birth reflects androgen levels during pregnancy and predicts adult AGD. Little is known about AGD in relation to female reproductive characteristics in humans, a question this study was designed to explore.

METHODS

We used multiple linear and logistic regression analyses to model the relationships between adult female reproductive system characteristics (e.g. ovarian morphology, menstrual cycle) and two measures of AGD [anus-fourchette (AGD(AF)) and anus-clitoris (AGD(AC))] in 100 college-age volunteers in Spain. Ovarian morphology was classified as having < 6 or ≥ 6 follicles per ovary.

RESULTS

Both AGD measures were positively associated with ovarian follicle number, with AGD(AF) being more strongly associated. Women in the upper tertile of the AGD(AF) and AGD(AC) distributions were more likely to have ≥ 6 ovarian follicles [OR: 6.0 (95% CI 2.0, 17.6) and 3.0 (95% CI 1.1, 8.6), respectively] compared to women in the lowest tertile.

CONCLUSIONS

Increased follicular recruitment has been related to excess androgen exposure in utero in toxicological studies. Our results suggest that the androgenic environment during early fetal life may influence reproductive system development, including AGD, in human females.

Relationships between heavy metal concentrations in three different body fluids and male reproductive parameters: a pilot study

BACKGROUND

Animal studies have shown the reproductive toxicity of a number of heavy metals. Very few human observational studies have analyzed the relationship between male reproductive function and heavy metal concentrations in diverse biological fluids.

METHODS

The current study assessed the associations between seminal and hormonal parameters and the concentration of the 3 most frequent heavy metal toxicants (lead, cadmium and mercury) in three different body fluids. Sixty one men attending infertility clinics that participated in a case-control study to explore the role of environmental toxins and lifestyles on male infertility were analyzed. Concentration of lead, cadmium and mercury were measured in blood and seminal plasma and whole blood using anodic stripping voltammetry and atomic absorption spectrophotometry. Serum samples were analyzed for follicle-stimulating hormone, luteinizing hormone and testosterone. Semen analyses were performed according to World Health Organization criteria. Mann-Whitney test and Spearman's rank correlations were used for unadjusted analyses. Multiple linear regression models were performed controlling for age, body mass index and number of cigarettes per day.

RESULTS

There were no significant differences between cases and controls in the concentrations of heavy metals in any of the three body fluids. In multivariate analyses using all subjects no significant associations were found between serum hormone levels and metal concentrations. However there was a significant positive association between the percentage of immotile sperms and seminal plasma levels of lead and cadmium.

CONCLUSIONS

Our results suggest that the presence of lead and cadmium in the reproductive tract of men may be related to a moderate alteration of their seminal parameters.

A low intake of antioxidant nutrients is associated with poor semen quality in patients attending fertility clinics

OBJECTIVE

To compare specific nutrient intake between normospermic and oligoasthenoteratospermic patients attending infertility clinics in two Mediterranean provinces of Spain.

DESIGN

Case-control study.

SETTING

Private fertility clinics in southeastern Spain.

PATIENT(S)

Thirty men with poor semen quality (case subjects) and 31 normospermic control subjects of couples attending our fertility clinics.

INTERVENTION(S)

We recorded dietary habits and nutrient consumption using a food frequency questionnaire adapted to meet specific study objectives.

MAIN OUTCOME MEASURE(S)

We calculated nutrient intakes by multiplying the frequency of use for each food by the nutrient composition of the portion size specified on the food frequency questionnaire and by addition across all foods to obtain a total nutrient intake for each individual. Semen quality was assessed by measuring volume, concentration, motility, and morphology. Hormones levels were also analyzed in case and control subjects.

RESULT(S)

In the logistic regression, control subjects had a significantly higher intake of carbohydrates, fiber, folate, vitamin C, and lycopene and lower intakes of proteins and total fat.

CONCLUSION(S)

A low intake of antioxidant nutrients was associated with a poor semen quality in this case-control study of Spanish men attending infertility clinics.