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Wyrwoll MJ, van der Heijden GW, Krausz C, Aston KI, Kliesch S, McLachlan R, Ramos L, Conrad DF, O'Bryan MK, Veltman JA, Tüttelmann F. Improved phenotypic classification of male infertility to promote discovery of genetic causes. Nat Rev Urol 2024; 21:91-101. [PMID: 37723288 DOI: 10.1038/s41585-023-00816-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/20/2023]
Abstract
An increasing number of genes are being described in the context of non-syndromic male infertility. Linking the underlying genetic causes of non-syndromic male infertility with clinical data from patients is important to establish new genotype-phenotype correlations. This process can be facilitated by using universal nomenclature, but no standardized vocabulary is available in the field of non-syndromic male infertility. The International Male Infertility Genomics Consortium aimed at filling this gap, providing a standardized vocabulary containing nomenclature based on the Human Phenotype Ontology (HPO). The "HPO tree" was substantially revised compared with the previous version and is based on the clinical work-up of infertile men, including physical examination and hormonal assessment. Some causes of male infertility can already be suspected based on the patient's clinical history, whereas in other instances, a testicular biopsy is needed for diagnosis. We assembled 49 HPO terms that are linked in a logical hierarchy and showed examples of morphological features of spermatozoa and testicular histology of infertile men with identified genetic diagnoses to describe the phenotypes. This work will help to record patients' phenotypes systematically and facilitate communication between geneticists and andrologists. Collaboration across institutions will improve the identification of patients with the same phenotypes, which will promote the discovery of novel genetic causes for non-syndromic male infertility.
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Affiliation(s)
- Margot J Wyrwoll
- Institute of Reproductive Genetics, University of Münster, Münster, Germany
| | | | - Csilla Krausz
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, University Hospital of Careggi (AOUC), Florence, Italy
| | - Kenneth I Aston
- Andrology and IVF Laboratory, Department of Surgery (Urology), University of Utah, Salt Lake City, UT, USA
| | - Sabine Kliesch
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University of Münster, Münster, Germany
| | - Robert McLachlan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Liliana Ramos
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Donald F Conrad
- Department of Genetics, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, USA
| | - Moira K O'Bryan
- School of BioSciences and Bio21 Institute, The University of Melbourne, Parkville, Victoria, Australia
| | - Joris A Veltman
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Frank Tüttelmann
- Institute of Reproductive Genetics, University of Münster, Münster, Germany.
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2
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Handelsman DJ, Sartorius G, Desai R, Idan A, Turner L, Savkovic S, Ly LP, Forbes E, Allan CA, McLachlan R, Conway AJ. Sex steroids and androgen biomarkers in the healthy man study: within-person variability and impact of fasting. Eur J Endocrinol 2024; 190:54-61. [PMID: 38141148 DOI: 10.1093/ejendo/lvad178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/20/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE Serum testosterone measurements in clinical practice mostly utilize "direct" (non-extraction) immunoassays which have method-specific bias due to steroid cross-reactivity and nonspecific matrix artifacts. Although more accurate, sensitive, and specific liquid chromatography-mass spectrometry (LCMS) dominates in clinical research, the within-person variability of serum testosterone in healthy men using LCMS measurement is not reported. DESIGN Longitudinal multi-sampling observational study of men in excellent health over 3 months. METHODS Elite healthy men (n = 325) over 40 years of age in excellent, asymptomatic health provided 9 blood samples over 3 months with serum testosterone, dihydrotestosterone (DHT), estradiol (E2), and estrone (E1) measured by validated LCMS with conventional biochemical and anthropometric variables. RESULTS Quantitative estimates of within-person variability within day and between day, week, month, and quarter were stable other than an increase due to fasting. The androgen biomarkers most sensitive to age and testosterone among widely used biochemical and anthropometric variables in middle-aged and older men were identified. CONCLUSIONS This study provides estimates of variability in serum testosterone and the best androgen biomarkers that may prove useful for future studies of androgen action in male ageing.
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Affiliation(s)
- David J Handelsman
- ANZAC Research Institute, University of Sydney, Sydney, NSW 2139, Australia
- Andrology Department, Concord Hospital, Sydney, NSW 2139, Australia
| | | | - Reena Desai
- ANZAC Research Institute, University of Sydney, Sydney, NSW 2139, Australia
| | - Amanda Idan
- Andrology Department, Concord Hospital, Sydney, NSW 2139, Australia
| | - Leo Turner
- Andrology Department, Concord Hospital, Sydney, NSW 2139, Australia
| | - Sasha Savkovic
- Andrology Department, Concord Hospital, Sydney, NSW 2139, Australia
| | - Lam P Ly
- Andrology Department, Concord Hospital, Sydney, NSW 2139, Australia
| | - Elise Forbes
- Hudson Institute, Monash University, Melbourne, VIC 3168, Australia
| | - Carolyn A Allan
- Hudson Institute, Monash University, Melbourne, VIC 3168, Australia
| | - Robert McLachlan
- Hudson Institute, Monash University, Melbourne, VIC 3168, Australia
| | - Ann J Conway
- Andrology Department, Concord Hospital, Sydney, NSW 2139, Australia
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3
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Hammarberg K, Halliday J, Kennedy J, Burgner DP, Amor DJ, Doyle LW, Juonala M, Ranganathan S, Welsh L, Cheung M, McLachlan R, McBain J, Lewis S. Does being conceived by assisted reproductive technology influence adult quality of life? HUM FERTIL 2023; 26:1008-1014. [PMID: 35317704 DOI: 10.1080/14647273.2022.2042860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/08/2021] [Indexed: 11/04/2022]
Abstract
Numerous studies have investigated the physical health and development of children and adolescents conceived with assisted reproductive technology (ART). Less is known about the quality of life of ART-conceived adults. This study explores the contributions of being conceived with ART and psychosocial cofactors present in young adulthood to the quality of life of adults aged 22-35 years. Young adults conceived through ART or natural conception (NC) completed questionnaires which included a standardized measure of quality of life (World Health Organization Quality of Life - Brief assessment (WHOQoL-BREF)) when aged 18-28 years (T1) and again when aged 22-35 years (T2). The WHOQoL-BREF has four domains: (i) Physical, (ii) Psychological, (iii) Social relationships and (iv) Environment. A total of 193 ART-conceived and 86 NC individuals completed both questionnaires. When accounting for other cofactors in multivariable analyses, being ART-conceived was strongly associated with higher scores (better quality of life) on the Social relationships, and Environment WHOQoL-BREF domains at T2. In addition, less psychological distress, a better relationship with parents, a better financial situation, and perceptions of being about the right weight at T1 were associated with higher scores on one or more of the WHOQoL-BREF domains at T2. In conclusion, being ART-conceived can confer advantages in quality of life in adulthood, independent of psychosocial cofactors.
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Affiliation(s)
- Karin Hammarberg
- Global and Women's Health, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia
| | - Jane Halliday
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Joanne Kennedy
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - David P Burgner
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - David J Amor
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Lex W Doyle
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, University of Melbourne, Parkville, Australia
| | - Markus Juonala
- Department of Internal Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Sarath Ranganathan
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Liam Welsh
- Murdoch Children's Research Institute, Parkville, Australia
| | - Michael Cheung
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Robert McLachlan
- Monash IVF Group Pty Ltd, Richmond, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | | | - Sharon Lewis
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
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4
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Biggs SN, Kennedy J, Lewis SL, Hearps S, O’Bryan MK, McLachlan R, von Saldern S, Chambers G, Halliday J. Lifestyle and environmental risk factors for unexplained male infertility: study protocol for Australian Male Infertility Exposure (AMIE), a case-control study. Reprod Health 2023; 20:32. [PMID: 36782223 PMCID: PMC9924856 DOI: 10.1186/s12978-023-01578-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/30/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Approximately 1 in 20 men are sub-fertile or infertile yet the aetiologies of male infertility remain largely unexplained. It is suggested that lifestyle choices and environmental factors contribute but research is limited. In particular, no study has evaluated early life exposures and subsequent male infertility. To address this knowledge gap, this study aims to characterise a cohort of men with idiopathic infertility and compare their general health, lifestyle choices and environmental exposures from teenage years onwards to men without reproductive abnormalities. METHODS Two groups of men (N = 500 cases; N = 500 controls), matched for age and socio-economic status, will be recruited from fertility clinics around Australia between June 2021 and June 2024. Men will be eligible if they are between 18 and 50 years, with a female partner less than 42 years, and have identified idiopathic male infertility (case) or are part of a couple with diagnosed female factor infertility but with no indication of compromised male fertility (control). Participants will complete an in-depth survey on general health, lifestyle and environmental exposures, reporting from teenage years onwards. An online medical data capture form will be used to gather fertility assessment information from participant medical records. Biological specimens of saliva (all study participants), blood and urine (optional) will be collected and stored for future genetic and epigenetic analysis. Differences in outcome measures between cases and controls will be determined using appropriate between groups comparisons. The relationship between explanatory variables and infertility will be analysed using multilevel modelling to account for clustering within fertility clinics. DISCUSSION This study addresses an important gap in research on the aetiology of male infertility and will provide a comprehensive profile of the lifestyle and environmental risk factors for male infertility, leading to provision of up-to-date health advice for male teenagers and adults about optimising their fertility.
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Affiliation(s)
- Sarah N. Biggs
- grid.1058.c0000 0000 9442 535XReproductive Epidemiology, Murdoch Children’s Research Institute, Melbourne, 3052 Australia
| | - Joanne Kennedy
- grid.1058.c0000 0000 9442 535XReproductive Epidemiology, Murdoch Children’s Research Institute, Melbourne, 3052 Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, University of Melbourne, Melbourne, 3052 Australia
| | - Sharon L. Lewis
- grid.1058.c0000 0000 9442 535XReproductive Epidemiology, Murdoch Children’s Research Institute, Melbourne, 3052 Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, University of Melbourne, Melbourne, 3052 Australia
| | - Stephen Hearps
- grid.1058.c0000 0000 9442 535XReproductive Epidemiology, Murdoch Children’s Research Institute, Melbourne, 3052 Australia ,grid.1008.90000 0001 2179 088XDepartment of Critical Care, University of Melbourne, Melbourne, 3052 Australia
| | - Moira K. O’Bryan
- grid.1008.90000 0001 2179 088XSchool of BioSciences and Bio21 Institute, Faculty of Science, University of Melbourne, Melbourne, 3010 Australia
| | - Robert McLachlan
- grid.1002.30000 0004 1936 7857Clinical Andrology, Hudson Institute of Medical Research, Monash University, Clayton, 3168 Australia ,Healthy Male, Melbourne, 3004 Australia
| | | | - Georgina Chambers
- grid.1005.40000 0004 4902 0432National Perinatal Epidemiology and Statistics Unit, University of New South Wales, Sydney, 2052 Australia
| | - Jane Halliday
- grid.1058.c0000 0000 9442 535XReproductive Epidemiology, Murdoch Children’s Research Institute, Melbourne, 3052 Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, University of Melbourne, Melbourne, 3052 Australia
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Kieu V, Stern C, Harris J, Jayasinghe Y, Bradford N, Cui W, Deans R, Hunter T, Allingham C, Kane SC, Lau LS, Logan S, McLachlan R, Neville K, Peate M, Phillips M, Saunders C, Tome M, Upreti R, White K, Anazodo A, Hart RJ. Australian fertility preservation guidelines for people with cancer 2022: review and recommendations. Med J Aust 2022; 217:564-569. [PMID: 36309915 PMCID: PMC10092779 DOI: 10.5694/mja2.51751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 09/11/2022] [Accepted: 09/18/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Violet Kieu
- University of Melbourne, Melbourne, VIC.,Royal Women's Hospital, Melbourne, VIC
| | - Catharyn Stern
- University of Melbourne, Melbourne, VIC.,Royal Women's Hospital, Melbourne, VIC
| | | | - Yasmin Jayasinghe
- University of Melbourne, Melbourne, VIC.,Royal Women's Hospital, Melbourne, VIC
| | | | - Wanyuan Cui
- Peter MacCallum Cancer Centre, Melbourne, VIC
| | - Rebecca Deans
- Royal Hospital for Women, Sydney, NSW.,University of New South, Wales, Sydney, NSW
| | | | | | - Stefan C Kane
- University of Melbourne, Melbourne, VIC.,Royal Women's Hospital, Melbourne, VIC
| | | | | | | | - Kristen Neville
- Queensland University of Technology, Brisbane, QLD.,University of New South, Wales, Sydney, NSW
| | - Michelle Peate
- University of Melbourne, Melbourne, VIC.,Royal Women's Hospital, Melbourne, VIC
| | | | | | | | - Rita Upreti
- Hudson Institute of Medical Research, Melbourne, VIC.,Monash Health, Melbourne, VIC
| | - Kate White
- Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital Randwick, Sydney, NSW.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW
| | - Roger J Hart
- Fertility Specialists of WA, Perth, WA.,King Edward Memorial Hospital, Perth, WA
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6
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Horta F, Fernando D, Lantsberg D, Holden S, Katz DJ, Green MP, McLachlan R, Zander-Fox D, Rombauts L. Are Clinical Outcomes of Micro-TESE in Non-obstructive Azoospermic Men Affected by the Use of Fresh or Frozen Gametes? FandR 2022. [DOI: 10.1142/s2661318222500086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: The combination of microsurgical testicular sperm extraction (mTESE) and intracytoplasmic sperm injection (ICSI) has become a common management option, with sperm motility being positively associated with successful outcomes. However, few studies have investigated whether the use of fresh or thawed gamete combinations affect clinical outcomes. Objectives: To determine whether the clinical outcomes of ICSI cycles using mTESE recovered testicular sperm of non-obstructive azoospermia (NOA) patients are affected by using fresh or thawed gametes. Material and Methods: A retrospective study was conducted of NOA patients who underwent mTESE between 2017 and 2020 at Monash IVF assisted reproductive clinics in Melbourne, Australia. The impact of gamete fresh/frozen status and sperm motility was investigated on clinical outcomes such as fertilization, blastocyst formation, clinical pregnancy, and live birth rates (LBRs). Results:A total of 103 NOA patients underwent mTESE, with a 65.1% successful surgical-sperm-retrieval. In total 56 patients contributed to 68 ICSI cycles, with a 35.1% fertilization rate and 25% LBR per embryo transfer. Compared with fresh testicular sperm, thawed testicular sperm did not affect clinical outcomes, including LBRs [16.7% vs 12.0%; odds ratio (OR) 0.68 (0.18–2.70)]. However, the use of thawed oocytes had a negative effect on fertilization rates [fresh-oocytes, 37.8%; vitrified-oocytes, 34.5%; OR 0.86 (0.02–0.48)]. Cycles using only motile sperm had a greater fertilization rate than those using a combination of motile and non-motile sperm (49.6% vs 37.2%, p ¡ 0.05). Importantly, when exclusively non-motile sperm were available (n = 26 cycles) their injection resulted in a very low fertilization rate (2.7%) and no live births were recorded. Conclusion: Micro-TESE is an effective treatment for NOA patients, with no clear advantage of using fresh over thawed sperm, however, the use of vitrified compared with fresh oocytes requires further investigation. Importantly, patients should be informed of the poor outcomes with the use of non-motile sperm in mTESE ICSI cycles.
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Affiliation(s)
- Fabrizzio Horta
- Monash IVF, Clayton, Victoria 3168, Australia
- Monash University, Clayton, Victoria 3168, Australia
| | - Dhanushi Fernando
- Monash IVF, Clayton, Victoria 3168, Australia
- Monash Health, Clayton, Victoria 3168, Australia
| | - Daniel Lantsberg
- Men’s Heath Melbourne, Melbourne, Australia
- The Royal Women’s Hospital, Melbourne 3052, Australia
- University of Melbourne, Melbourne 3010, Australia
| | | | - Darren J. Katz
- Men’s Heath Melbourne, Melbourne, Australia
- University of Melbourne, Melbourne 3010, Australia
- Department of Urology, Western Health, Victoria, Australia
| | - Mark P. Green
- Monash IVF, Clayton, Victoria 3168, Australia
- University of Melbourne, Melbourne 3010, Australia
| | - Robert McLachlan
- Monash IVF, Clayton, Victoria 3168, Australia
- Monash Health, Clayton, Victoria 3168, Australia
- Hudson Institute of Medical Research, Monash University, Clayton, Victoria 3168, Australia
| | - Deirdre Zander-Fox
- Monash IVF, Clayton, Victoria 3168, Australia
- Monash University, Clayton, Victoria 3168, Australia
- University of Adelaide, Adelaide, South Australia 5000, Australia
- University of South Australia, Adelaide, South Australia 5095, Australia
| | - Luk Rombauts
- Monash IVF, Clayton, Victoria 3168, Australia
- Monash University, Clayton, Victoria 3168, Australia
- Monash Health, Clayton, Victoria 3168, Australia
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7
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Bryan ER, Redgrove KA, Mooney AR, Mihalas BP, Sutherland JM, Carey AJ, Armitage CW, Trim LK, Kollipara A, Mulvey PBM, Palframan E, Trollope G, Bogoevski K, McLachlan R, McLaughlin EA, Beagley KW. Chronic testicular Chlamydia muridarum infection impairs mouse fertility and offspring development†. Biol Reprod 2021; 102:888-901. [PMID: 31965142 PMCID: PMC7124966 DOI: 10.1093/biolre/ioz229] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/28/2019] [Accepted: 01/12/2020] [Indexed: 12/26/2022] Open
Abstract
With approximately 131 million new genital tract infections occurring each year, Chlamydia is the most common sexually transmitted bacterial pathogen worldwide. Male and female infections occur at similar rates and both cause serious pathological sequelae. Despite this, the impact of chlamydial infection on male fertility has long been debated, and the effects of paternal chlamydial infection on offspring development are unknown. Using a male mouse chronic infection model, we show that chlamydial infection persists in the testes, adversely affecting the testicular environment. Infection increased leukocyte infiltration, disrupted the blood:testis barrier and reduced spermiogenic cell numbers and seminiferous tubule volume. Sperm from infected mice had decreased motility, increased abnormal morphology, decreased zona-binding capacity, and increased DNA damage. Serum anti-sperm antibodies were also increased. When both acutely and chronically infected male mice were bred with healthy female mice, 16.7% of pups displayed developmental abnormalities. Female offspring of chronically infected sires had smaller reproductive tracts than offspring of noninfected sires. The male pups of infected sires displayed delayed testicular development, with abnormalities in sperm vitality, motility, and sperm-oocyte binding evident at sexual maturity. These data suggest that chronic testicular Chlamydia infection can contribute to male infertility, which may have an intergenerational impact on sperm quality.
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Affiliation(s)
- Emily R Bryan
- School of Biomedical Sciences and Institute of Health & Biomedical Innovation, Queensland University of Technology, Herston, Queensland, Australia
| | - Kate A Redgrove
- School of Environmental and Life Sciences, Faculty of Science, The University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Alison R Mooney
- School of Biomedical Sciences and Institute of Health & Biomedical Innovation, Queensland University of Technology, Herston, Queensland, Australia
| | - Bettina P Mihalas
- School of Environmental and Life Sciences, Faculty of Science, The University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Jessie M Sutherland
- School of Environmental and Life Sciences, Faculty of Science, The University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Alison J Carey
- School of Biomedical Sciences and Institute of Health & Biomedical Innovation, Queensland University of Technology, Herston, Queensland, Australia
| | - Charles W Armitage
- School of Biomedical Sciences and Institute of Health & Biomedical Innovation, Queensland University of Technology, Herston, Queensland, Australia.,Peter Goher Department of Immunobiology, King's College London, London, United Kingdom
| | - Logan K Trim
- School of Biomedical Sciences and Institute of Health & Biomedical Innovation, Queensland University of Technology, Herston, Queensland, Australia
| | - Avinash Kollipara
- School of Biomedical Sciences and Institute of Health & Biomedical Innovation, Queensland University of Technology, Herston, Queensland, Australia
| | - Peter B M Mulvey
- School of Biomedical Sciences and Institute of Health & Biomedical Innovation, Queensland University of Technology, Herston, Queensland, Australia
| | - Ella Palframan
- School of Biomedical Sciences and Institute of Health & Biomedical Innovation, Queensland University of Technology, Herston, Queensland, Australia
| | - Gemma Trollope
- School of Biomedical Sciences and Institute of Health & Biomedical Innovation, Queensland University of Technology, Herston, Queensland, Australia
| | - Kristofor Bogoevski
- Scientific Services, Histology Services, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Robert McLachlan
- Department of Obstetrics and Gynaecology, Hudson Institute of Medical Research, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
| | - Eileen A McLaughlin
- School of Environmental and Life Sciences, Faculty of Science, The University of Newcastle, University Drive, Callaghan, New South Wales, Australia.,School of Science, Western Sydney University, Richmond, New South Wales, Australia.,School of Life Sciences, The University of Auckland, Auckland, New Zealand
| | - Kenneth W Beagley
- School of Biomedical Sciences and Institute of Health & Biomedical Innovation, Queensland University of Technology, Herston, Queensland, Australia
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8
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Juonala M, Lewis S, McLachlan R, Hammarberg K, Kennedy J, Saffery R, McBain J, Welsh L, Cheung M, Doyle LW, Amor DJ, Burgner DP, Halliday J. American Heart Association ideal cardiovascular health score and subclinical atherosclerosis in 22-35-year-old adults conceived with and without assisted reproductive technologies. Hum Reprod 2021; 35:232-239. [PMID: 31834929 DOI: 10.1093/humrep/dez240] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/13/2019] [Accepted: 10/07/2019] [Indexed: 01/21/2023] Open
Abstract
STUDY QUESTION Is ART related with the association of American Heart Association (AHA) ideal cardiovascular health score and markers of subclinical atherosclerosis? SUMMARY ANSWER The associations between AHA score and markers of subclinical atherosclerosis in ART and non-ART groups were similar in magnitude. WHAT IS KNOWN ALREADY Long-term consequences of ART on cardiovascular health are unknown. STUDY DESIGN, SIZE, DURATION The study cohort for the cross-sectional analyses consisted of 172 ART-conceived and 78 non-ART conceived individuals of same age (range 22-35 years). PARTICIPANTS/MATERIALS, SETTING, METHODS Cardiovascular risk factor status was evaluated with American Heart Association (AHA) ideal cardiovascular health score consisting of seven factors (body mass index, blood pressure, total cholesterol, glucose, diet and physical activity, non-smoking). Carotid artery intima-media thickness (cIMT), arterial pulse-wave velocity (PWV) and retinal microvascular parameters were evaluated as markers of early atherosclerosis. Group comparisons in continuous variables were performed with t-tests. For categorical variables, comparisons were performed with chi-square tests. The relationships between AHA score and the markers of atherosclerosis were examined with linear regression analyses adjusted for age and sex. MAIN RESULTS AND THE ROLE OF CHANCE There was no difference in AHA ideal health score between the ART and non-ART groups; mean (SD) scores were 4.1(1.4) versus 4.0(1.5), respectively, P = 0.65. No differences were observed between groups for any individual ideal health metric (P always >0.2). AHA score was not associated with cIMT or retinal measures in either group (P always >0.05). An inverse association was observed between AHA score and PWV in the ART group (beta (95% CI) -0.18(-0.26 to -0.10)). A numerically similar relationship was observed in the smaller non-ART group (-0.19(-0.39 to 0.01)). LIMITATIONS, REASONS FOR CAUTION Even though this cohort is among the largest ART studies with extensive cardiovascular data, the sample is still relatively small and the statistical power is limited. As the study population was still in early adulthood, we were not able to evaluate the associations with clinical cardiovascular events, but utilized non-invasive methods to assess early markers of subclinical atherosclerosis. WIDER IMPLICATIONS OF THE FINDINGS These findings suggest that ART-conceived individuals do not have increased vulnerability for cardiovascular risk factors. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by a National Health & Medical Research Council Project Grant (APP1099641), The Royal Children's Hospital Research Foundation, Monash IVF Research and Education Foundation, and Reproductive Biology Unit Sperm Fund, Melbourne IVF. The authors have no conflicts of interest relevant to this article to disclose.
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Affiliation(s)
- Markus Juonala
- Department of Internal Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
- Murdoch Children's Research Institute, Parkville, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Robert McLachlan
- Hudson Institute of Medical Research, Clayton, Australia
- Monash IVF Group Pty Ltd, Richmond, Australia
- Dept of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Karin Hammarberg
- Global Public Health, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia
| | - Joanne Kennedy
- Murdoch Children's Research Institute, Parkville, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - John McBain
- Reproductive Services, Royal Women's Hospital, Parkville, Australia
| | - Liam Welsh
- Murdoch Children's Research Institute, Parkville, Australia
- Departments of Respiratory Medicine, Cardiology and Infectious Diseases, The Royal Children's Hospital, Parkville, Australia
| | - Michael Cheung
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Departments of Respiratory Medicine, Cardiology and Infectious Diseases, The Royal Children's Hospital, Parkville, Australia
| | - Lex W Doyle
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
- Research Office, The Royal Women's Hospital, Parkville, Australia
| | - David J Amor
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - David P Burgner
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Departments of Respiratory Medicine, Cardiology and Infectious Diseases, The Royal Children's Hospital, Parkville, Australia
| | - Jane Halliday
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
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9
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Pearson L, Holton S, McLachlan R, Hammarberg K. Australian men's fertility information seeking attitudes and behaviour: A qualitative investigation. Sex Reprod Healthc 2021; 29:100621. [PMID: 33894435 DOI: 10.1016/j.srhc.2021.100621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/21/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Most women and men want and expect to have children but increasing maternal and paternal ages reduce their ability to achieve this. Most research relating to childbearing has focused on women. The aim of this study was to explore reproductive-aged men's fertility information-seeking attitudes and behaviours. METHODS Focus group discussions were conducted with younger (18-30 years, 3 groups) and older (31-45 years, 3 groups) men, residing in urban, peri-urban or rural settings in Victoria, Australia. The topics covered included men's fatherhood aspirations and intentions, and their attitudes and behaviours relating to seeking information about fertility. Focus group discussions were audio-recorded and transcribed, and transcripts analyzed thematically. RESULTS Six focus group discussions were conducted with a total of 39 participants. Four key themes were identified: 1. 'No need for fertility-related information'; 2. 'Knowledge and awareness of fertility'; 3. 'Fertility is women's business'; and 4. 'Fertility and manhood'. Fertility and fertility information seeking was perceived by many participants as women's domain. While men did not seek information about fertility unless they experienced fertility difficulties, they reported learning about fertility through the lived experiences of others, predominantly family and friends who experienced infertility. CONCLUSION Fertility-related health promotion initiatives and reproductive health information targeting men are needed to encourage men to be active participants in reproductive decision making to optimize the chance of both women and men achieving their parenthood goals. Narrative health messages may be a successful way to convey fertility information to men.
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Affiliation(s)
- Lauren Pearson
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, 4/553 St Kilda Road, Melbourne 3004, Victoria, Australia
| | - Sara Holton
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, 4/553 St Kilda Road, Melbourne 3004, Victoria, Australia; School of Nursing and Midwifery, Deakin University, Geelong Waterfront Campus, 1 Geringhap Street, Geelong 3220, Victoria, Australia.
| | - Robert McLachlan
- Healthy Male, Melbourne, Vic 3004, Australia; Monash IVF Group Pty Ltd, Richmond 3121, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton 3168, Australia
| | - Karin Hammarberg
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, 4/553 St Kilda Road, Melbourne 3004, Victoria, Australia; Victorian Assisted Reproductive Treatment Authority, Level 30/570 Bourke Street Melbourne, Victoria 3000, Australia
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10
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Harper J, Kearns N, Bird G, McLachlan R, Eathorne A, Weatherall M, Beasley R. Audit of oxygen administration to achieve a target oxygen saturation range in acutely unwell medical patients. Postgrad Med J 2021; 98:461-465. [PMID: 33589491 DOI: 10.1136/postgradmedj-2020-139511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/12/2021] [Accepted: 01/20/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE OF THE STUDY To evaluate documentation of a target oxygen saturation (SpO2) range and ability to achieve this range in acutely unwell inpatients. STUDY DESIGN In this single-centre audit, patients with discharge diagnoses of pneumonia, heart failure and exacerbation of asthma or COPD admitted to Wellington Regional Hospital, New Zealand between 1 June 2019 and 31 August 2019 who received oxygen were identified. In those with a documented target SpO2 range, the proportion of SpO2 measurements in the observation chart which were within, above and below range were determined as well as the maximum and minimum SpO2. Regression analysis was performed to determine whether these outcomes were influenced by the prescribed range, high-dependency care or the number of adjustments to oxygen administration. RESULTS 268 admissions were screened. Of the 100 eligible admissions who received oxygen, a target SpO2 range was documented in 62. The mean (SD) proportion of SpO2 measurements within range was 56.2 (30.6)%. A hypercapnic target SpO2 range was associated with a higher probability of an SpO2 above range; multivariate OR 5.34 (95% CI 1.65 to 17.3, p=0.006) and a lower probability of an SpO2 below range; multivariate OR 0.25 (95% CI 0.08 to 0.80) p=0.02. The mean (SD) maximum SpO2 was similar in those with a target range of 92%-96% versus a hypercapnic range; 96.2 (3.0)% and 95.2 (3.4)%, respectively. CONCLUSIONS Oxygen prescription and delivery in this clinical setting was suboptimal. SpO2 values above the designated range are common, particularly in patients with a hypercapnic target range.
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Affiliation(s)
- James Harper
- Medical Research Institute of New Zealand, Wellington, New Zealand .,Capital and Coast District Health Board, Wellington, New Zealand.,Victoria University of Wellington, Wellington, New Zealand
| | - Nethmi Kearns
- Medical Research Institute of New Zealand, Wellington, New Zealand.,Capital and Coast District Health Board, Wellington, New Zealand
| | - Grace Bird
- Medical Research Institute of New Zealand, Wellington, New Zealand.,Capital and Coast District Health Board, Wellington, New Zealand.,Victoria University of Wellington, Wellington, New Zealand
| | - Robert McLachlan
- Medical Research Institute of New Zealand, Wellington, New Zealand.,Capital and Coast District Health Board, Wellington, New Zealand
| | - Allie Eathorne
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand.,Capital and Coast District Health Board, Wellington, New Zealand.,Victoria University of Wellington, Wellington, New Zealand
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11
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Wittert G, Bracken K, Robledo KP, Grossmann M, Yeap BB, Handelsman DJ, Stuckey B, Conway A, Inder W, McLachlan R, Allan C, Jesudason D, Fui MNT, Hague W, Jenkins A, Daniel M, Gebski V, Keech A. Testosterone treatment to prevent or revert type 2 diabetes in men enrolled in a lifestyle programme (T4DM): a randomised, double-blind, placebo-controlled, 2-year, phase 3b trial. Lancet Diabetes Endocrinol 2021; 9:32-45. [PMID: 33338415 DOI: 10.1016/s2213-8587(20)30367-3] [Citation(s) in RCA: 130] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Men who are overweight or obese frequently have low serum testosterone concentrations, which are associated with increased risk of type 2 diabetes. We aimed to determine whether testosterone treatment prevents progression to or reverses early type 2 diabetes, beyond the effects of a community-based lifestyle programme. METHODS T4DM was a randomised, double-blind, placebo-controlled, 2-year, phase 3b trial done at six Australian tertiary care centres. Men aged 50-74 years, with a waist circumference of 95 cm or higher, a serum testosterone concentration of 14·0 nmol/L or lower but without pathological hypogonadism, and impaired glucose tolerance (oral glucose tolerance test [OGTT] 2-h glucose 7·8-11·0 mmol/L) or newly diagnosed type 2 diabetes (provided OGTT 2-h glucose ≤15·0 mmol/L) were enrolled in a lifestyle programme and randomly assigned (1:1) to receive an intramuscular injection of testosterone undecanoate (1000 mg) or placebo at baseline, 6 weeks, and then every 3 months for 2 years. Randomisation was done centrally, including stratification by centre, age group, waist circumference, 2-h OGTT glucose, smoking, and first-degree family history of type 2 diabetes. The primary outcomes at 2 years were type 2 diabetes (2-h OGTT glucose ≥11·1 mmol/L) and mean change from baseline in 2-h OGTT glucose, assessed by intention to treat. For safety assessment, we did a masked monitoring of haematocrit and prostate-specific antigen, and analysed prespecified serious adverse events. This study is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12612000287831. FINDINGS Between Feb 5, 2013, and Feb 27, 2017, of 19 022 men who were pre-screened, 1007 (5%) were randomly assigned to the placebo (n=503) and testosterone (n=504) groups. At 2 years, 2-h glucose of 11·1 mmol/L or higher on OGTT was reported in 87 (21%) of 413 participants with available data in the placebo group and 55 (12%) of 443 participants in the testosterone group (relative risk 0·59, 95% CI 0·43 to 0·80; p=0·0007). The mean change from baseline 2-h glucose was -0·95 mmol/L (SD 2·78) in the placebo group and -1·70 mmol/L (SD 2·47) in the testosterone group (mean difference -0·75 mmol/L, -1·10 to -0·40; p<0·0001). The treatment effect was independent of baseline serum testosterone. A safety trigger for haematocrit greater than 54% occurred in six (1%) of 484 participants in the placebo group and 106 (22%) of 491 participants in the testosterone group, and a trigger for an increase of 0·75 μg/mL or more in prostate-specific antigen occurred in 87 (19%) of 468 participants in the placebo group and 109 (23%) of 480 participants in the testosterone group. Prespecified serious adverse events occurred in 37 (7·4%, 95% CI 5·4 to 10·0) of 503 patients in the placebo group and 55 (10·9%, 8·5 to 13·9) of 504 patients in the testosterone group. There were two deaths in each group. INTERPRETATION Testosterone treatment for 2 years reduced the proportion of participants with type 2 diabetes beyond the effects of a lifestyle programme. Increases in haematocrit might be treatment limiting. Longer-term durability, safety, and cardiovascular effects of the intervention remain to be further investigated. FUNDING Australian National Health and Medical Research Council, Bayer, Eli Lilly, University of Adelaide, and WW (formerly Weight Watchers).
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Affiliation(s)
- Gary Wittert
- Freemasons Centre for Male Health and Wellbeing, University of Adelaide, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
| | - Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Kristy P Robledo
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Mathis Grossmann
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
| | - Bu B Yeap
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia; Medical School, University of Western Australia, Perth, WA, Australia
| | - David J Handelsman
- ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, NSW, Australia
| | - Bronwyn Stuckey
- Medical School, University of Western Australia, Perth, WA, Australia; Keogh Institute for Medical Research, Perth, WA, Australia; Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Ann Conway
- ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, NSW, Australia
| | - Warrick Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, QLD, Australia; Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Robert McLachlan
- Hudson Institute of Medical Research and Monash University, Clayton, VIC, Australia
| | - Carolyn Allan
- Hudson Institute of Medical Research and Monash University, Clayton, VIC, Australia
| | - David Jesudason
- Department of Endocrinology, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Mark Ng Tang Fui
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
| | - Wendy Hague
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Mark Daniel
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Anthony Keech
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
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12
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Wittert G, McLachlan R. Covid-19: Spiking a focus on men's health. Obes Res Clin Pract 2020; 14:293-294. [PMID: 32828210 PMCID: PMC7437404 DOI: 10.1016/j.orcp.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Gary Wittert
- Freemasons Foundation Centre for Men's Health, University of Adelaide, South Australia, Australia; South Australian Institute for Health and Medical Research, Adelaide, South Australia, Australia.
| | - Robert McLachlan
- Hudson Institute of Medical Research and Monash University, Clayton, Victoria, Australia; Healthy Male Level 2, 492 St Kilda Road, Melbourne, Victoria, Australia.
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13
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Hart RJ, Doherty DA, Mori TA, Adams LA, Huang RC, Minaee N, Handelsman DJ, McLachlan R, Norman RJ, Dickinson JE, Olynyk JK, Beilin LJ. Features of the metabolic syndrome in late adolescence are associated with impaired testicular function at 20 years of age. Hum Reprod 2020; 34:389-402. [PMID: 30576537 DOI: 10.1093/humrep/dey371] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 11/16/2018] [Accepted: 11/28/2018] [Indexed: 12/11/2022] Open
Abstract
STUDY QUESTION Are early signs of metabolic disorder in late adolescence associated with features of impaired testicular function many years before the majority seek parenthood? SUMMARY ANSWER Adolescents with features of metabolic disorder at 17 years, or insulin resistance (IR) at 20 years of age, show impaired testicular function and altered hormone levels compared to those without metabolic disorder. WHAT IS KNOWN ALREADY Controversial evidence suggests a recent decline in sperm production potentially linked to environmental influences, but its cause remains unclear. Concomitant increases in obesity and diabetes suggest that lifestyle factors may contribute to this decline in testicular function. Although obesity has been associated with adverse testicular function in some studies, it remains unclear whether poor testicular function merely reflects, or causes, poor metabolic health. If metabolic disorder were present in adolescence, prior to the onset of obesity, this may suggest that metabolic disorder maybe a precursor of impaired testicular function. STUDY DESIGN, SIZE, DURATION The Western Australian Pregnancy Cohort (Raine) Study is a longitudinal study of children born in 1989-1991 who have undergone detailed physical assessments since birth (1454 male infants born). At 17 years of age, 490 boys underwent a hepatic ultrasound examination, serum cytokine assessment (n = 520) and a metabolic assessment (n = 544). A further metabolic assessment was performed at 20 years (n = 608). Testicular assessment was performed at 20 years; 609 had reproductive hormones measured, 404 underwent a testicular ultrasound and 365 produced a semen sample. PARTICIPANTS/MATERIALS, SETTING, METHODS Testicular volume was estimated by ultrasonography, and semen analysis was performed according to World Health Organization guidelines. Concentrations of LH, FSH and inhibin B (inhB) in serum were measured by immunoassay and total testosterone by liquid chromatography-mass spectrometry.At 17 years of age, a liver ultrasound examination was performed to determine the presence of non-alcoholic fatty liver disease (NAFLD), and serum analysed for the cytokines interleukin-18 and soluble tumour necrosis factor receptor 1 and 2 (sTNFR1, sTNFR2).At 17 and 20 years of age, fasting blood samples were analysed for serum liver enzymes, insulin, glucose, triglycerides (TG), total cholesterol, high density lipoprotein and low density lipoprotein cholesterol, high sensitivity C-reactive protein and uric acid. The homoeostatic model assessment (HOMA) was calculated and approximated IR was defined by a HOMA >4. Anthropometric data was collected and dual energy X-ray absorptiometry measurement performed for lean and total fat mass. As at this young age the prevalence of metabolic syndrome was expected to be low, a two-step cluster analysis was used using waist circumference, TGs, insulin, and systolic blood pressure to derive a distinct high-risk group with features consistent with the metabolic syndrome and increased cardiometabolic risk. MAIN RESULTS AND THE ROLE OF CHANCE Men at age 17 years with increased cardiometabolic risk had lower concentrations of serum testosterone (medians: 4.0 versus 4.9 ng/mL) and inhB (193.2 versus 221.9 pg/mL) (P < 0.001 for both) compared to those within the low risk metabolic cluster. Men with ultrasound evidence of NAFLD (n = 45, 9.8%) had reduced total sperm output (medians: 68.0 versus 126.00 million, P = 0.044), testosterone (4.0 versus 4.7 ng/mL, P = 0.005) and inhB (209.1 versus 218.4 pg/mL, P = 0.032) compared to men without NAFLD.Men with higher concentrations of sTNFR1 at 17 years of age had a lower sperm output and serum concentration of inhB, with an increase in LH and FSH (all P < 0.05 after adjustment for age, BMI, abstinence and a history of cryptorchidism, varicocele, cigarette smoking, alcohol and drug use), compared to those without an elevated sTNFR1. Multivariable regression analysis, adjusting for confounders, demonstrated that men in the high-risk metabolic cluster at 20 years had a lower serum testosterone and inhB (P = 0.003 and P = 0.001, respectively). A HOMA-IR > 4 was associated with a lower serum testosterone (P = <0.001) and inhB (P = 0.010) and an increase in serum FSH (P = 0.015). LIMITATIONS, REASONS FOR CAUTION This study is limited by the sample size and multiple comparisons, and causality cannot be proven from an observational study. Due to a 3-year interval between some metabolic assessments and assessment of testicular function, we cannot exclude the introduction of a bias into the study, as some of the participants and their testicular function will not have been fully mature at the 17-year assessment. WIDER IMPLICATIONS OF THE FINDINGS Irrespective of a proven causation, our study findings are important in that a significant minority of the men, prior to seeking parenthood, presented co-existent features of metabolic disorder and signs of testicular impairment. Of particular note is that the presence of NAFLD at 17 years of age, although only present in a minority of men, was associated with an almost 50% reduction in sperm output at 20 years of age, and that the presence of IR at 20 years was associated with a 20% reduction in testicular volume. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by Australian NHMRC (Grant Numbers 634457, 35351417 and 403981) and received support from the Raine Medical Research Foundation, The Telethon Kids Institute, University of Western Australia, Women and Infants Research Foundation, Curtin University and Edith Cowan University. D.A.D., J.E.D., N.M., L.A.A., R.-C.H., T.A.M., J.K.O., L.J.B. have nothing to declare. R.J.H. is Medical Director of Fertility Specialists of Western Australia, has equity interests in Western IVF, and has received grant support from MSD, Merck-Serono and Ferring Pharmaceuticals. RMcL has equity interests in the Monash IVF Group. R.J.N. has equity interests in FertilitySA, and has received grant support from Merck Serono and Ferring Pharmaceuticals. D.J.H. has received institutional grant funding (but no personal income) for investigator-initiated testosterone pharmacology studies from Lawley and Besins Healthcare and has provided expert testimony to anti-doping tribunals and for testosterone litigation.This abstract was awarded the Fertility Society of Australia clinical exchange award for the oral presentation at ESHRE, Barcelona, in 2018.
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Affiliation(s)
- R J Hart
- Division of Obstetrics and Gynaecology, University of Western Australia (UWA), Perth, Western Australia, Australia.,Fertility Specialists of Western Australia, Claremont, Western Australia, Australia
| | - D A Doherty
- Division of Obstetrics and Gynaecology, University of Western Australia (UWA), Perth, Western Australia, Australia.,Women and Infants Research Foundation, Perth, Western Australia, Australia
| | - T A Mori
- Medical School, UWA, Royal Perth Hospital, Western Australia, Australia
| | - L A Adams
- Medical School, UWA, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - R-C Huang
- Telethon Kids Institute, UWA, Perth, Western Australia, Australia
| | - N Minaee
- Women and Infants Research Foundation, Perth, Western Australia, Australia
| | - D J Handelsman
- ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - R McLachlan
- Hudson Institute, Monash University, Melbourne, Australia
| | - R J Norman
- Robinson Institute, Research Institute, School of Medicine, University of Adelaide & Fertility SA, Adelaide, Australia
| | - J E Dickinson
- Division of Obstetrics and Gynaecology, University of Western Australia (UWA), Perth, Western Australia, Australia
| | - J K Olynyk
- Department of Gastroenterology, Fiona Stanley and Fremantle Hospital and School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - L J Beilin
- Medical School, UWA, Royal Perth Hospital, Western Australia, Australia
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Bracken K, Keech A, Hague W, Allan C, Conway A, Daniel M, Gebski V, Grossmann M, Handelsman DJ, Inder WJ, Jenkins A, McLachlan R, Robledo KP, Stuckey B, Yeap BB, Wittert G. A high-volume, low-cost approach to participant screening and enrolment: Experiences from the T4DM diabetes prevention trial. Clin Trials 2019; 16:589-598. [PMID: 31581816 DOI: 10.1177/1740774519872999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS Participant recruitment to diabetes prevention randomised controlled trials is challenging and expensive. The T4DM study, a multicentre, Australia-based, Phase IIIb randomised controlled trial of testosterone to prevent Type 2 diabetes in men aged 50-74 years, faced the challenge of screening a large number of prospective participants at a small number of sites, with few staff, and a limited budget for screening activities. This article evaluates a high-volume, low-cost, semi-automated approach to screen and enrol T4DM study participants. METHODS We developed a sequential multi-step screening process: (1) web-based pre-screening, (2) laboratory screening through a network of third-party pathology centres, and (3) final on-site screening, using online data collection, computer-driven eligibility checking, and automated, email-based communication with prospective participants. Phone- and mail-based data collection and communication options were available to participants at their request. The screening process was administered by the central coordinating centre through a central data management system. RESULTS Screening activities required staffing of approximately 1.6 full-time equivalents over 4 years. Of 19,022 participants pre-screened, 13,108 attended a third-party pathology collection centre for laboratory screening, 1217 received final, on-site screening, and 1007 were randomised. In total, 95% of the participants opted for online pre-screening over phone-based pre-screening. Screening costs, including both direct and staffing costs, totalled AUD1,420,909 (AUD75 per subject screened and AUD1411 per randomised participant). CONCLUSION A multi-step, semi-automated screening process with web-based pre-screening facilitated low-cost, high-volume participant enrolment to this large, multicentre randomised controlled trial. Centralisation and automation of screening activities resulted in substantial savings compared to previous, similar studies. Our screening approach could be adapted to other randomised controlled trial settings to minimise the cost of screening large numbers of participants.
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Affiliation(s)
- Karen Bracken
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Anthony Keech
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Wendy Hague
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Carolyn Allan
- Hudson Institute of Medical Research, Monash University, Melbourne, VIC, Australia
| | - Ann Conway
- ANZAC Research Institute, University of Sydney, Concord Hospital, Sydney, NSW, Australia
| | - Mark Daniel
- University of Canberra, Canberra, ACT, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Mathis Grossmann
- The Austin Hospital and University of Melbourne, Melbourne, VIC, Australia
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney, Concord Hospital, Sydney, NSW, Australia
| | - Warrick J Inder
- Princess Alexandra Hospital and The University of Queensland, Brisbane, QLD, Australia
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Robert McLachlan
- Hudson Institute of Medical Research, Monash University, Melbourne, VIC, Australia
| | - Kristy P Robledo
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Bronwyn Stuckey
- Keogh Institute of Medical Research and The University of Western Australia, Perth, WA, Australia
| | - Bu B Yeap
- Medical School, The University of Western Australia and Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia
| | - Gary Wittert
- Freemasons Foundation Centre for Men's Health, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
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15
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Bracken K, Hague W, Keech A, Conway A, Handelsman DJ, Grossmann M, Jesudason D, Stuckey B, Yeap BB, Inder W, Allan C, McLachlan R, Robledo KP, Wittert G. Recruitment of men to a multi-centre diabetes prevention trial: an evaluation of traditional and online promotional strategies. Trials 2019; 20:366. [PMID: 31217024 PMCID: PMC6585027 DOI: 10.1186/s13063-019-3485-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 05/30/2019] [Indexed: 11/30/2022] Open
Abstract
Background Effective interventions are required to prevent the current rapid increase in the prevalence of Type 2 diabetes. Clinical trials of large-scale interventions to prevent Type 2 diabetes are essential but recruitment is challenging and expensive, and there are limited data regarding the most cost-effective and efficient approaches to recruitment. This paper aims to evaluate the cost and effectiveness of a range of promotional strategies used to recruit men to a large Type 2 diabetes prevention trial. Methods An observational study was conducted nested within the Testosterone for the Prevention of Type 2 Diabetes (T4DM) study, a large, multi-centre randomised controlled trial (RCT) of testosterone treatment for the prevention of Type 2 diabetes in men aged 50–74 years at high risk of developing diabetes. Study participation was promoted via mainstream media—television, newspaper and radio; direct marketing using mass mail-outs, publicly displayed posters and attendance at local events; digital platforms, including Facebook and Google; and online promotions by community organisations and businesses. For each strategy, the resulting number of participants and the direct cost involved were recorded. The staff effort required for each strategy was estimated based on feedback from staff. Results Of 19,022 men screened for the study, 1007 (5%) were enrolled. The most effective recruitment strategies were targeted radio advertising (accounting for 42% of participants), television news coverage (20%) and mass mail-outs (17%). Other strategies, including radio news, publicly displayed posters, attendance at local events, newspaper advertising, online promotions and Google and Facebook advertising, each accounted for no more than 4% of enrolled participants. Recruitment promotions cost an average of AU$594 per randomised participant. The most cost-effective paid strategy was mass mail-outs by a government health agency (AU$745 per participant). Other paid strategies were more expensive: mail-out by general practitioners (GPs) (AU$1104 per participant), radio advertising (AU$1081) and newspaper advertising (AU$1941). Conclusion Radio advertising, television news coverage and mass mail-outs by a government health agency were the most effective recruitment strategies. Close monitoring of recruitment outcomes and ongoing enhancement of recruitment activities played a central role in recruitment to this RCT. Trial registration ANZCTR, ID: ACTRN12612000287831. Registered on 12 March 2012. Electronic supplementary material The online version of this article (10.1186/s13063-019-3485-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
| | - Wendy Hague
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Anthony Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Ann Conway
- Anzac Research Institute, and Andrology Department, Concord Hospital, Sydney, NSW, Australia
| | - David J Handelsman
- Anzac Research Institute, and Andrology Department, Concord Hospital, Sydney, NSW, Australia
| | - Mathis Grossmann
- Department of Medicine, the University of Melbourne, and Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
| | | | - Bronwyn Stuckey
- Department of Endocrinology and Diabetes, Keogh Institute of Medical Research, Sir Charles Gairdner Hospital and Medical School, University of Western Australia, Perth, WA, Australia
| | - Bu B Yeap
- Department of Endocrinology and Diabetes, Medical School, University of Western Australia and Fiona Stanley Hospital, Perth, WA, Australia
| | - Warrick Inder
- Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Carolyn Allan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Robert McLachlan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Kristy P Robledo
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Gary Wittert
- Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide, Adelaide, SA, Australia
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16
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Bardin M, Ritchie D, McLachlan R, Yates CJ. Acute myeloid leukaemia presenting with diabetes insipidus. Intern Med J 2019; 49:785-788. [PMID: 31185522 DOI: 10.1111/imj.14312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 12/18/2018] [Accepted: 03/10/2019] [Indexed: 11/30/2022]
Abstract
A 41-year-old man was diagnosed with hypogonadotropic hypogonadism managed with gonadotropins after routine fertility review. Eight months later he presented with new polydipsia and polyuria, lethargy and easy bruising. A full blood count showed 28% circulating blasts. A bone marrow biopsy confirmed a diagnosis of acute myeloid leukaemia with inv(3)(q21.3q26.2) with additional monosomy 7. Central diabetes insipidus (DI) was diagnosed following a water deprivation test. Pituitary magnetic resonance imaging showed a slightly thickened pituitary stalk, stable Rathke's cyst, and new absence of the pituitary bright spot. The patient was commenced on desmopressin and induction chemotherapy, subsequently requiring a bone marrow transplant. Bone marrow examination at 100 days post-transplant revealed cytogenetic remission. All symptoms of DI resolved and magnetic resonance imaging showed return of the posterior bright spot and a pituitary stalk of normal thickness. Biochemical hypogonadotropic hypogonadism persisted but was uninterpretable in the context of systemic illness and recent chemotherapy. DI is a rare complication of haematological malignancies, and the prevalence and pathophysiology of DI in this context are poorly understood. Pathogenic mechanisms proposed include leukaemic infiltration of the pituitary, interference with antidiuretic hormone synthesis, and abnormal thrombopoiesis influencing hormone levels. Particular cytogenetic abnormalities such as inv(3)(q21.3q26.2) and monosomy 7 appear to be more commonly associated with DI and also appear to confer worse outcomes. Aetiologies in the literature remain elusive but as DI is a recognised association of haematological malignancies it should be considered in a patient presenting with polydipsia and polyuria.
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Affiliation(s)
- Michele Bardin
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Ritchie
- Department of Haematology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - Christopher J Yates
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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17
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Olesen IA, Joensen UN, Petersen JH, Almstrup K, Rajpert-De Meyts E, Carlsen E, McLachlan R, Juul A, Jørgensen N. Decrease in semen quality and Leydig cell function in infertile men: a longitudinal study. Hum Reprod 2019; 33:1963-1974. [PMID: 30247578 DOI: 10.1093/humrep/dey283] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 08/23/2018] [Indexed: 12/30/2022] Open
Abstract
STUDY QUESTION Are infertile men with reduced semen quality at risk of a further decrease in testicular function? SUMMARY ANSWER Infertile men with severely reduced semen quality risk further deterioration of semen quality 15 years after treatment for infertility, and a lower baseline sperm concentration was associated with a more pronounced increase in LH and decrease in testosterone/LH ratio at follow-up. WHAT IS KNOWN ALREADY Male factors account for up to 50% of human infertility. The most common finding is spermatogenic failure (SgF) yet the life course of semen quality and testosterone production in such men has not been described. STUDY DESIGN, SIZE, DURATION A follow-up study of men with SgF was performed 15 years after the initial infertility assessment between January 1995 and December 2000. PARTICIPANTS/MATERIALS, SETTING, METHODS Hospital records were used to identify potential participants in the study. A total of 137 men with primary male infertility due to SgF and 70 controls with good semen quality from couples with female factor infertility who attended a tertiary referral centre were included: the participation rate was 31% and 26%, respectively. The men provided semen samples and underwent a physical examination. Blood samples were taken to measure levels of reproductive hormones (FSH, LH, testosterone, sex hormone-binding globulin, estradiol and inhibin B). Current results were compared with results from the initial assessments. MAIN RESULTS AND THE ROLE OF CHANCE At the time of follow up the SgF men had significantly lower Leydig cell capacity than the control group as well as much lower semen quality. For the SgF men, between baseline sampling and follow up, the median sperm concentration decreased from 1.9 to 0.6 mill/ml and total sperm count from 7.7 to 2.0 million (P = 0.019 and 0.012, respectively), and 10% developed azoospermia. Calculated free testosterone (cFT), but not total testosterone (tT) decreased in the SgF group by ~0.6% (95% CI 0.1-1.2%) per year. In the SgF group, LH increased by 1.6% (CI 0.9-2.3%) annually, and consequently tT/LH and cFT/LH ratios had decreased by 1.3% (CI 0.5-2.1) and 2.1% (CI 1.2-3.0%), respectively. The increase in LH and the decreases in tT/LH and cFT/LH ratios were more pronounced in men with lower baseline sperm concentrations. LIMITATIONS, REASONS FOR CAUTION We consider the case group as representative of infertile men not in need of testosterone treatment at baseline investigation, but do not have information on those that chose not to participate in the follow-up study. There were alterations in some hormone analysis methods during the follow-up period that may introduce uncertainty in interpretation of long-term changes in hormone levels despite rigorous quality control. The validity of the control group suffers from a lack of hormone values at baseline. Also, at follow-up, for practical reasons only one semen sample could be obtained, which makes the effect estimate more uncertain and there is a risk of non-differential misclassification. WIDER IMPLICATIONS OF THE FINDINGS Without being able to predict individual outcomes, it is prudent to consider sperm cryopreservation or advise not to postpone fertility treatment when men present with infertility due to impaired semen quality. Whether partly compensated Leydig cell insufficiency in men with SgF will eventually develop into overt testosterone deficiency cannot be determined from our study. STUDY FUNDING/COMPETING INTEREST(s) Aase and Einar Danielsen (Grant no. 10-001053), Nordic Research Committee (Grant no. 5109), The Kirsten and Freddie Johansen Fund, and Rigshospitalet's Research Fund (grant no. R24-A812). There are no competing interests.
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Affiliation(s)
- I A Olesen
- University Department of Growth and Reproduction, Rigshospitalet section 5064, Blegdamsvej 9, Copenhagen Ø, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet section 5064, Blegdamsvej 9, Copenhagen Ø, Denmark
| | - U N Joensen
- University Department of Growth and Reproduction, Rigshospitalet section 5064, Blegdamsvej 9, Copenhagen Ø, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet section 5064, Blegdamsvej 9, Copenhagen Ø, Denmark
| | - J H Petersen
- University Department of Growth and Reproduction, Rigshospitalet section 5064, Blegdamsvej 9, Copenhagen Ø, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet section 5064, Blegdamsvej 9, Copenhagen Ø, Denmark.,Department of Biostatistics, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5 Building 10, Copenhagen K, Denmark
| | - K Almstrup
- University Department of Growth and Reproduction, Rigshospitalet section 5064, Blegdamsvej 9, Copenhagen Ø, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet section 5064, Blegdamsvej 9, Copenhagen Ø, Denmark
| | - E Rajpert-De Meyts
- University Department of Growth and Reproduction, Rigshospitalet section 5064, Blegdamsvej 9, Copenhagen Ø, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet section 5064, Blegdamsvej 9, Copenhagen Ø, Denmark
| | - E Carlsen
- University Department of Fertility, Rigshospitalet section 4071, Blegdamsvej 9, Copenhagen Ø, Denmark
| | - R McLachlan
- Hudson Institute of Medical Research and Monash University, 27-31 Wright St, Clayton, Australia
| | - A Juul
- University Department of Growth and Reproduction, Rigshospitalet section 5064, Blegdamsvej 9, Copenhagen Ø, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet section 5064, Blegdamsvej 9, Copenhagen Ø, Denmark
| | - N Jørgensen
- University Department of Growth and Reproduction, Rigshospitalet section 5064, Blegdamsvej 9, Copenhagen Ø, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet section 5064, Blegdamsvej 9, Copenhagen Ø, Denmark
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18
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Bracken K, Keech A, Hague W, Kirby A, Robledo KP, Allan C, Conway A, Daniel M, Gebski V, Grossmann M, Handelsman DJ, Inder W, Jenkins A, McLachlan R, Stuckey B, Yeap BB, Wittert G. Telephone call reminders did not increase screening uptake more than SMS reminders: a recruitment study within a trial. J Clin Epidemiol 2019; 112:45-52. [PMID: 31051248 DOI: 10.1016/j.jclinepi.2019.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/18/2019] [Accepted: 04/24/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of the study was to compare the response rates and costs of phone call vs. short message service (SMS) screening reminders to prospective randomized controlled trial (RCT) participants. STUDY DESIGN AND SETTING This study was a randomized evaluation within a large Australian diabetes prevention RCT. Participants were men aged 50-74 years, overweight or obese, without a previous type 2 diabetes diagnosis. Those eligible on a prescreening questionnaire who did not attend a further screening assessment within 4 weeks were randomized to receive an SMS or phone call reminder (N = 709). The primary outcome was attendance for further screening assessment within 8 weeks of prescreening. RESULTS Attendance was 18% (62/354) in the SMS reminder group, and 23% (80/355) in the phone reminder group, with no statistically significant difference in response according to reminder type (relative risk = 1.29, 95% confidence interval [CI]: 0.96-1.73, P = 0.09). The lower confidence limits for response to SMS (95% CI: 14-22%) and phone reminders (95% CI: 18-27%) did not include the 8-week attendance rate before this evaluation, 12%. Phone reminders cost substantially more than SMS reminders (AU$6.21 vs. AU$0.53 per reminder). CONCLUSION SMS reminders were as adequate a method as phone reminders to boost RCT screening uptake and were considerably more affordable.
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Affiliation(s)
- Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.
| | - Anthony Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Wendy Hague
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Adrienne Kirby
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Kristy P Robledo
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Carolyn Allan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Ann Conway
- Anzac Research Institute and Andrology Department, Concord Hospital, Sydney, New South Wales, Australia
| | - Mark Daniel
- Health Research Institute, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Mathis Grossmann
- Department of Medicine, The Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - David J Handelsman
- Anzac Research Institute and Andrology Department, Concord Hospital, Sydney, New South Wales, Australia
| | - Warrick Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Robert McLachlan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Bronwyn Stuckey
- Keogh Institute of Medical Research and Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Bu B Yeap
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital and Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Gary Wittert
- Freemasons Foundation Centre for Mens Health, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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19
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Sarlos S, Giummarra M, Allan C, Arnold C, Choy K, Doery J, McLachlan R. SUN-228 Opioid Use Is Not Associated with Clinical Hypogonadism in Men with Chronic Non-Cancer Pain. J Endocr Soc 2019. [PMCID: PMC6553223 DOI: 10.1210/js.2019-sun-228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: Opioid analgesia is widely used in the management of chronic pain despite lacking a strong evidence base of efficacy and concerns about adverse effects. Opioid use has been associated with hypogonadotrophic hypogonadism in a limited number of small chronic pain studies. Aim: To determine the prevalence and degree of hypogonadism in men with chronic non-malignant pain treated with or without opioid analgesia. Method: A cross-sectional study of community dwelling Australian men over the age of 18yrs with chronic non-cancer pain of at least 6 months duration attending a single multidisciplinary pain clinic between February 2016 to August 2017, and who were managed either with or without opioid therapy for a minimum of 6 weeks. Men with known pituitary or testicular causes of hypogonadism, previous or current testosterone use, and men treated with androgen deprivation therapy were excluded. Men completed questionnaires about sexual function (International Index of Erectile Function-5), pain (Brief Pain Inventory (BPI)) and mood (Depression, Anxiety and Stress Scale (DASS21)). Medications, age and BMI were recorded. Blood was obtained to assess serum total testosterone (TT), FSH, LH and prolactin (mean ± SD) between the two groups. TT levels were measured using gold standard liquid chromatography-tandem mass spectrometry. Results: Participants were 50 men treated with oral or transdermal opioids (oral morphine equivalent daily dose (oMEDD) 100 ± 92mg) and 37 men managed without opioids. Age (48.8 ± 11.5 vs 51 ± 16.3 yrs) and BMI (28.7 ± 5.0 vs 27.8 ± 4.5) were similar. Mean serum TT levels were within the normal range for both groups although were lower in the opioid vs non-opioid group (13.3 ± 6.1 vs 15.9 ± 5.5 nmol/L [383 ± 175.6 vs 457.9 ± 158.4 ng/dL], p=0.04). TT was < 8nmol/L [<230 ng/dL] in 9/50 men from the opioid group and 3/37 men from the non-opioid group. TT was negatively correlated with BMI in both groups. There was no difference in the opioid vs non-opioid treated men in serum FSH (6.6 ± 3.5 vs 6.3 ± 3.2 IU/L, p=0.63), LH (4.0 ± 2.2 vs 4.8 ± 1.9 IU/L, p=0.06) or prolactin (193 ± 97 vs 178 ± 98 mIU/L, p=0.48). TT levels did not correlate with oMEDD across the group nor in the subset of men (n=17) on oMEDD > 100mg per day. Sexual function scores were similar between the groups and did not correlate with TT. Men taking opioids reported higher severity and intensity of pain (BPI), and higher anxiety, depression and stress levels (DASS21). Discussion: There was no clinically significant association between opioid use or dose and TT in this cohort of men with chronic non-cancer pain. Previous smaller studies of men with chronic non-cancer pain documenting lower testosterone levels have utilised significantly higher oMEDD suggesting a possible threshold dose effect. Although opioid use may contribute to hypogonadism in some men, this should not preclude endocrine evaluation to identify other causes.
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Affiliation(s)
- Stella Sarlos
- Hudson Institute of Medical Research; Department of Medicine, Monash University, Clayton VIC, , Australia
| | - Melita Giummarra
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Caulfield VIC; Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Clayton VIC, , Australia
| | - Carolyn Allan
- Hudson Institute of Medical Research; Department of Obstetrics and Gynaecology, Monash University, Clayton VIC, , Australia
| | - Carolyn Arnold
- Caulfield Pain Management & Research Centre, Alfred Health Melbourne, VIC; Department of Anaesthesia & Peri-operative Medicine, Monash University, Clayton VIC, , Australia
| | - Kay Choy
- Department of Pathology, Monash Health, Clayton VIC, , Australia
| | - James Doery
- Department of Pathology, Monash Health; Department of Medicine, Monash University, Clayton VIC, , Australia
| | - Robert McLachlan
- Hudson Institute of Medical Research; Department of Obstetrics and Gynaecology, Monash University; Andrology Australia, Clayton VIC, , Australia
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20
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Wittert G, Atlantis E, Allan C, Bracken K, Conway A, Daniel M, Gebski V, Grossmann M, Hague W, Handelsman DJ, Inder W, Jenkins A, Keech A, McLachlan R, Robledo K, Stuckey B, Yeap BB. Testosterone therapy to prevent type 2 diabetes mellitus in at-risk men (T4DM): Design and implementation of a double-blind randomized controlled trial. Diabetes Obes Metab 2019; 21:772-780. [PMID: 30520208 DOI: 10.1111/dom.13601] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/18/2018] [Accepted: 12/01/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Low circulating testosterone is associated with an increased risk of developing type 2 diabetes (T2DM) in overweight men with impaired glucose tolerance (IGT). AIMS To determine in a multi-centre, double-blinded placebo-controlled randomized trial whether testosterone treatment combined with lifestyle intervention (Weight Watchers) relative to lifestyle intervention alone reduces T2DM incidence and improves glucose tolerance at 2 years. STUDY POPULATION Overweight or obese men aged 50-74 years with a serum testosterone of ≤14 nmol/L and IGT or newly diagnosed T2DM established by an oral glucose tolerance test (OGTT). SETTING, DRUG AND PROTOCOL Six Australian capital city-based tertiary care centres. Participants were randomized 1:1 and injected with testosterone undecanoate (1000 mg/4 mL) or vehicle (4 mL castor oil), at baseline, 6 weeks and 3-monthly thereafter. PRIMARY ENDPOINTS: (a) Proportion of participants with 2-hour OGTT ≥11.1 mmol/L at 2 years, and (b) a difference at 2 years ≥0.6 mmol/L in the mean 2-hour OGTT glucose between treatments. SECONDARY ENDPOINTS Fasting insulin, HbA1c, body composition, maximal handgrip strength; sexual function and lower urinary tract symptoms; serum sex steroids and sex hormone binding globulin; mood and psychosocial function; adherence to lifestyle intervention; and healthcare utilization and costs. SAFETY Overseen by an Independent Data Safety Monitoring Committee. Haematocrit, lipids and prostate-specific antigen (PSA) are assessed 6-monthly and information relating to haematological, urological and cardiovascular adverse events from each clinic visit. SUB-STUDIES: (a) Changes in bone density and micro-architecture, (b) motivation and behaviour, (c) telomere length, (d) extended treatment up to 4 years, and (e) hypothalamo-pituitary testicular axis recovery at treatment end.
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Affiliation(s)
- Gary Wittert
- Freemasons Foundation Centre for Mens Health, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Evan Atlantis
- Freemasons Foundation Centre for Mens Health, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
| | - Carolyn Allan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, Australia
| | - Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Ann Conway
- Anzac Research Institute and Andrology Department, Concord Hospital, Sydney, New South Wales, Australia
| | - Mark Daniel
- Health Research Institute, University of Canberra, Australian Capital Territory, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Mathis Grossmann
- Dept. of Medicine, The Austin Hospital and University of Melbourne, Victoria, Australia
| | - Wendy Hague
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - David J Handelsman
- Anzac Research Institute and Andrology Department, Concord Hospital, Sydney, New South Wales, Australia
| | - Warrick Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital and University of Queensland, Woolloongabba, Australia
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Anthony Keech
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Robert McLachlan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, Australia
| | - Kristy Robledo
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Bronwyn Stuckey
- Keogh Institute for Medical Research, Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, and Medical School, University of Western Australia, Perth, Western Australia
| | - Bu B Yeap
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, and Medical School University of Western Australia, Perth, Western Australia
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21
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Ognjenovic M, Ambrosini GL, Malacova E, Doherty DA, Oddy WH, Handelsman DJ, McLachlan R, Dickinson J, Hart RJ. Associations between major dietary patterns and testicular function in a population-based cohort of young men: results from the Western Australian Pregnancy Cohort (Raine) Study. Andrology 2019; 7:273-280. [PMID: 30854803 DOI: 10.1111/andr.12598] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Controversial speculation suggestions that dietary intake may affect semen quality and testicular function, however, there are limited comprehensive studies observing dietary patterns. OBJECTIVE To study associations between major dietary patterns and markers of testicular function in adulthood. MATERIAL AND METHODS Observational cross-sectional study of two hundred and ninety men with an average age of 20 years, from the Western Australian Pregnancy Cohort (Raine) Study. Usual dietary intake assessed using a semi-quantitative food frequency questionnaire at 20 years of age. Two dietary patterns previously identified using exploratory factor analysis ("Healthy" or "Western") and participants received z-scores for each dietary pattern. Primary endpoints were testicular volume, total sperm per ejaculate, morning serum testosterone concentration. Secondary endpoints were semen sample parameters, inhibin B and sex steroids (DHT: 3α-diol, 3β-diol; LH; FSH; DHEA; estradiol; estrone). RESULT(S) Participants were on average 20.0 ± 0.4 years old, had a median of 2 days sexual abstinence and a body mass index of 24.1 ± 3.9 kg/m2 , 13% were smokers, 52% were 'moderate' alcohol drinkers, 23% frequently used recreational drugs and 68% reported 'high' physical activity levels. Sperm concentration and DHT 3α-diol were negatively associated with a greater z-score for the "Western" dietary pattern (p = 0.007 and; p = 0.044, respectively), and serum estradiol concentration was positively associated with a "Western" dietary pattern (p = 0.007) after adjustment for BMI, varicocele, cryptorchidism and sexual abstinence. DISCUSSION Despite associations between greater intake of the "Western" dietary pattern and a decreased male reproductive health markers, our lack of consistent associations of either a "Healthy" or a "Western" dietary pattern, limit clinical or biological significance in isolation. CONCLUSIONS A potential negative association of a "Western" dietary pattern with male reproductive health was detected and should be studied further in population-based studies.
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Affiliation(s)
- M Ognjenovic
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - G L Ambrosini
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia
| | - E Malacova
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.,School of Public Health, Curtin University, Perth, WA, Australia
| | - D A Doherty
- Women and Infants Research Foundation, King Edward Memorial Hospital, Perth, WA, Australia.,Division of Obstetrics & Gynaecology, The University of Western Australia, Perth, WA, Australia
| | - W H Oddy
- Menzies Institute for Medical Research, The University of Tasmania, Hobart, TAS, Australia
| | - D J Handelsman
- ANZAC Research Institute, Concord Hospital, University of Sydney, Concord, NSW, Australia
| | - R McLachlan
- Hudson Institute of Medical Research, Monash Medical Centre, Melbourne, VIC, Australia
| | - J Dickinson
- Division of Obstetrics & Gynaecology, The University of Western Australia, Perth, WA, Australia
| | - R J Hart
- Division of Obstetrics & Gynaecology, The University of Western Australia, Perth, WA, Australia.,Fertility Specialists of Western Australia, Bethesda Hospital, Claremont, WA, Australia
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22
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Wittert G, Atlantis E, Allan C, Bracken K, Conway A, Daniel M, Gebski V, Grossmann M, Hague W, Handelsman DJ, Inder W, Jenkins A, Keech A, McLachlan R, Robledo K, Stuckey B, Yeap BB. Testosterone therapy to prevent type 2 diabetes mellitus in at-risk men (T4DM): Design and implementation of a double-blind randomized controlled trial. Diabetes Obes Metab 2018. [PMID: 30520208 DOI: 10.1111/dom.13601.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Low circulating testosterone is associated with an increased risk of developing type 2 diabetes (T2DM) in overweight men with impaired glucose tolerance (IGT). AIMS To determine in a multi-centre, double-blinded placebo-controlled randomized trial whether testosterone treatment combined with lifestyle intervention (Weight Watchers) relative to lifestyle intervention alone reduces T2DM incidence and improves glucose tolerance at 2 years. STUDY POPULATION Overweight or obese men aged 50-74 years with a serum testosterone of ≤14 nmol/L and IGT or newly diagnosed T2DM established by an oral glucose tolerance test (OGTT). SETTING, DRUG AND PROTOCOL Six Australian capital city-based tertiary care centres. Participants were randomized 1:1 and injected with testosterone undecanoate (1000 mg/4 mL) or vehicle (4 mL castor oil), at baseline, 6 weeks and 3-monthly thereafter. PRIMARY ENDPOINTS: (a) Proportion of participants with 2-hour OGTT ≥11.1 mmol/L at 2 years, and (b) a difference at 2 years ≥0.6 mmol/L in the mean 2-hour OGTT glucose between treatments. SECONDARY ENDPOINTS Fasting insulin, HbA1c, body composition, maximal handgrip strength; sexual function and lower urinary tract symptoms; serum sex steroids and sex hormone binding globulin; mood and psychosocial function; adherence to lifestyle intervention; and healthcare utilization and costs. SAFETY Overseen by an Independent Data Safety Monitoring Committee. Haematocrit, lipids and prostate-specific antigen (PSA) are assessed 6-monthly and information relating to haematological, urological and cardiovascular adverse events from each clinic visit. SUB-STUDIES: (a) Changes in bone density and micro-architecture, (b) motivation and behaviour, (c) telomere length, (d) extended treatment up to 4 years, and (e) hypothalamo-pituitary testicular axis recovery at treatment end.
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Affiliation(s)
- Gary Wittert
- Freemasons Foundation Centre for Mens Health, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Evan Atlantis
- Freemasons Foundation Centre for Mens Health, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
| | - Carolyn Allan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, Australia
| | - Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Ann Conway
- Anzac Research Institute and Andrology Department, Concord Hospital, Sydney, New South Wales, Australia
| | - Mark Daniel
- Health Research Institute, University of Canberra, Australian Capital Territory, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Mathis Grossmann
- Dept. of Medicine, The Austin Hospital and University of Melbourne, Victoria, Australia
| | - Wendy Hague
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - David J Handelsman
- Anzac Research Institute and Andrology Department, Concord Hospital, Sydney, New South Wales, Australia
| | - Warrick Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital and University of Queensland, Woolloongabba, Australia
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Anthony Keech
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Robert McLachlan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, Australia
| | - Kristy Robledo
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Bronwyn Stuckey
- Keogh Institute for Medical Research, Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, and Medical School, University of Western Australia, Perth, Western Australia
| | - Bu B Yeap
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, and Medical School University of Western Australia, Perth, Western Australia
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23
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Aleksova J, Rodriguez AJ, McLachlan R, Kerr P, Milat F, Ebeling PR. Gonadal Hormones in the Pathogenesis and Treatment of Bone Health in Patients with Chronic Kidney Disease: a Systematic Review and Meta-Analysis. Curr Osteoporos Rep 2018; 16:674-692. [PMID: 30328552 DOI: 10.1007/s11914-018-0483-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Patients with chronic kidney disease (CKD) have a greatly increased fracture risk compared with the general population. Gonadal hormones have an important influence on bone mineral density (BMD) and fracture risk, and hormone therapies can significantly improve these outcomes. Gonadal dysfunction is a frequent finding in patients with CKD; yet, little is known about the impact of gonadal hormones in the pathogenesis and treatment of bone health in patients with CKD. This systematic review and meta-analysis aimed to examine the effects of gonadal hormones and hormone therapies on bone outcomes in men and women with CKD. METHODS EMBASE, MEDLINE, SCOPUS, and clinical trial registries were systematically searched from inception to February 14, 2018 for studies that assessed gonadal hormones or hormone treatments with bone outcomes in patients with CKD stage 3-5D. Two independent reviewers screened the titles and abstracts of search results according to inclusion criteria and assessed study quality and risk of bias using validated assessment tools. RECENT FINDINGS Thirteen studies met the inclusion criteria. Six moderate-to-high quality observational studies showed inconsistent association between any gonadal hormone and bone outcomes, limited by significant study heterogeneity. Five moderate-high risk of bias interventional studies examined treatment with selective oestrogen receptor modulators in post-menopausal women (four using raloxifene and one bazedoxifene) and demonstrated variable effects on BMD and fracture outcomes. Meta-analysis of raloxifene treatment in post-menopausal women demonstrated improvement in lumbar spine (SMD 3.30; 95% CI 3.21-3.38) and femoral neck (SMD 3.29; 95% CI 3.21-3.36) BMD compared with placebo. Transdermal oestradiol/norethisterone in pre-menopausal women receiving dialysis (n = 1 study), demonstrated BMD improvement over 12 months. Testosterone treatment for 6 months in dialysis-dependant men (n = 1 study) did not improve BMD. There is evidence that raloxifene treatment may be beneficial in improving BMD in post-menopausal women with CKD. There is insufficient evidence for other hormone treatments in men or women. Despite high fracture rates and frequent gonadal dysfunction in patients with CKD, significant evidence gaps exist, and well-designed studies are required to specifically assess the impact of gonadal status in the pathogenesis of CKD-related bone fragility and its treatment.
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Affiliation(s)
- Jasna Aleksova
- Department of Endocrinology, Monash Health, 246 Clayton Rd. Clayton, Melbourne, Victoria, 3168, Australia.
- Hudson Institute of Medical Reearch, Clayton, Melbourne, Australia.
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia.
| | - Alexander J Rodriguez
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
- Bone & Muscle Health Research Group, Department of Medicine, Monash University, Melbourne, Australia
| | - Robert McLachlan
- Department of Endocrinology, Monash Health, 246 Clayton Rd. Clayton, Melbourne, Victoria, 3168, Australia
- Hudson Institute of Medical Reearch, Clayton, Melbourne, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Peter Kerr
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
- Department of Nephrology, Monash Health, Melbourne, Australia
| | - Frances Milat
- Department of Endocrinology, Monash Health, 246 Clayton Rd. Clayton, Melbourne, Victoria, 3168, Australia
- Hudson Institute of Medical Reearch, Clayton, Melbourne, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Peter R Ebeling
- Department of Endocrinology, Monash Health, 246 Clayton Rd. Clayton, Melbourne, Victoria, 3168, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
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24
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Hart RJ, Frederiksen H, Doherty DA, Keelan JA, Skakkebaek NE, Minaee NS, McLachlan R, Newnham JP, Dickinson JE, Pennell CE, Norman RJ, Main KM. The Possible Impact of Antenatal Exposure to Ubiquitous Phthalates Upon Male Reproductive Function at 20 Years of Age. Front Endocrinol (Lausanne) 2018; 9:288. [PMID: 29922230 PMCID: PMC5996240 DOI: 10.3389/fendo.2018.00288] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/15/2018] [Indexed: 12/31/2022] Open
Abstract
Phthalates are ubiquitous environmental endocrine-disrupting chemicals suspected to interfere with developmental androgen action leading to adverse effects on male reproductive function. Prenatal exposure studies in rodents show cryptorchidism, hypospadias and reduced testicular volume (TV), testosterone and anogenital distance in males. It is postulated that there is a developmental window in utero when phthalate exposure has the most potent adverse effects. Some human studies show associations between prenatal phthalate exposure and reduced calculated "free" serum testosterone in infant boys and shorter anogenital distance. However, there are no data available yet which link antenatal exposure to long-term effects in men. We aimed to correlate antenatal phthalate exposure with adult TV, semen parameters and serum reproductive hormone concentrations. 913 men from the Western Australian (Raine) Pregnancy Cohort were contacted aged 20-22 years. 423 (56%) agreed to participate; 404 underwent testicular ultrasound examination; 365 provided semen samples, and reproductive hormones were measured in 384. Maternal antenatal serum phthalate metabolite measurements were available for 185 and 111 men, who provided serum and semen, respectively. Maternal serum collected at 18 and 34 weeks gestation, stored at -80°C, was pooled and analyzed for 32 phthalate metabolites by liquid chromatography-tandem mass spectrometry. TV was calculated, semen analysis performed by WHO approved methods, and serum concentrations of gonadotrophins, inhibin B, and testosterone measured. Eleven phthalate metabolites were detected. Primary and secondary metabolites of di-(2-ethyl-hexyl) phthalate (DEHP) and di-iso-nonyl phthalate (DiNP) were positively correlated. After correction for adult height, BMI, presence of a varicocele and exposure to maternal smoking mono-iso-nonyl phthalate (MiNP) (r = -0.22) and sums of DEHP and DiNP metabolites (r = -0.24) and the sum of the metabolites of the high molecular weight phthalates (r = -0.21) were negatively correlated with TV (all p < 0.05). After adjustment for BMI adult serum total testosterone was positively associated with exposure to the following antenatal serum phthalate metabolites: mono-(2-ethylhexyl) phthalate (r = 0.26), MiNP (r = 0.18), the sum of metabolites for DEHP (r = 0.21) and DiNP (r = 0.18), and the sum of high molecular phthalates (r = 0.20) (p = 0.0005 to p = 0.02). Given sample size, storage duration and confounding through postnatal exposures, further studies are required.
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Affiliation(s)
- Roger J. Hart
- Division of Obstetrics & Gynaecology, University of Western Australia, Perth, WA, Australia
- Fertility Specialists of Western Australia, Bethesda Hospital, Claremont, WA, Australia
- *Correspondence: Roger J. Hart,
| | - Hanne Frederiksen
- Department of Growth and Reproduction and EDMaRC, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Dorota A. Doherty
- Division of Obstetrics & Gynaecology, University of Western Australia, Perth, WA, Australia
- Women and Infants Research Foundation, King Edward Memorial Hospital, Perth, WA, Australia
| | - Jeffrey A. Keelan
- Division of Obstetrics & Gynaecology, University of Western Australia, Perth, WA, Australia
- Women and Infants Research Foundation, King Edward Memorial Hospital, Perth, WA, Australia
| | - Niels E. Skakkebaek
- Department of Growth and Reproduction and EDMaRC, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Noviani S. Minaee
- Women and Infants Research Foundation, King Edward Memorial Hospital, Perth, WA, Australia
| | - Robert McLachlan
- Hudson Institute of Medical Research, Monash Medical Centre, Melbourne, VIC, Australia
| | - John P. Newnham
- Division of Obstetrics & Gynaecology, University of Western Australia, Perth, WA, Australia
- Women and Infants Research Foundation, King Edward Memorial Hospital, Perth, WA, Australia
| | - Jan E. Dickinson
- Division of Obstetrics & Gynaecology, University of Western Australia, Perth, WA, Australia
| | - Craig E. Pennell
- Division of Obstetrics & Gynaecology, University of Western Australia, Perth, WA, Australia
- Women and Infants Research Foundation, King Edward Memorial Hospital, Perth, WA, Australia
| | - Robert J. Norman
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Katharina M. Main
- Department of Growth and Reproduction and EDMaRC, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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25
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Hart RJ, Doherty DA, Keelan JA, Minaee NS, Thorstensen EB, Dickinson JE, Pennell CE, Newnham JP, McLachlan R, Norman RJ, Handelsman DJ. The impact of antenatal Bisphenol A exposure on male reproductive function at 20-22 years of age. Reprod Biomed Online 2017; 36:340-347. [PMID: 29291929 DOI: 10.1016/j.rbmo.2017.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
Abstract
Bisphenol A (BPA) is a ubiquitous chemical suspected to possess oestrogenic hormonal activities. Male population studies suggest a negative impact on testicular function. As Sertoli cell proliferation occurs during fetal or early postnatal life, it is speculated that oestrogenic environmental exposures may influence mature testicular function. Among 705 Western Australian Pregnancy Cohort (Raine) Study men aged 20-22 years, 404 underwent testicular ultrasound examination (149 had maternal serum available), and/or 365 provided semen (136 had maternal serum) and/or 609 serum samples for sex steroids, gonadotrophins and inhibin B analysis (244 had maternal serum). Maternal serum collected at 18 and 34 weeks' gestation was pooled and assayed for concentrations of total BPA (free plus conjugated) as an estimate of antenatal exposure. Testicular volume was calculated by ultrasonography, and semen analysis performed. Serum LH, FSH and inhibin B were measured by immunoassay; testosterone, oestradiol, oestrone andBPA were measured by liquid chromatography-mass spectrometry. BPA levels were detectable in most (89%) maternal serum samples. After adjustment for maternal smoking, abstinence and varicocele, sperm concentration and motility were significantly correlated to maternal serum BPA (r = 0.18; P = 0.04 for both). No other associations of maternal serum BPA with testicular function were observed.
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Affiliation(s)
- Roger J Hart
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Western Australia, Australia; Fertility Specialists of Western Australia, Bethesda Hospital, Claremont, Western Australia, Australia.
| | - Dorota A Doherty
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Western Australia, Australia; Women and Infants Research Foundation, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Jeffrey A Keelan
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Western Australia, Australia; Women and Infants Research Foundation, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Novia S Minaee
- Women and Infants Research Foundation, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | | | - Jan E Dickinson
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Western Australia, Australia
| | - Craig E Pennell
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Western Australia, Australia; Women and Infants Research Foundation, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - John P Newnham
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Western Australia, Australia; Women and Infants Research Foundation, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Robert McLachlan
- Hudson Institute of Medical Research, Monash Medical Centre, Melbourne, Australia
| | - Robert J Norman
- Robinson Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - David J Handelsman
- ANZAC Research Institute, Concord Hospital, Sydney, New South Wales, Australia
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Barratt CLR, Björndahl L, De Jonge CJ, Lamb DJ, Osorio Martini F, McLachlan R, Oates RD, van der Poel S, St John B, Sigman M, Sokol R, Tournaye H. The diagnosis of male infertility: an analysis of the evidence to support the development of global WHO guidance-challenges and future research opportunities. Hum Reprod Update 2017; 23:660-680. [PMID: 28981651 PMCID: PMC5850791 DOI: 10.1093/humupd/dmx021] [Citation(s) in RCA: 247] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 04/12/2017] [Accepted: 07/12/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Herein, we describe the consensus guideline methodology, summarize the evidence-based recommendations we provided to the World Health Organization (WHO) for their consideration in the development of global guidance and present a narrative review of the diagnosis of male infertility as related to the eight prioritized (problem or population (P), intervention (I), comparison (C) and outcome(s) (O) (PICO)) questions. Additionally, we discuss the challenges and research gaps identified during the synthesis of this evidence. OBJECTIVE AND RATIONALE The aim of this paper is to present an evidence-based approach for the diagnosis of male infertility as related to the eight prioritized PICO questions. SEARCH METHODS Collating the evidence to support providing recommendations involved a collaborative process as developed by WHO, namely: identification of priority questions and critical outcomes; retrieval of up-to-date evidence and existing guidelines; assessment and synthesis of the evidence; and the formulation of draft recommendations to be used for reaching consensus with a wide range of global stakeholders. For each draft recommendation the quality of the supporting evidence was then graded and assessed for consideration during a WHO consensus. OUTCOMES Evidence was synthesized and recommendations were drafted to address the diagnosis of male infertility specifically encompassing the following: What is the prevalence of male infertility and what proportion of infertility is attributable to the male? Is it necessary for all infertile men to undergo a thorough evaluation? What is the clinical (ART/non ART) value of traditional semen parameters? What key male lifestyle factors impact on fertility (focusing on obesity, heat and tobacco smoking)? Do supplementary oral antioxidants or herbal therapies significantly influence fertility outcomes for infertile men? What are the evidence-based criteria for genetic screening of infertile men? How does a history of neoplasia and related treatments in the male impact on (his and his partner's) reproductive health and fertility options? And lastly, what is the impact of varicocele on male fertility and does correction of varicocele improve semen parameters and/or fertility? WIDER IMPLICATIONS This evidence synthesis analysis has been conducted in a manner to be considered for global applicability for the diagnosis of male infertility.
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Affiliation(s)
- Christopher L R Barratt
- Department of Reproductive and Developmental Biology, Medical School, Ninewells Hospital, University of Dundee, Dundee, DD1 9SY, Scotland
| | - Lars Björndahl
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | - Robert D Oates
- Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Sheryl van der Poel
- Department of Reproductive Health and Research, Human Reproduction Programme, (HRP, The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction), WHO, Geneva, Switzerland
- Population Council, New York, NY, USA
| | - Bianca St John
- Hudson Institute of Medical Research, Clayton, Australia
| | - Mark Sigman
- Warren Alpert Medical School of Brown University, RI, USA
| | - Rebecca Sokol
- Department of Obstetrics and Gynaecology and Medicine, Keck School of Medicine, University of Southern California, CA, USA
| | - Herman Tournaye
- Centre for Reproductive Medicine, Vrije Universiteit Brussel, Brussels, Belgium
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27
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Hammarberg K, Collins V, Holden C, Young K, McLachlan R. Men's knowledge, attitudes and behaviours relating to fertility. Hum Reprod Update 2017; 23:458-480. [PMID: 28333354 DOI: 10.1093/humupd/dmx005] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/26/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The increasingly common practice in high-income countries to delay childbearing to the fourth and fifth decades of life increases the risk of involuntary childlessness or having fewer children than desired. Older age also increases the risk of age-related infertility, the need for ART to conceive, and obstetric and neonatal complications. Existing research relating to childbearing focusses almost exclusively on women, and in public discourse declining fertility rates are often assumed to be the result of women delaying childbearing to pursue other life goals such as a career and travel. However, evidence suggests that the lack of a partner or a partner willing to commit to parenthood is the main reason for later childbearing. OBJECTIVE AND RATIONALE To better understand men's contributions to childbearing decisions and outcomes, the literature pertaining to men's fertility-related knowledge, attitudes and behaviours was reviewed. SEARCH METHODS The electronic databases of Medline, Embase and PsycINFO were searched to identify investigations of men's knowledge, attitudes and behaviours relating to fertility, infertility, reproductive health or childbearing using relevant fertility keyword search terms. Studies were included if they had investigated factors associated with men's fertility-related knowledge, attitudes and behaviours, had been conducted in a high-income country and were published in an English language peer-reviewed journal between January 2005 and August 2016. OUTCOMES The search yielded 1349 citations. Of these, 47 papers representing 43 unique studies were included in the review. Where response rate was reported, it ranged between 13 and 94%. Studies varied in terms of research design; inclusion and exclusion criteria; recruitment strategies; adequacy of sample size; recruitment and retention rates and data collection tools. However, findings were consistent and indicate that men almost universally value parenthood, want and expect to become fathers, and aspire to have at least two children. Yet most men have inadequate knowledge about the limitations of female and male fertility and overestimate the chance of spontaneous and assisted conception. Perceptions of ideal circumstances in which to have children included being in a stable and loving relationship, having completed studies, secured a permanent job and a dependable income, having achieved personal maturity, and having a partner who desires children and is 'suitable' as a potential co-parent. Although all studies were conducted in high-income countries, between-country social and cultural differences may have influenced the findings relating to attitudes. WIDER IMPLICATIONS Men aspire to parenthood as much as women do but have limited knowledge about the factors that influence fertility. The gap between ideal biological and ideal social age for having children appears to be widening, narrowing the time frame in which parenthood can be achieved. This may lead to unfulfilled parenthood aspirations. The findings can inform government policies and public education strategies aimed to support childbearing during the most fertile years, reduce the personal and societal cost of infertility and ART use, and allow people to fulfil their parenthood goals.
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Affiliation(s)
- Karin Hammarberg
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne 3004, Australia.,Victorian Assisted Reproductive Treatment Authority, Level 30, 570 Bourke Street, Melbourne 3000, Australia
| | - Veronica Collins
- Andrology Australia, School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne 3004, Australia
| | - Carol Holden
- Andrology Australia, School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne 3004, Australia
| | - Kate Young
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne 3004, Australia
| | - Robert McLachlan
- Andrology Australia, School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne 3004, Australia.,Hudson Institute of Medical Research, 27-31 Wright Street, Clayton 3168, Australia
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Lewis S, Kennedy J, Burgner D, McLachlan R, Ranganathan S, Hammarberg K, Saffery R, Amor DJ, Cheung MMH, Doyle LW, Juonala M, Donath S, McBain J, Halliday J. Clinical review of 24-35 year olds conceived with and without in vitro fertilization: study protocol. Reprod Health 2017; 14:117. [PMID: 28931409 PMCID: PMC5607609 DOI: 10.1186/s12978-017-0377-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 09/08/2017] [Indexed: 12/13/2022] Open
Abstract
Background Children conceived by assisted reproductive technologies (ART) currently comprise 4% of Australian births. The manipulation of biological parameters related to fertilization and implantation are integral to successful ART but potentially pose a risk to the longer-term health of the offspring. There is consensus that many common adult health problems (particularly cardiovascular, metabolic and respiratory conditions) have their origins in early life, possibly before birth, and that risk trajectories track through childhood until clinical disease manifests in adulthood. Early life epigenetic variation may play a role in this process. However little is known about the long-term health of individuals conceived by ART. In a previous study, based on telephone-interviews, we found that young adults conceived by in vitro fertilization (IVF) had significantly more maternal reported atopic respiratory, endocrine, nutritional, and metabolic conditions than non-IVF conceived matched controls. Here we outline the protocol for a follow-up biomedical assessment of this cohort and a questionnaire to obtain information on potential confounders. Methods We are conducting a clinical review of an existing, well characterised cohort comprising 547 IVF-conceived adults and 549 matched controls. We are measuring cardiovascular intermediate phenotypes, metabolic parameters and respiratory function, complemented by epigenome-wide DNA methylation analysis. A pilot study demonstrated the feasibility of our proposed protocol and its acceptability to participants. Participants attend a 2–3 h clinical assessment and complete a study-specific online questionnaire. Measurements include: 1) cardiovascular phenotypes: carotid artery intima-media thickness and distensibility, retinal vascular calibre, resting blood pressure, pulse wave velocity and pulse wave analysis; 2) respiratory function: spirometry, plethysmography, multiple breath washout; 3) auxology: height, weight, waist circumference, bio-impedance. Blood is collected for 4) biomarkers of cardiometabolic profile including inflammatory markers and 5) epigenetic analysis. Discussion Recruitment for this clinical review is challenging as many of the participants have moved to regional, interstate or international locations. Additionally, many female participants are pregnant or breastfeeding, and are therefore ineligible. Nevertheless, comprehensive strategies have been developed to optimize recruitment. Given the increasing use of IVF and related technologies, the potential long-term consequences for risk of common adult diseases is an important clinical and public health issue.
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Affiliation(s)
- Sharon Lewis
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, 3052, Australia. .,Department of Paediatrics, University of Melbourne, Melbourne, Australia.
| | - Joanne Kennedy
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, 3052, Australia
| | - David Burgner
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - Robert McLachlan
- Hudson Institute of Medical Research, Monash University, Clayton, 3168, Australia.,Monash IVF Group, Richmond, 3121, Australia
| | - Sarath Ranganathan
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Monash IVF Group, Richmond, 3121, Australia
| | - Karin Hammarberg
- Department of Respiratory and Sleep Medicine, The Royal Children's Hospital, Melbourne, Australia.,Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - David J Amor
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Australia
| | - Michael M H Cheung
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Cardiology, The Royal Children's Hospital, Melbourne, Australia
| | - Lex W Doyle
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Research Office, Royal Women's Hospital, Melbourne, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Markus Juonala
- Department of Internal Medicine, University of Turku and Division of Medicine Turku University Hospital, Turku, Finland
| | - Susan Donath
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - John McBain
- Reproductive Services, Royal Women's Hospital, Melbourne, Australia
| | - Jane Halliday
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
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29
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Aleksova J, Wong P, Mulley WR, Choy KW, McLachlan R, Ebeling PR, Kerr PG, Milat F. Serum phosphorus levels and fracture following renal transplantation. Clin Endocrinol (Oxf) 2017; 87:141-148. [PMID: 28449252 DOI: 10.1111/cen.13363] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/19/2017] [Accepted: 04/23/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE Increased fracture rates are observed in renal transplant recipients (RTRs) compared with the general population. Risk factors include age, diabetes, dialysis vintage, immunosuppression and mineral and bone disorders.1 Low serum phosphorus levels occur post-transplantation; however, its relationship with fracture risk has not been evaluated. The purpose of this study was to evaluate risk factors for fracture in RTRs at a single tertiary referral centre. METHODS A retrospective cross-sectional analysis of 146 patients (75 M, 71 F) who had been referred for dual energy X-ray densitometry (DXA) post-renal transplantation was performed. Aetiology of end stage kidney disease (ESKD), duration of dialysis, parathyroidectomy history, immunosuppression regimen, bone mineral density (BMD), biochemistry and fractures were documented. Statistical analyses included univariable and multivariable regression. RESULTS The mean age of patients was 54 years and mean time post-transplantation 6.7 years. A total of 79 fractures occurred in 52 patients (35%), with 40 fractures occurring post-transplantation. Ankle/foot fractures were most common (48%). Lower serum phosphorus levels and declining femoral neck (FN) T-score and were associated with fractures in both univariable and multivariable regression analyses after adjusting for age, gender, weight, estimated glomerular filtration rate and pre-transplant history of fracture (P=.011 and P=.042 respectively). The relationship between serum phosphorus and fracture remained significant independent of FN T-score, parathyroid hormone levels, parathyroidectomy status and prednisolone use. CONCLUSION Fracture was common post-renal transplantation. Lower serum phosphorus levels and declining FN T-scores were associated with fractures. The mechanism of this previously unreported observation requires further evaluation in prospective studies.
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Affiliation(s)
- Jasna Aleksova
- Department of Endocrinology, Monash Health, Melbourne, Australia
- Hudson Institute for Medical Research, Clayton, Melbourne, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Phillip Wong
- Department of Endocrinology, Monash Health, Melbourne, Australia
- Hudson Institute for Medical Research, Clayton, Melbourne, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - William R Mulley
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
- Department of Nephrology, Monash Health, Melbourne, Australia
| | - Kay Weng Choy
- Department of Biochemistry, Monash Health, Melbourne, Australia
| | - Robert McLachlan
- Department of Endocrinology, Monash Health, Melbourne, Australia
- Hudson Institute for Medical Research, Clayton, Melbourne, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Peter R Ebeling
- Department of Endocrinology, Monash Health, Melbourne, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Peter G Kerr
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
- Department of Nephrology, Monash Health, Melbourne, Australia
| | - Frances Milat
- Department of Endocrinology, Monash Health, Melbourne, Australia
- Hudson Institute for Medical Research, Clayton, Melbourne, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
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Hammarberg K, Norman RJ, Robertson S, McLachlan R, Michelmore J, Johnson L. Development of a health promotion programme to improve awareness of factors that affect fertility, and evaluation of its reach in the first 5 years. Reprod Biomed Soc Online 2017; 4:33-40. [PMID: 29774264 PMCID: PMC5952837 DOI: 10.1016/j.rbms.2017.06.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/27/2017] [Accepted: 06/08/2017] [Indexed: 06/08/2023]
Abstract
Awareness among people of reproductive age about the factors that influence fertility and reproductive outcomes, including medically assisted reproduction outcomes, is generally low. To improve awareness about the potentially modifiable factors that affect fertility and reproductive outcomes, 'Your Fertility', a fertility health promotion programme funded by the Australian Government, was established in 2011. This paper describes the development and evaluation of the reach of the Your Fertility programme from its inception in 2011 to June 2016. Systematically recorded outcomes for the programme's key focus areas and Google Analytics data were collated. Key achievements include developing and maintaining an internationally renowned website that experiences high growth and demand for fertility-related information; by 2016, over 5 million users had viewed more than 10 million webpages, and over 96,000 users had engaged in programme messages across social media. Programme messages have reached more than 4 million Australian social media users, and a potential audience of 150 million through media coverage across more than 320 media features. More than 4200 education and health professionals have completed online learning modules, and external partnerships have been established with 14 separate organizations. Data collected over 5 years indicate that the Your Fertility programme meets a need for targeted, evidence-based, accessible fertility-related information.
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Affiliation(s)
- Karin Hammarberg
- Victorian Assisted Reproductive Treatment Authority, Level 30, 570 Bourke Street, Melbourne 3000, Australia
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robert J. Norman
- Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, North Adelaide, Australia
| | - Sarah Robertson
- Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, North Adelaide, Australia
| | | | | | - Louise Johnson
- Victorian Assisted Reproductive Treatment Authority, Level 30, 570 Bourke Street, Melbourne 3000, Australia
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Harris K, Burley H, McLachlan R, Bowman M, Macaldowie A, Taylor K, Chapman M, Chambers GM. Socio-economic disparities in access to assisted reproductive technologies in Australia. Reprod Biomed Online 2016; 33:575-584. [PMID: 27595434 DOI: 10.1016/j.rbmo.2016.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/16/2016] [Accepted: 07/28/2016] [Indexed: 11/30/2022]
Abstract
Women from disadvantaged socio-economic groups access assisted reproductive technology treatment less than women from more advantaged groups. However, women from disadvantaged groups tend to start families younger, making them less likely to suffer from age-related subfertility and potentially have less need for fertility treatment. Whether socio-economic disparities in access to assisted reproductive technology treatment persist after controlling for the need for treatment, has not been previously explored. This population based study demonstrates that socio-economic disparities in access to assisted reproductive technology treatment persist after adjusting for several confounding factors, including age at first birth (used as a measure of delayed childbearing, hence a proxy for need for fertility treatment), geographic remoteness and Australian jurisdiction. Assisted reproductive technology access progressively decreased as socio-economic quintiles became more disadvantaged, with a 15.8% decrease in access in the most disadvantaged quintile compared with the most advantaged quintile after controlling for confounding factors. The adjusted rate of access to assisted reproductive technology treatment also decreased by 12.3% for women living in regional and remote areas compared with those in major cities. These findings indicate that financial and sociocultural barriers to assisted reproductive technology treatment remain in disadvantaged groups after adjusting for need.
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Affiliation(s)
- Katie Harris
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health UNSW, University of New South Wales, Sydney, Australia.
| | - Hugh Burley
- School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, Australia; Commonwealth Scientific and Industrial Research Organisation (CSIRO), CSIRO Land and Water, Canberra, ACT, Australia
| | - Robert McLachlan
- Hudson Institute of Medical Research, Australia; Department of Endocrinology, Monash Medical Centre, Clayton, Australia; Andrology Australia, Alfred Hospital, Monash University School of Public Health, Prahran, Australia
| | - Mark Bowman
- Genea, Sydney, NSW, Australia; Department of Obstetrics and Gynaecology, University of Sydney, Australia
| | - Alan Macaldowie
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health UNSW, University of New South Wales, Sydney, Australia
| | - Kate Taylor
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia; Australian Fertility Medicine Foundation, Sydney, New South Wales, Australia
| | - Michael Chapman
- School of Women's and Children's Health UNSW, University of New South Wales, Sydney, Australia; St George Private Hospital, IVF Australia, Pty Ltd, Sydney, Australia
| | - Georgina Mary Chambers
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health UNSW, University of New South Wales, Sydney, Australia
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Halliday J, Wilson C, Hammarberg K, Doyle LW, Bruinsma F, McLachlan R, McBain J, Berg T, Fisher JR, Amor D. Comparing indicators of health and development of singleton young adults conceived with and without assisted reproductive technology. Fertil Steril 2014; 101:1055-63. [PMID: 24559723 DOI: 10.1016/j.fertnstert.2014.01.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/07/2014] [Accepted: 01/07/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare outcomes for young adults conceived by assisted reproductive technology (ART) with non-ART-conceived young adults. DESIGN Cohort study. SETTING Not applicable. PARTICIPANT(S) Mothers and their offspring (aged 18-28 years) conceived by ART; mothers and their non-ART-conceived offspring, randomly selected from the same source population. INTERVENTION(S) Structured telephone interviews, one with mothers and another with their young adult offspring. MAIN OUTCOME MEASURE(S) Maternal report on young adult offspring hospitalizations and chronic illness accumulated over the first 18 years of their lives; young adult self-report on perceived current quality of life, body mass index, pubertal development, and educational achievement. RESULT(S) Of 1,480 eligible ART mothers, 80% were traced and contacted. Of those, 656 (55%) participated, reporting on 705 ART-conceived offspring; 269 (23%) declined participation and 262 (22%) did not respond. Of the participants, 84% consented to contact with their young adult offspring, of whom 547 (92%) participated. Random-digit dialing recruited 868 non-ART mothers and 549 offspring. Compared with non-ART young adults, the ART group had significant increases in three maternally reported outcomes: 1) hospital admissions, including those in the secondary school years; 2) atopic respiratory conditions; and 3) combined endocrine, nutritional, and metabolic disease ICD-10 category. Young adult reported outcomes were similar for both groups. CONCLUSION(S) This study addresses gaps in knowledge of outcomes beyond adolescence for those conceived by ART. Results show few adverse outcomes in this large cohort of young adults, but additional assessment through clinical review is required to address issues unable to be examined in this study.
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Affiliation(s)
- Jane Halliday
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia.
| | - Cate Wilson
- Cancer Epidemiology Centre, Cancer Council Victoria, Carlton, Australia
| | - Karin Hammarberg
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lex W Doyle
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Australia
| | - Fiona Bruinsma
- Cancer Epidemiology Centre, Cancer Council Victoria, Carlton, Australia
| | - Robert McLachlan
- Monash IVF, Epworth Hospital, Richmond, Australia; Prince Henry's Institute and Department of Obstetrics and Gynaecology, Clayton, Australia; Monash Medical Centre, Clayton, Australia
| | - John McBain
- Reproductive Services, Royal Women's Hospital, Parkville, Australia; Melbourne IVF, East Melbourne, Victoria, Australia
| | - Turi Berg
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia
| | - Jane R Fisher
- School of Population Health, University of Melbourne, Parkville, Australia; Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - David Amor
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
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Handelsman DJ, Newman JD, Jimenez M, McLachlan R, Sartorius G, Jones GRD. Performance of direct estradiol immunoassays with human male serum samples. Clin Chem 2013; 60:510-7. [PMID: 24334824 DOI: 10.1373/clinchem.2013.213363] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Steroid immunoassays originally required solvent extraction, chromatography, and structurally authentic tracers to avoid interference from steroid cross-reactivity and matrix effects. The demand for steroid assays has driven assay simplification, bypassing this triplet of validity criteria to allow use of unextracted serum, which has introduced bias and nonspecificity at low steroid concentrations. We aimed to evaluate the performance of commercial direct estradiol (E2) immunoassays relative to the reference method of LC-MS and compared serum E2 measurements from each assay with biomarkers of estrogen action. METHODS We measured serum E2 in duplicate using 5 commercial direct immunoassays and LC-MS in a nested cohort of 101 healthy, asymptomatic men >40 years old from the Healthy Man Study. For each immunoassay, we evaluated the detectability and distribution of serum E2 measurements, CV, and bias (relative to LC-MS) by Passing-Bablok regression and deviance plots. RESULTS Three assays detected E2 in all samples, whereas E2 was detected in only 53% and 72% of samples by 2 other assays. All 5 assays had positive biases, ranging from 6% to 74%, throughout their ranges. CVs were lower with 4 immunoassays than with LC-MS. LC-MS, but none of the direct immunoassays, correlated with serum testosterone and sex steroid-binding globulin. CONCLUSIONS The positive bias of direct E2 immunoassays throughout their working range reflects the nonspecific effects of steroid cross-reactivity and/or matrix interference arising from the violation of the triplet validity criteria for steroid immunoassay.
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Affiliation(s)
- David J Handelsman
- ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, NSW, Australia
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Pedros DCC, Oliveira JBA, Petersen CG, Mauri AL, Nascimento AM, Vagnini LD, Nicoletti A, Massaro FC, Cavagna M, Martins AMVC, Baruffi RLR, Franco JG, Hart R, Doherty DA, Handelsman DJ, McLachlan R, Skakkebaek NE, Keelan JA, Norman RJ, Dokuzeylul N, Onal M, Acet M, Basar M, Kahraman S, Garolla A, Pizzol D, Ghezzi M, Selice R, Bertoldo A, Menegazzo M, Foresta C, Jordan C, Broderick P. Session 18: Lifestyle dangers for men's fertility. Hum Reprod 2013. [DOI: 10.1093/humrep/det145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Snidvongs K, McLachlan R, Chin D, Pratt E, Sacks R, Earls P, Harvey RJ. Osteitic bone: a surrogate marker of eosinophilia in chronic rhinosinusitis. Rhinology 2013; 50:299-305. [PMID: 22888488 DOI: 10.4193/rhino12.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Causes of osteitis in chronic rhinosinusitis (CRS) other than previous surgery are poorly defined. Patients with eosinophilic CRS (ECRS) have more severe disease and poorer outcomes despite repeated surgery. Associations between osteitis and markers of ECRS are not well described. METHODS A cross-sectional study of CRS patients undergoing sinus surgery was conducted. Osteitis was scored radiologically using previously published measures. Associations between osteitis and histopathology, symptoms, endoscopy, CT mucosal score and seromarkers were analyzed. RESULTS Eighty-eight patients were assessed of whom forty-five had osteitis. Patients undergoing revision surgery recorded higher osteitis scores. Patients with mucosal eosinophilia had higher osteitis score than those without. Patients with osteitis had higher serum eosinophil. Similar relationships were also found in primary surgery. Osteitis was associated with endoscopic and radiologic, but not symptomatic disease severity. CONCLUSIONS Osteitis is associated with tissue and serum eosinophilia in both patients with and without prior surgery. Patients with these features may benefit from post-operative corticosteroid therapy to prevent osteitis.
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Beyer CE, Kayler B, Osborne E, McLachlan R, Osianlis T. Supersensitive fluorescent semen analysis: validation on azoospermic and oligozoospermic samples. Fertil Steril 2012; 98:843-8.e1. [PMID: 22818286 DOI: 10.1016/j.fertnstert.2012.06.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 06/15/2012] [Accepted: 06/15/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To compare the clinical utility of a supersensitive fluorescent semen analysis (SSSA) procedure published by Cooper et al. (2006) with a conventional World Health Organization (WHO)-based semen analysis technique in males with severe oligozoospermia or azoospermia who are undergoing fertility assessment. DESIGN Prospective single-center study. SETTING IVF clinic. PATIENT(S) Patients attending an infertility clinic for semen analysis. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Presence of spermatozoa in the ejaculate. RESULT(S) Semen samples from 100 men were analyzed using conventional WHO 4th Edition semen analysis and determined to be either severely oligozoospermic or azoospermic (reported lower limit of detection of 0.1 million sperm/mL). An aliquot of the same unprocessed sample was also analyzed using the SSSA protocol (reported lower limit of detection of approximately 8000 sperm/mL). The SSSA method confirmed the results of conventional semen analysis in 77% of cases. In 22% of cases, sperm were identified only using SSSA. Overall, SSSA was capable of identifying the presence of sperm in significantly more samples than conventional semen analysis. CONCLUSION(S) The reliable differentiation of extreme oligospermia from azoospermia has profound implications in fertility management. This paper provides the first data comparing sperm detection rates using SSSA or conventional WHO-based approaches in extreme oligozoospermic and azoospermic men in an IVF setting. Results indicate that approximately one in four men classified as azoospermic by conventional semen analysis may actually have sperm present. The improved sensitivity of the SSSA technique may be of significant benefit to patients, particularly in fertility and assisted reproductive technique decision making.
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Snidvongs K, McLachlan R, Chin D, Pratt E, Sacks R, Earls P, Harvey R. Osteitic bone: a surrogate marker of eosinophilia in chronic rhinosinusitis. Rhinology 2012. [DOI: 10.4193/rhin12.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Pariente-Khayat A, Conard J, Lemardeley G, Merlet F, Creusvaux H, Bissonnette F, Phillips S, Holzer H, Mahutte N, St-Michel P, Gunby J, Kadoch IJ, Wetzels A, Hendriks J, Cleine J, Curfs M, Kastrop P, Consten D, Woodward BJ, Norton WJ, Almeida P, Gilling-Smith C, Mol B, Van den Boogaard NM, Bruhl SW, Hompes PGA, Kremer JAM, Van der Veen F, Nelen WLDM, Emerson G, Hughes C, Mocanu E, Halliday J, Wilson C, Fisher JR, Hammarberg K, Sanson A, McBain J, McLachlan R. SELECTED ORAL COMMUNICATION SESSION, SESSION 71: QUALITY MANAGEMENT IN ART Wednesday 6 July 201114:00 - 15:45. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.71] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Thorup J, McLachlan R, Cortes D, Nation TR, Balic A, Southwell BR, Hutson JM. What is new in cryptorchidism and hypospadias--a critical review on the testicular dysgenesis hypothesis. J Pediatr Surg 2010; 45:2074-86. [PMID: 20920735 DOI: 10.1016/j.jpedsurg.2010.07.030] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 07/18/2010] [Accepted: 07/19/2010] [Indexed: 11/25/2022]
Abstract
It has been hypothesized that poor semen quality, testis cancer, undescended testis, and hypospadias are symptoms of one underlying entity--the testicular dysgenesis syndrome--leading to increasing male fertility impairment. Though testicular cancer has increased in many Western countries during the past 40 years, hypospadias rates have not changed with certainty over the same period. Also, recent studies demonstrate that sperm output may have declined in certain areas of Europe but is probably not declining across the globe as indicated by American studies. However, at the same time, there is increasing recognition of male infertility related to obesity and smoking. There is no certain evidence that the rates of undescended testes have been increasing with time during the last 50 years. In more than 95% of the cases, hypospadias is not associated with cryptorchidism, suggesting major differences in pathogenesis. Placental abnormality may occasionally cause both cryptorchidism and hypospadias, as it is also the case in many other congenital malformations. The findings of early orchidopexy lowering the risk of both infertility and testicular cancer suggest that the abnormal location exposes the cryptorchid testis to infertility and malignant transformation, rather than there being a primary abnormality. Statistically, 5% of testicular cancers only are caused by cryptorchidism. These data point to the complexity of pathogenic and epidemiologic features of each component and the difficulties in ascribing them to a single unifying process, such as testicular dysgenesis syndrome, particularly when so little is known of the actual mechanisms of disease.
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Affiliation(s)
- Jorgen Thorup
- Department of Pediatric Surgery, Faculty of Health Science, University of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark.
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Dias VL, Rajpert-De Meyts E, McLachlan R, Loveland KL. Analysis of activin/TGFB-signaling modulators within the normal and dysfunctional adult human testis reveals evidence of altered signaling capacity in a subset of seminomas. Reproduction 2009; 138:801-11. [PMID: 19661148 DOI: 10.1530/rep-09-0206] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Activin is a pleiotropic growth factor belonging to the transforming growth factor-beta (TGFB) superfamily of signaling molecules. Regulated activin signaling is known to influence several steps in rodent male gamete differentiation. TGFB ligand isoforms, TGFB1-B3, also influence germ cell survival in the rodent testis at the onset of spermatogenesis and around the time of puberty. Given the importance of regulated activin and TGFB signaling in testis development and function, we sought to investigate the cellular production sites of activin/TGFB-signaling modulators in normal and dysfunctional adult human testes samples. Signaling transducers phosphorylated SMAD2/3, and signaling modulators SMAD6, MAN-1, inhibin alpha (INHA), and beta-glycan were detected in Bouins fixed, paraffin-embedded adult human testis sections using immunohistochemistry. Additional samples examined were from testicular cancer patients and from normal men subjected to gonadotropin suppression with androgen-based contraceptives. Our findings identify distinct differences between normal and gonadotropin-deprived human testis in the expression and cellular localization of activin/TGFB-signaling modulators. The presence of a nuclear phosphorylated SMAD2/3 signal in all analyzed seminoma specimens indicated active activin/TGFB signaling. Moreover, a subset of seminoma specimens exhibited selective enhanced expression of beta-glycan (4 out of 28 seminoma tumors), INHA (6 out of 28), and MAN-1 (6 out of 28), highlighting potential functional differences between individual tumors in their capacity to regulate activin/TGFB signaling. Within the heterogenous nonseminomas, expression of signaling modulators was variable and reflected the degree of somatic differentiation. Thus, synthesis of activin and TGFB-signaling modulators may be affected by spermatogenic disruption and altered hormone levels in the testis.
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Affiliation(s)
- Vinali L Dias
- Monash Institute of Medical Research, Monash University, Clayton, Victoria, Australia
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Sartorius G, Ly LP, Sikaris K, McLachlan R, Handelsman DJ. Predictive accuracy and sources of variability in calculated free testosterone estimates. Ann Clin Biochem 2009; 46:137-43. [DOI: 10.1258/acb.2008.008171] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Serum free testosterone (FT) concentrations are commonly requested, but because reference FT methods are too laborious various calculational algorithms for FT based on total testosterone (TT) and sex hormone-binding globulin (SHBG) are frequently used. This study provides the first large-scale evaluation of the predictive accuracy and sources of variability for different FT formulae compared with direct laboratory measurements. Methods Using a large data-set of direct FT measurements by centrifugal ultrafiltration, the predictive accuracy of five different formulas for cFT (four existing plus a new formula) is evaluated in 3975 consecutive blood samples. In a second data-set of 124 samples from a reference panel of healthy eugonadal young men, we estimate the relative influence of the five algorithms and eight different TT and two SHBG assays including all available commercial total TT and SHBG assays together with a gas chromatography/mass spectrometry T reference method. Results cFT formulae show wide discrepancies with equilibrium-binding algorithms showing systematic overestimation relative to direct FT measurements, whereas two empirical cFT methods were more concordant. Variations between commercially available TT immunoassays have a strong impact on calculation of FT with TT assays contributing 82.2% of overall variance compared with 13.7% for the cFT algorithms and 4.1% for the SHBG assays. Conclusions If FT measurements are requested and direct measurement impractical, cFT formulae using TT and SHBG immunoassays provide an approximation to direct FT measurement that is strongly dependent on the TT, cFT formula used and, to a lesser extent, SHBG immunoassays.
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Affiliation(s)
- Gideon Sartorius
- Andrology Department, Concord Hospital
- ANZAC Research Institute, University of Sydney, Sydney, NSW 2139
| | - Lam P Ly
- Andrology Department, Concord Hospital
- ANZAC Research Institute, University of Sydney, Sydney, NSW 2139
| | - Ken Sikaris
- Melbourne Pathology, University of Melbourne, Melbourne
| | - Robert McLachlan
- Prince Henry's Institute of Medical Research, Clayton, Victoria, Australia
| | - David J Handelsman
- Andrology Department, Concord Hospital
- ANZAC Research Institute, University of Sydney, Sydney, NSW 2139
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Krausz C, Giachini C, Xue Y, O'Bryan MK, Gromoll J, Rajpert-de Meyts E, Oliva R, Aknin-Seifer I, Erdei E, Jorgensen N, Simoni M, Ballescà JL, Levy R, Balercia G, Piomboni P, Nieschlag E, Forti G, McLachlan R, Tyler-Smith C. Phenotypic variation within European carriers of the Y-chromosomal gr/gr deletion is independent of Y-chromosomal background. J Med Genet 2008; 46:21-31. [PMID: 18782837 DOI: 10.1136/jmg.2008.059915] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Previous studies have compared sperm phenotypes between men with partial deletions within the AZFc region of the Y chromosome and non-carriers, with variable results. In this study, a separate question was investigated, the basis of the variation in sperm phenotype within gr/gr deletion carriers, which ranges from normozoospermia to azoospermia. Differences in the genes removed by independent gr/gr deletions, the occurrence of subsequent duplications or the presence of linked modifying variants elsewhere on the chromosome have been suggested as possible causal factors. This study set out to test these possibilities in a large sample of gr/gr deletion carriers with known phenotypes spanning the complete range. RESULTS In total, 169 men diagnosed with gr/gr deletions from six centres in Europe and one in Australia were studied. The DAZ and CDY1 copies retained, the presence or absence of duplications and the Y-chromosomal haplogroup were characterised. Although the study had good power to detect factors that accounted for >or=5.5% of the variation in sperm concentration, no such factor was found. A negative effect of gr/gr deletions followed by b2/b4 duplication was found within the normospermic group, which remains to be further explored in a larger study population. Finally, significant geographical differences in the frequency of different subtypes of gr/gr deletions were found, which may have relevance for the interpretation of case control studies dealing with admixed populations. CONCLUSIONS The phenotypic variation of gr/gr carriers in men of European origin is largely independent of the Y-chromosomal background.
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Affiliation(s)
- C Krausz
- Andrology Unit, Department of Clinical Physiopathology, University of Florence, Viale Pieraccini, 6 Florence 50139, Italy.
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Dias V, Meachem S, Rajpert-De Meyts E, McLachlan R, Manuelpillai U, Loveland KL. Activin receptor subunits in normal and dysfunctional adult human testis. Hum Reprod 2007; 23:412-20. [PMID: 18077314 DOI: 10.1093/humrep/dem343] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The cellular sites of activin action and its regulation in the normal and dysfunctional adult human testis are unknown. METHODS Activin type I (ALK2 and ALK4) and type II (ActRIIA and ActRIIB) receptors were detected using immunohistochemistry on Bouins fixed sections of normal, carcinoma in situ (CIS), seminoma, non-seminoma and gonadotropin-deprived human testis. ActRIIA mRNA was localized by in situ hybridization. RESULTS ALK2, ALK4 and ActRIIB proteins were observed in Sertoli cells, spermatogonia and some spermatocytes within normal and gonadotropin-suppressed adult human testis; all three receptor subunits were also detected in CIS, seminoma and non-seminoma cells. ActRIIA immunoreactivity was faint to absent in the normal testis and in CIS and non-seminoma cells, whereas some seminoma cells displayed a strong signal. Also in contrast to the normal testis, a majority of spermatogonia and Sertoli cells in gonadotropin-deprived samples exhibited a strong ActRIIA immunohistochemical and in situ hybridization signal. CONCLUSIONS Spermatogonia and Sertoli cells appear as the primary targets of activin action in the adult human testis. Changes in testicular function associated with altered hormone levels may enhance ActRIIA mRNA and protein synthesis, thus modifying signalling by activin or other TGFbeta ligands within specific cells of the seminiferous epithelium.
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Affiliation(s)
- V Dias
- Monash Institute of Medical Research, 27-31 Wright Street Clayton, Victoria 3168, Australia
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Abstract
Diffeomorphic image registration, where images are aligned using diffeomorphic warps, is a popular subject for research in medical image analysis. We introduce a novel algorithm for computing diffeomorphic warps that solves the Euler equations on the diffeomorphism group explicitly, based on a discretisation of the Hamiltonian, rather than using an optimiser. The result is an algorithm that is many times faster than those considered previously.
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Affiliation(s)
- Stephen Marsland
- Massey University, Private Bag 11-222, Palmerston North, New Zealand.
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Osborne EC, Lynch M, McLachlan R, Trounson AO, Cram DS. Microarray detection of Y chromosome deletions associated with male infertility. Reprod Biomed Online 2007; 15:673-80. [DOI: 10.1016/s1472-6483(10)60534-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Cram D, Gabbe M, de Kretser D, McLachlan R. P▪42 PGD for infertility: is there a case for the Y chromosome? Reprod Biomed Online 2005. [DOI: 10.1016/s1472-6483(11)60364-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
The effects of infertility and its treatment on cancer risk are of concern to many infertile couples. Infertile women appear to be at no higher risk for breast cancer although they may be more at risk for cancers of the uterus, particularly if they have ovulation disorders. Most studies show no increase in the risk of invasive ovarian cancer in infertile women, but ovarian tumours of borderline malignancy are more common. There seems to be no overall increase in cancer risk associated with fertility drug treatment, but questions remain about risk in subgroups of infertile women. Male infertility has been associated with an increased risk of testis cancer. Cancer incidence in children born after fertility treatment appears to be similar to that in the general population. Discussion of cancer risks in the context of other reproductive and community risks can be helpful to patients.
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Affiliation(s)
- Alison Venn
- Menzies Centre for Population Health Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS 7000, Australia.
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Abstract
We developed a recurrence relation that counts the number of tandem duplication trees (either rooted or unrooted) that are consistent with a set of n tandemly repeated sequences generated under the standard unequal recombination (or crossover) model of tandem duplications. The number of rooted duplication trees is exactly twice the number of unrooted trees, which means that on average only two positions for a root on a duplication tree are possible. Using the recurrence, we tabulated these numbers for small values of n. We also developed an asymptotic formula that for large n provides estimates for these numbers. These numbers give a priori probabilities for phylogenies of the repeated sequences to be duplication trees. This work extends earlier studies where exhaustive counts of the numbers for small n were obtained. One application showed the significance of finding that most maximum-parsimony trees constructed from repeat sequences from human immunoglobins and T-cell receptors were tandem duplication trees. Those findings provided strong support to the proposed mechanisms of tandem gene duplication. The recurrence relation also suggests efficient algorithms to recognize duplication trees and to generate random duplication trees for simulation. We present a linear-time recognition algorithm.
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Affiliation(s)
- Olivier Gascuel
- Département d'Informatique Fondamentale et Applications, LIRMM, 161 Rue Ada, 34392 Montpellier, France
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