Increased Mortality Among Men Diagnosed With Impaired Fertility: Analysis of US Claims Data.

OBJECTIVE: To determine whether male infertility or impaired spermatogenesis is associated with mortality. METHODS: The Optum de-identified Clinformatics Data Mart database was queried from 2003 to 2017. Infertile men were compared to subjects undergoing semen analysis (ie, infertility testing). Infertile men with oligozoospermia or azoospermia were included. Mortality was determined by data linkage to the Social Security Administration Death Master File. Results were adjusted for age, smoking, obesity, year of evaluation, and health care visits as well as for most prevalent comorbidities. We separately examined men with prevalent or incident cardiovascular disease and cancer diagnoses to determine associations with mortality. RESULTS: A total of 134,796 infertile men and 242,282 controls were followed for a mean of 3.6 and 3.1 years respectively. Overall, infertile men had a higher risk of death (Hazard Ratio [HR]= 1.42, 95% CI: 1.27-1.60) The diagnosis of azoospermia was associated with a significantly increased risk of death (HR= 2.01, 95% CI: 1.60-2.53) with a higher trend among men with oligospermia (HR: 1.17, 95% CI: 0.92-1.49) compared to controls. Subanalysis was done excluding prevalent cardiovascular and malignant disease (alone and combined) showing similar hazard ratios. CONCLUSION: Male infertility is associated with a higher risk of mortality especially among azoospermic men. Prevalent disease (which is known to be higher among infertile men) did not explain the higher risk of death among infertile men. The implications for treatment and surveillance of infertile men require further study.

Socio-psycho-behavioural factors associated with male semen quality in China: results from 1346 healthy men in Chongqing.

BACKGROUND: Human semen quality in China has decreased in the last few decades. A previous study found that 61.1% of healthy males in Chongqing City in Southwest China had abnormal semen parameters values according to 1999 World Health Organization criteria. OBJECTIVE: This cross-sectional study explored the associations between socio-psycho-behavioural factors and semen quality in Chongqing City. METHODS: The study participants comprised 1346 eligible healthy men who were examined and researched in respect to 15 socio-psycho-behavioural factors. RESULTS: Men from a higher occupational class had better semen volume (ß coefficient 1.18, p=0.034), while men who often wore underwear made from man-made fibres had a lower percentage of morphologically normal sperm (ß coefficient 0.82, p=0.001). As regards psychological stress, men with less stress had an increased total sperm count and percentage of morphologically normal sperm (ß coefficient 1.19 and 1.25 respectively, p=0.02 and 0.04 respectively). The other 12 factors examined in the study demonstrated no significant association with semen quality in Chongqing. CONCLUSIONS: Semen quality can be impacted by socio-psycho-behavioural factors (occupational class, psychological stress and wearing man-made fibre underwear). A health programme that deals directly with psychological health and healthy lifestyle, and the implementation of policies that address social factors for men may play a part in the improvement of male reproductive health in China.

[European regulation REACH and the assessment of testicular toxicity]. / Analyse de la spermatogenèse ex vivo : application à l'analyse de la toxicité testiculaire.

Several studies suggest that exposure to environmental pollutants is partly responsible for testicular pathologies that have considerably increased over the last decades (cryptorchidism, hypospadias, cancer, decrease in the number of ejaculated spermatozoa). However, the cellular and molecular mechanisms involved in this reprotoxicity remain mostly unknown. One of the challenges of the european regulation REACH is to improve the knowledge on the chemical, toxic and ecotoxic properties of substances used in everyday life. As for the testicular toxicity, the few in vivo models used are not always the most appropriate for mechanistic studies. Our laboratory has developed and validated on a physiological point of view, coculture systems of germ cells in bicameral chambers, which reproduce a blood-testis barrier, allowing the determination of the mechanisms responsible for the toxicity of organic or mineral compounds on spermatogenesis, while reducing greatly the number of animals required.

Social class and semen analysis.

It has often been postulated that certain occupations may be hazardous to semen counts, but there are many conflicting views, with others finding either no differences in sperm count or only subtle differences in semen variables. We studied the effect of occupation (in relation to social class) on 207 men attending the fertility clinic of a district general hospital. In our own population azoospermic men were more likely to be of social class 3 m (3 semi-skilled manual) and below. Men who failed to provide a sample were more likely to be of social class 3 m. There was no statistical occupation difference in men whose sperm counts were normal or low. It may not be occupation alone, but also lifestyle differences between social classes which affect semen parameters.

Characterization of patients presenting with male factor infertility in an equal access, no cost medical system.

OBJECTIVES: Demographic information on patients presenting for the diagnosis and treatment of male factor infertility has been limited in the past by the paucity of subspecialty trained providers and concentrated sequential patient information. Previously reported studies looking at the characteristics of patients being evaluated for male subfertility may represent a selected subset of patients able to access these services. The changes in the diagnostic modalities available in the 1990s and new diagnostic categories may also affect the characterization of patients seen with the diagnosis of male factor infertility. METHODS: A retrospective analysis was performed using a centralized database of patient records at a single military male infertility clinic. Seven hundred consecutive patients were studied to obtain information on patient and spouse age, race, length of subfertile period, medical history and examination, and laboratory evaluation. A single provider categorized the etiology of male factor infertility after the evaluation. RESULTS: The mean patient age was 36 years (range 17 to 68). The mean spouse age was 31.2 years (range 19 to 50). The mean subfertile period was 5.5 years (range 0.5 to 35). Of the 700 patients, 51% were white, 10% African American, 2% Hispanic, and 37% other/unknown. Eleven percent of the patients were active smokers. The most common etiologic category groups describing male subfertility were previous vasectomy (56%), varicocele (14%), idiopathic infertility (8%), and nonobstructive azoospermia (6%). CONCLUSIONS: An equal access, no cost medical system mirrors the demographics of the military population served. The clinical characteristics of patients presenting with male factor infertility have changed significantly during the past 30 years. Obstruction from a previous vasectomy is now the most common presenting complaint of patients visiting an infertility clinic. Vasectomy reversal may be more frequently requested when the cost is not a factor in providing fertility services. Idiopathic male factor infertility occurs in less than 10% of patients.

[Cryptorchidism and fertility: an assessment in adulthood]. / Criptorchidismo e fertilità: valutazione in età adulta.

Impairment of fertility rate has been found to be associated with cryptorchidism. In this study we assessed the fertility of 172 adult subjects with unilateral and bilateral cryptorchidism who underwent surgical correction in pediatric age. Fertility has been evaluated by sperm analysis. Moreover test of function of spermatozoa membrane (swelling-test) and the research of antisperm antibodies (spermmar test) were carried out. The report presents data demonstrating that the fertility rate in patients with bilateral cryptorchidism is markedly reduced if compared with subjects affected by unilateral cryptorchidism. Azoospermia is present in 18% of bilateral cryptorchids. The timing of surgery and the anatomical position of the cryptorchid testes do not seem to affect the fertility rate.