Relationship between risk factors for infertility in women and lead, cadmium, and arsenic blood levels: a cross-sectional study from Taiwan.

BACKGROUND: The World Health Organization reported that more than 10 % of women are severely affected by infertility, making the condition a major worldwide public health problem. Lead (Pb), cadmium (Cd), and arsenic (As) are environmental pollutants that may contribute to reproductive disorders. This cross-sectional study investigated the association between blood concentrations of Pb, Cd, and As and risk factors for infertility in women. METHODS: Women who were infertile (N = 310) or pregnant (N = 57) were recruited from the gynecology and obstetrics department of a hospital. The participants were interviewed to obtain their sociodemographic, reproductive, and lifestyle information. The concentrations of Pb, Cd, and As in their blood samples were measured using inductively coupled plasma mass spectrometry. RESULTS: Our findings suggested that the concentrations of Pb and As, but not Cd, were significantly higher in the blood of infertile women than in that of pregnant women. A higher percentage of the infertile women consumed more alcohol, used Chinese herbal medicine more frequently, and lacked physical activity compared with the pregnant women. After accounting for potentially relevant predictors, we observed that blood Pb levels might be elevated by using Chinese herbal medicine 1-6 times per week (aOR = 2.82, p = 0.05). In addition, engaging in physical activity 1-2 times per week (aOR = 0.37, p = 0.05) might assist in reducing Pb accumulation in infertile women, though the p value was borderline. CONCLUSIONS: Lack of physical activity and frequent use of Chinese herbal medicine may be associated with elevated blood Pb levels in infertile women. Chinese herbal medicine use was observed to increase the Pb body burden of both infertile and pregnant women in this study. The risk-benefit for Chinese herbal medicine intake should be evaluated by women of childbearing age.

Dietary intake, glucose metabolism and sex hormones in women with polycystic ovary syndrome (PCOS) compared with women with non-PCOS-related infertility.

The present study investigated dietary intake, glucose metabolism and sex hormones in women with polycystic ovary syndrome (PCOS). A total of forty-five women (aged 25­40 years) with PCOS and 161 control women (aged 25­43 years) with non-PCOS-related infertility were recruited. Anthropometry, glucose tolerance and sex hormones were determined and dietary intake was assessed. Women with PCOS had lower serum sex hormone-binding globulin and increased BMI, waist:hip ratio, luteinising hormone, ratio of luteinising hormone: follicle-stimulating hormone, testosterone and free androgen index (FAI). Postprandial glucose, fasting insulin and insulin resistance were elevated in women with PCOS. Women with PCOS had reduced energy and carbohydrate intake but higher fat intake. Serum sex hormone-binding globulin level was negatively associated with BMI in both groups and negatively correlated with macronutrient intake in the PCOS group with hyperandrogenism. However, FAI was positively correlated with BMI, waist circumference and glucose metabolic parameters in both groups. Therefore, women with PCOS consume lower energy and carbohydrate compared with those with non-PCOS-related infertility and macronutrient intake is only negatively associated with serum sex hormone-binding globulin level in the PCOS group with hyperandrogenism.

Preliminary study of blood methylmercury effects on reproductive hormones and relevant factors among infertile and pregnant women in Taiwan.

Methylmercury (MeHg) is the most poisonous mercury species and an endocrine-disrupting chemical that could cause reproductive and developmental harm effects in animals. In this study, we recruited 310 infertile women and 57 pregnant women and investigated their blood MeHg levels. The distribution of blood reproductive hormone, selenium and zinc levels, and the difference of relevant factors by the reference level of blood MeHg (5.8 µg/L) of infertile women were further examined. Results showed that greater percentages of sashimi consumption, frequencies of Chinese herbal medicine use, alcohol consumption, and lack of physical activity were observed in infertile women than those for pregnant women. Blood MeHg concentration was significantly greater in infertile than that in pregnant women. Significant concentration differences for FSH and LH by the dichotomized reference level of blood MeHg (5.8 µg/L) in infertile women were not observed, which may stem from that these reproductive hormones in participated infertile women were mostly in the normal reference range. Consumption of fish and sashimi represented the major source of MeHg exposure in infertile women. MeHg levels were elevated in infertile women, and consistent with fish consumption frequency. Compared to the referent level of blood MeHg levels <5.8 µg/L, the elevated blood MeHg levels (⩾5.8 µg/L) in infertile women were 3.35 and 4.42 folds risk in categorized frequencies of fish consumption 1-2 meals per week and more than 3 meals per week, respectively. The obtained results provide evidences and help updating the advisory of fish consumption and improving women's reproductive health.

Prevalence of insulin resistance and determination of risk factors for glucose intolerance in polycystic ovary syndrome: a cross-sectional study of Chinese infertility patients.

OBJECTIVE: To determine the prevalence of abnormalities in glucose metabolism in patients with polycystic ovary syndrome (PCOS) and control infertility patients in Taiwan, and to determine the predictive risk factors for PCOS. DESIGN: Cross-sectional study. SETTING: Infertility Center, Taiwan Adventist Hospital. PATIENT(S): Three hundred fifty-six patients with PCOS and 974 control infertility patients. INTERVENTION(S): None. MAIN OUTCOMES MEASURE(S): Hormone assay and 75-g oral glucose tolerance test. RESULT(S): Patients with PCOS were younger (32.7 vs. 35.3 years) with a higher body mass index (BMI) (22.4 vs. 20.6 kg/m(2)) than controls. Even after BMI adjustment, patients with PCOS still had significantly higher fasting glucose (97.2 vs. 94.4 mg/dL), fasting insulin (5.6 vs. 4.1 microIU/mL), 2-hour glucose (108.1 vs. 96.0 mg/dL), and 2-hour insulin levels (38.0 vs. 27.0 microIU/mL), and higher homeostasis model assessment of insulin resistance (HOMA-IR) values (1.3 vs. 1.0) than control patients. The prevalence of impaired glucose tolerance and diabetes mellitus in patients with PCOS was 7.6% and 3.1%, respectively, compared with 2.9% and 0.2% in the control group, respectively. Only fasting glucose and insulin, 2-hour insulin, HOMA-IR, age, androstenedione, and status (PCOS vs. control) had a significant impact on 2-hour glucose level. However, BMI and waist/hip ratio did not show a significant impact on 2-hour glucose level. CONCLUSION(S): Chinese women with PCOS are at increased risk for insulin resistance and glucose intolerance compared with controls. Body mass index failed to show significant impact on 2-hour glucose levels in our infertility patients.

Abnormal preconception oral glucose tolerance test predicts an unfavorable pregnancy outcome after an in vitro fertilization cycle.

OBJECTIVE: To determine the relationship between the 75-g oral glucose tolerance test and pregnancy outcome after women's first IVF cycle. DESIGN: Prospective study. SETTING: Infertility center at a private tertiary hospital in Taiwan. PATIENT(S): All 280 patients who went through their initial IVF cycle at the hospital between January 2004 and April 2005 were included in the study. INTERVENTION(S): Two hundred eighty patients underwent an oral glucose tolerance test before entering an IVF cycle; all pregnancy outcomes and pregnancy complications were recorded. MAIN OUTCOME MEASURE(S): The relationships between glycemic parameters and insulin resistance and IVF pregnancy outcome were determined. Linear regression between birth weight and levels of preconception fasting insulin, 2-hour glucose, and 2-hour insulin was performed. RESULT(S): One hundred twenty patients conceived after their initial IVF cycle. Twenty-five of 89 ongoing pregnancies had various complications. The most common pregnancy complication was preterm birth (n = 11). These patients had higher body mass index (23.46 vs. 20.97 kg/m(2)); higher fasting glucose (107.36 vs. 95.14 mg/dL), fasting insulin (10.55 vs. 6.20 microIU/mL), and 2-hour glucose (120.55 vs. 99.97 mg/dL) levels; and higher homeostatic model assessment of insulin resistance (3.43 vs. 1.45) than did patients with full-term pregnancies. Linear regression between birth weight and the fasting glucose level and between birth weight and the homeostatic model assessment of insulin resistance had positive correlations. CONCLUSION(S): Before proceeding with IVF, preconception oral glucose tolerance testing is suggested, especially in patients with higher body mass index, to help identify groups who are at high risk for preterm birth.

Correlation between fluorescence in situ hybridization and testicular biopsy for the prediction of spermatogenesis in 37 patients with nonobstructive azoospermia.

OBJECTIVES: We applied interphase fluorescence in situ hybridization (FISH) to testis sections to examine the evidence of spermatogenesis in patients with nonobstructive azoospermia. This technique was evaluated and compared with conventional testicular histopathologic findings for the possibility of additional clinical applications. METHODS: Thirty-seven consecutive patients with nonobstructive azoospermia were carefully evaluated clinically. Testes were biopsied for both sperm extraction and histopathologic examination. FISH staining was performed with a CEP 18 SpectrumAqua/CEP X SpectrumGreen/CEP Y SpectrumOrange probe. RESULTS: Eight of 11 cases (sensitivity 73%) that were found to have spermatids on the histopathologic slides also were proven to produce haploid cells by FISH staining. On the other hand, 21 of the 26 cases (specificity 81%) for which no spermatids could be found on the histopathologic slides also had only diploid cells by FISH staining. On the basis of the good correlation between the FISH staining and conventional histopathologic findings, we could confirm the diagnosis of spermatogenesis using both methods. CONCLUSIONS: FISH staining of testicular sections allows more reliable prediction of spermatogenesis and provides benefits for a patient's decision regarding fertility counseling.