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Routine Assessment of Occupational Exposure and Its Relation to Semen Quality in Infertile Men: a Cross-Sectional Study

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Routine Assessment of Occupational Exposure and Its Relation to Semen Quality in Infertile Men: a Cross-Sectional Study Turkish Journal of Medical Sciences Turk J Med Sci (2017) 47: 902-907 http://journals.tubitak.gov.tr/medical/ © TÜBİTAK Research Article doi:10.3906/sag-1605-47 Routine assessment of occupational exposure and its relation to semen quality in infertile men: a cross-sectional study 1, 1 2 3 Salima DAOUD *, Afifa SELLAMI , Mehdi BOUASSIDA , Sahbi KEBAILI , 1 1 1 Leila AMMAR KESKES , Tarek REBAI , Nozha CHAKROUN FEKI 1 Laboratory of Histology and Embryology, Faculty of Medicine of Sfax, University of Sfax, Tunisia 2 Urology Department, Habib Bourguiba University Hospital, Sfax, Tunisia 3 Gynecology and Obstetrics Department, Hedi Chaker University Hospital, Sfax, Tunisia Received: 07.05.2016 Accepted/Published Online: 05.12.2016 Final Version: 12.06.2017 Background/aim: Concerns about the detrimental effects of occupational and environmental exposure on male reproductive function have been raised by reports of declining sperm quality over the last decades. The aim of this study was to investigate the association between altered semen parameters and exposure to occupational risk factors as assessed by questionnaire. Materials and methods: We conducted a cross-sectional questionnaire-based study among a population of 2122 men who underwent andrological investigation for couple infertility. All participants were interviewed and their semen samples were analyzed. Information about medical history and occupational exposure was used to classify participants into exposed and unexposed groups. Results: Exposure to pesticides was associated with a significantly higher risk of asthenozoospermia (adjusted odds ratio [OR] = 1.6; 95% CI, 1.0–2.4) and necrozoospermia (OR = 2.6; 95% CI, 1.4–4.7). Exposure to cement was found to be correlated with a higher risk of oligozoospermia (OR = 1.1; 95% CI, 0.9–1.4). There was no association between semen impairment and exposure to solvents, excess heat, or mechanical vibrations. Conclusion: We found an association between self-reported occupational exposure and altered semen parameters. These results support the usefulness of questionnaires for routine assessment and management of occupational exposures in infertile men. Key words: Male infertility, occupational exposure, questionnaire, semen quality 1. Introduction as pesticides, solvents, and heavy metals could result in It is estimated that one in six couples has problems reduced semen quality and increased abortion rates (7,8). conceiving a child. Despite its negative psychological Excess heat, mechanical vibrations, ionizing radiations, and social impact, the financial burden of infertility is and, recently, electromagnetic fields are classified as substantial. A male factor is responsible in about half of physical factors and reported to increase the risk of infertile couples (1). Furthermore, increasing evidence disrupted spermatogenesis and altered sperm parameters suggests a decline of semen quality in developed countries (7,9). over the past decades (2–4). In a previous report (5), we Assessing the effects of occupational exposures on fertility is difficult given the wide variety of epidemiologic found the same trend among a Tunisian infertile population methods used for this purpose. Experimental animal with a decreased sperm count and morphology for over a models provide interesting information about specific decade. Several hypotheses have been advanced to explain exposure targets and their mechanisms of toxicity. these observations, such as exposure to occupational and However, the results of these studies need to be interpreted environmental pollutants and rapid changes in lifestyles with caution. (6). Despite its limitations (10), self-reported exposure In the literature, risk factors are continuously added was reported to have similar accuracy and reliability to to a long list of specific occupational exposures that could other common methods of exposure assessment, such as alter male reproductive function. A number of reviews quantitative exposure measurement (11) and job-exposure have pointed out that exposure to chemical agents such matrices (12). * Correspondence: [email protected] 902 DAOUD et al. / Turk J Med Sci In the present study we aimed to investigate the potentially exposed were divided into six categories as association between semen quality and self-reported detailed in Table 1. occupational exposures among infertile men. To During the data collection process, we considered accomplish this goal, we designed a questionnaire for occupational activities undertaken in the 3 to 6 months use during routine consultation in couples attending before semen analysis. One semen analysis was considered our reproductive biology laboratory for infertility for each subject. A shorter period between filling out investigation. questionnaire date and semen analysis date was the main selection criterion if there was more than one semen 2. Materials and methods analysis. 2.1. Study population Ethical approval for the study was obtained from the We conducted a retrospective cross-sectional study Research Ethics Committee of the Faculty of Medicine of on 2122 men attending the Laboratory of Histology, Sfax, Tunisia. Embryology and Reproductive Biology at the Faculty 2.3. Semen analysis of Medicine of Sfax, Tunisia, for couple infertility. Study Semen samples were collected in the laboratory by subjects were recruited between January 1996 and masturbation after 2–5 days of abstinence. After December 2012. Each one of them provided at least liquefaction, semen analysis was performed by two trained one semen sample for analysis as a part of the infertility technicians according to prevailing guidelines of the investigation of the couple. Subjects with a known male World Health Organization (WHO) at the time of analysis infertility factor that was not linked to occupational (13–15). This test evaluates ejaculate volume, sperm count, exposure were excluded: varicocele, cryptorchidism, motility, vitality, and morphology. The modified David genetic or endocrine disorders, urogenital tract classification was used to assess sperm morphology (14). infection, and medication associated with male fertility In the present study, semen anomalies were defined impairment. We also excluded those aged under 20 or according to the WHO 5th edition criteria as follows (15): above 55 years. hypospermia (semen volume <1.5 mL), oligozoospermia 6 2.2. Study design (sperm count <15 × 10 /mL), asthenozoospermia (sperm All patients’ data were extracted from a database built on progressive motility <32% or sperm total motility the basis of a questionnaire that consisted of two sections. <40%), and necrozoospermia (sperm vitality <58%). The first section includes questions about age, geographic Teratozoospermia was defined by a percentage of normal origin, lifestyle, medical history, and risk factors for forms less than 30%, according to the fourth edition of semen quality impairment. The second section focuses the WHO manual (14) for sperm morphology assessment on occupational information, i.e. job title and duties and using David’s classification. duration of occupational exposure. All questionnaires 2.4. Statistical analysis were completed by four trained interviewers during Statistical analysis was carried out using SPSS version 13.0 routine consultations. (IBM Corp., Armonk, NY, USA) in order to compare age, We tried to keep the questionnaire short and focused duration of infertility, and semen parameters between by including only risk factors that were most related to unexposed and exposed groups (chi-square test). Logistic male fertility impairment in the literature. Information regression models adjusted for age and abstinence about occupational exposure was used to classify subjects period were performed to evaluate the odds of semen into exposed or unexposed groups. Those classified as abnormalities as a function of exposure risk factor. Table 1. Occupational exposure groups considered by the questionnaire. Occupational exposure group Occupational activities Unexposed group Teacher, professor, lawyer, physician, trader Exposed group Pesticides Farmer, gardener Painter, printer, carpenter, shoe and leather worker, Solvents rubber and plastic product maker Cement Bricklayer, cement industry worker Mechanical vibrations Truck and fork-lift driver, pneumatic drill worker Excess heat Baker, cook, blacksmith, welder 903 DAOUD et al. / Turk J Med Sci 3. Results 4. Discussion Overall, the median age was 36 ± 6 years, and two out of This is, to the best of our knowledge, the first three men (65%) were aged between 30 and 40 years. Of the epidemiological study that investigates the hazardous 2122 men included, 1804 (85%) lived in urban areas and effects of occupational exposure on male fertility in Tunisia 318 (15%) were rural inhabitants. Most of the participants and North Africa. (86%) were from the city of Sfax and surroundings. The In Tunisia, uncontrolled use of pesticides for several mean infertility duration was 3.7 ± 3 years. decades has led to a worrying situation. Despite being Based on questionnaire information, we classified 847 banned since the early 1980s, highly toxic pesticides such (40%) men as unexposed and 1275 (60%) men as exposed as polychlorinated biphenyls (PCB), organochlorine (OC), to occupational risk factors. There was no significant and dichlorodiphenyltrichloroethane (DDT) are suspected difference with regard to age between exposed and to have persistent environmental and health effects on the unexposed groups (35.8 vs. 36.2 years).
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