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Human Reproduction vol.8 no.8 pp.1153-1154, 1993
EDITORIAL
Male infertility: is its rising incidence due to better methods of detection or an Increasing frequency?
In the last four decades the...
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Human Reproduction vol.8 no.8 pp.1153-1154, 1993
EDITORIAL
Male infertility: is its rising incidence due to better methods of detection or an Increasing frequency?
In the last four decades the world population has more than doubled, from 2.5 billion in 1950 to 5.3 billion in 1990. The rate of population growth is the result of the combination of different growth rates which are generally very high in developing countries (2-3%/year) and very low in the developed countries of Europe and North America (< 1%/year) (Horiuchi, 1992). In Western countries the progressive reduction of the mean number of children per couple is also accompanied by a progressive, increasing concern with infertility, a problem affecting about > 10% of couples after 1 year of marriage during which no contraceptives were used. The increase in demand for infertility services is probably related to different factors: (i) the tendency of women to delay child-bearing because of their work so that desired reproduction is condensed into a shorter interval than before; (ii) an increased awareness of different treatments for infertility; (ill) an increased number of physicians with infertility interests. In this context several reports of the last 20 years suggest a progressive decrease of the mean sperm density over the past 50 years. These reports have been carefully reviewed together with many others in a recent paper published in the British Medical Journal (Carisen et al, 1992) in which a linear weighted regression analysis was performed of the mean sperm densities and mean seminal volumes of donors or men without a history of infertility drawn from 61 papers taken from the intemational literature between 1938 and 1991. In their paper the authors, after a careftil evaluation of the several possible methodological biases in determination of sperm concentration as well as in subject selection, concluded that the decrease in sperm count is likely to be a real biological phenomenon. As the so-called 'malefactor' is involved in -35-40% of infertile couples, this fmding would be extremely important for human fertility, especially if this decline is continuing.
Since the majority of the studies reviewed by Carisen et al (49 out of 61) were performed in developed countries, it is reasonable to think that this phenomenon could be related to environmental pollution, different kinds of nutrition and/or the form of lifestyle.
The contamination of the environment with persistent pollutants is a major concern in Western countries, but the possible effects on spermatogenesis are very difficult to assess, for three main reasons. First, there is a large number of pollutants present in the environment. Second, it is difficult to perform appropriate epidemiological studies with adequate control groups (i.e. with significant numbers of unexposed subjects of the same population). Third, the possible confounding effect of individual exposure to other toxic substances such as smoke and alcohol
Editorial by: G.Forti and M.Serio^ Andrology and 'Endocrinology Units, Department of Clinical Physiopatbology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy.
must be assessed (Feichtinger, 1991). The adverse effects on male fertility have been reported mostly when the level of a dangerous substance was very high, i.e. mainly in occupationally exposed workers. The classical examples of occupational hazards which may interfere with spermatogenesis are radioactivity (a parameter which usually can be well controlled both in working areas and in the environment), lead and heat. The adverse effect of lead exposure on spermatogenesis is well known in experimental animals (Sokol, 1990) and was recently confumed in exposed workers (Bonde et al, 1989; Gennart et al, 1992). Heat exposure and reduced male fertility was reported by several authors (Robinson and Rock, 1967; Brown-Woodman etal, 1984).
Concerning the changes over the last 50 years in lifestyle, we must remember that in Western countries large numbers of men spend a lot of their time sitting in an office or driving a car. A higher frequency of poor sperm parameters was recently reported both in white collar workers and in transportation workers such as fiill-time drivers of taxis and buses (Figa-Talamanca et al., 1992). The possibility that the sitting position might involve a slight impairment of heat dispersion and, as a consequence, a slight increase of scrotal temperature, was suggested in the same report. However, the epidemiologic evidence supporting an association between high temperature and male reproductive function is only sporadic. A large-scale epidemiologic case-control study suggested an adverse effect on fertility of occupational exposure to heat (Rachootin and Olsen, 1983). According to this hypothesis, improved semen characteristics in infertile men were reported after a conservative treatment regimen based on the avoidance of testicular hyperthermia such as avoiding hot baths and wearing loose cotton shorts (Lynch et al, 1986). On the other hand the possibility that the reduced sperm concentration found in summer is due to an increase of environmental temperature was ruled out by recent studies reporting that an air-conditioned environment does not prevent deterioration of human semen quality during summer (Levine etal., 1990; Snyder, 1992).
We do not know whether the reduced sperm concentration observed in the last 50 years was also accompanied by a reduced fertilizing potential of the spermatozoa. In men affected by
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Contents
Human Reproduction
Volume 8 number 8 August 1993
EDITORIAL
Male infertility: is its rising incidence due to better methods of detection or an increasing frequency?
G.Forti and M.Serio
1153
DEBATE
The value of co-culture in sustaining human embryos
The search for improved in-vitro systems should not be ignored: embryo co-culture may be one of them
Response to the use of co-culture for embryo development
ARTICLES Physiology
Transplantation of frozen-thawed mouse primordial follicles
Autonomic nervous modulation and effects of a prostaglandin synthase inhibitor on human cervical secretion
Immunohistochemical properties of the endothelial cells in the human uterus during the menstrual cycle
A.Bongso, C.-Y.Fong, S.-C.Ng and S.Ratnam 1155
B.D.Bavister 1160
J.Carroll and R.G.Gosden 1163
B.Jonsson and M.Hammarström 1168
M.C.P.Rees, A.R.Heryet and R.Bicknell 1173
Endocrinology
Insulin hypersecretion together with high luteinizing hormone concentration augments androgen secretion in oral glucose tolerance test in women with polycystic ovarian disease
Repeated aspiration of ovarian follicles and early corpus luteum cysts in an in-vitro fertilization programme reduces the risk of ovarian hyperstimulation syndrome in high responders
The impact of cigarette smoking on the plasma concentrations of gonadotrophins, ovarian steroids and androgens and upon the metabolism of oestrogens in the human female
Insulin actions on ovarian steroidogenesis are not modulated by metformin
L.Anttila, P.Koskinen, T.-A.Jaatinen, R.Erkkola, 1179 K.Iqala and K.Ruutiainen
A.Amit, Y.Yaron, I.Yovel, M.R.Peyser, 1184
M.P.David, A.Botchan and J.B.Lessing
E.J.Thomas, W.Edridge, A.WeddeU, A.McGill 1187 and H.H.G.McGarrigle
A.J.Duleba, L.A.Pawelczyk, B.Ho Yuen and 1194
Y.S.Moon
Immunology
Evidence for the in-vitro de-novo synthesis of immunoglobulin and a previously undescribed 17 kDa protein (TEP-2) by the mucosa of the Fallopian tube
Distribution of cell adhesion molecules on CD56-H-, CD3-, CD16- large granular lymphocytes and endothelial cells in first-trimester human decidua
Infertility
Treatment of male infertility: is it effective? Review and meta-analyses of published randomized controlled trials
Beta-1 integrin cell adhesion molecules in the endometrium of fertile and infertile women
Gamete intra-Fallopian transfer: outcome following the elective or non-elective replacement of two, three or four oocytes
S.D.Maguiness, K.Shrimanker, O.Djahanbakhch, 1199 B.Teisner and J.G.Gradzinskas
K.Marzusch, P.Ruck, A.Geiselhart, 1203
R.Handgretinger, J.A.Dietl, E.Kaiserling, H.-P.Horny, G.Vince and C.W.G.Redman
P.A.O'Donovan, P.Vandekerckhove, R.J.Lilford 1209 and E.Hughes
L.D.Klentzeris, J.N.Bulmer, L.K.Trejdosiewicz, 1223 L.Morrison and I.D.Cooke
X.J.Wang, G.M.Warnes, R.J.Norman, 1231
C.A.Kirby, A.M.Clark and C.D.Matthews
Andrology
Osmo-sensitivity of the human sperm acrosome reaction
The ability of the hemizona assay to predict human fertilization in different and consecutive in-vitro fertilization cycles
Subzonal sperm insertion with aged human oocytes from failed in-vitro fertilization attempts: fertilization results and some applications
Effects of multiple ejaculations after extended periods of sexual abstinence on total, motile and normal sperm numbers, as well as accessory gland secretions, from healthy normal and Oligozoospermie men
Cystic fibrosis mutations impair the fertilization rate of epididymal sperm from men with congenital absence of the vas deferens
P.Bielfeld, R.S.Jeyendran and L.J.D.Zaneveld
D.R.Franken, T.F.Kruger, S.Oehninger, C.C.Coddington, C.Lombard, K.Smith and G.D.Hodgen
J.Tesarik
T.G.Cooper, C.Keck, U.Oberdieck and E.Nieschlag
P.Patrizio, T.Ord, S.J.Silber and R.H.Asch
1235 1240
1245
1251
1259
Surgery
The multicentre transcervical balloon tuboplasty study: conclusions and comparison to alternative technologies
Vaginal squamous cells in follicular aspirates following transvaginal puncture
Fertilization and early embryology
The role of calcium in mammalian oocyte maturation and egg activation
N.Gleicher, E.Confino, R.Corfman, C.Coulam, A.DeChemey, G.Haas, E.Katz, E.Robinson, I.Tur-Kaspa and M.Vermesh
J.K.Artley, P.R.Braude and P.Cooper
S.T.Homa, J.Carroll and K.Swann
1264
1272
1274
Endometriosis
Case Report: Ovarian abscess following puncture of an endometrioma during ultrasound-guided oocyte retrieval
S.L.Padilla
1282
Pregnancy
Analysis of the risk factors with regard to the occurrence of ectopic pregnancy after medically assisted procreation
The effect of RU486 on progesterone and oestrogen receptor concentration in human decidua on early pregnancy
Adverse effect of a homogeneous hyperechogenic endometrial sonographic pattern, despite adequate endometrial thickness on pregnancy rates following in-vitro fertilization
The increased risk of complication observed in singleton pregnancies resulting from in-vitro fertUization (IVF) does not seem to be related to the IVF method itself
Laparoscopy: a dispensable tool in the diagnosis of ectopic pregnancy?
Transvaginal sonography and human chorionic gonadotrophin measurements in suspected ectopic pregnancy: a detailed analysis of a diagnostic approach
G.Verhulst, M.Camus, N.Bollen, A.Van Steirteghem and P.Devroey
T.S.Zaytseva, V.N.Goncharova, M.S.Morozova, T.M.Astakhova, LA.Manuilova and Y.A.Pankov
J.H.Check, D.Lurie, C.Dietterich, C.Callan and A.Baker
F.Olivennes, P.Rufat, B.André, A.Pourade, M.C.Quiros and R.Frydman
W.M.Ankum, F.Van der Veen, J.V.Th.H.Hamerlynck and F.B.Lammes
W.M.Ankum, F.Van der Veen, J.V.Th.H.Hamerlynck and F.B.Lammes
1284 1288
1293
1297
1301 1307
Endometrial ultrasonography as a predictor of pregnancy in an in-vitro fertilization programme
A genetically defmed animal model of anembryonic pregnancy
The influence of the number of embryos transferred in 1060 in-vitro fertilization pregnancies on miscarriage rates and pregnancy outcome
Case Report: Severe ovarian hyperstimulation syndrome, selective embryo reduction and heterotopic pregnancy
Counselling
An evaluation of counselling for couples undergoing treatment for in-vitro fertilization
J.B.A.Oliveira, R.L.R.Bamffi, A.L.lVlauri, 1312
C.G.Petersen, M.S.Campos and J.G.Franco,Jr
J.D.West 1316
A.H.Baien, J.MacDougall and S.-L.Tan
L.Mascarenhas and B.Eliot
K.J.Connolly, R.J.Edelmann, H.Bartlett, LD.Cooke, E.Lenton and S.Pike
1324
1329
1332
LETTERS TO THE EDITOR
Endometrial thickness and echo patterns
Successful fertilization by testicular spermatozoa in an in-vitro fertilization programme
E.Krampl and W.Feichtinger 1339
R.Schoysman, P.Vanderzwalmen, M.Nijs, 1339
G.Segal-Bertln and M.van de Casseye
ERRATUM
1341
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