Reproductive function in young Swedish men - Time trend, prenatal and adult exposure to smoking and phthalates

A decrease in male reproductive function, including sperm counts, during the second half of the 20th century, has been postulated. During this period, testicular cancer has increased several-fold. Environmental and lifestyle-related factors have been proposed as explanations for a possible negative trend in male reproductive function. One important lifestyle factor is smoking. However, smoking during pregnancy appears to play a greater role for a man's reproductive function than smoking by the man himself. As regards environmental chemicals, one type of compound to which humans are exposed is phthalates. These are often used as plasticizers in different consumer products. Several phthalates have been reported as decreasing male reproductive function in laboratory animals, especially when given during the foetal period. Between 2008 and 2010, 314 men from the general Swedish population were recruited. Their semen quality was compared with a group of men recruited in a similar manner between 2000 and 2001. The participants also delivered serum and urinary samples and answered questionnaires concerning maternal and paternal smoking during pregnancy. Data on maternal smoking was additionally assessed through the Swedish Medical Birth Register. Through a Swedish screening program for rubella, maternal serum samples were retrieved from the men's prenatal period. We analysed metabolites of phthalates as exposure markers both in the maternal sera and in urine and serum of the men. Associations between parental smoking during pregnancy as well as phthalate metabolite levels, and parameters of male reproductive function were studied. In summary, we found no change in semen quality between 2000-2001 and 2008-2010. However, both maternal and paternal smoking during pregnancy were associated with reduced sperm counts in men whose other parent did not smoke. In addition, prenatal exposure to diethylhexyl phthalate (DEHP) and diisononyl phthalate (DiNP) appeared to be associated with decreased semen volume, and exposure to DiNP as well with smaller testicular size. Finally, adult exposure to DEHP and dibutyl phthalate (DBP) were associated with decreased progressive sperm motility, and DEHP exposure was also linked to a higher proportion of immature sperm. Thus, although no change in semen quality appeared to have occurred in Swedish men during the last decade, parental smoking and prenatal and adult exposure to certain phthalates may play a role in the male reproductive function

To hope for the best and be prepare for the worst : The patient's experiences of waiting for an organ transplant

Bakgrund: Organtransplantation är en rutinmässig behandling i vården. Ett underskott på organ gör väntetiden lång, vilket leder till långa väntetider och medför oro och rädsla. När en människa placeras på väntelistan är en organtransplantation den sista utvägen eftersom organet är så pass skadat. Syfte: Syftet var att belysa patientens upplevelse av väntan på en organtransplantation. Metod: Studien är en litteraturstudie med induktiv ansats där åtta artiklar ligger till grund för resultatet. Datan analyserades och delades in i kategorier och subkategorier med utgångspunkt från syftet. Resultat: Tre huvudkategorier med tillhörande subkategorier framkom; Känslor till följd av väntandet på en organtransplantation, Behovet av stöd och information och Ett begränsat liv. Patienter som väntar på en organtransplantation upplevde osäkerhet och oro för döden blandat med hopp inför framtiden. Denna osäkerhet kunde kännas större vid upplevd brist på information från vården. Begränsningen i vardagen upplevdes svår och då blev stödet från sjuksköterskor och anhöriga viktigare, tillsammans med att skapa strategier för att hålla hoppet uppe. Konklusion: Litteraturstudien visar att upplevelsen av väntan på en transplantation är liknande runt om i världen. Det finns ett behov av information och stöd från sjuksköterskan då detta skapar mer trygghet. Det är av vikt för sjuksköterskan att ha en förståelse för denna patientgrupp. Background: Organ transplantation is a routine treatment in modern healthcare. Due to lack of organs in relation to the need, waiting is increased which causes anxiety and fear for patients. When a person is placed on the waiting list, an organ transplant is the last resort since the organ is highly damaged. Aim: The aim was to illustrate the patient’s experience of waiting for an organ transplant. Method: This study is a literature study and have an inductive approach and is based on eight articles. The data was analyzed and categorized in regard to the aim. Results: The result reports three categories and associated subcategories; Feelings about waiting for an organ transplant, The need for support and information and A limited life. Patients experience uncertainty and anxiety during the waiting time and a fear of death alongside hope. The uncertainty grew with lack of information from care givers. Limitations of daily life perceived tough hence the nursing and family support became paramount, all together creating strategies to inspire hope. Conclusion: The literature study shows that the waiting experience for a transplant is similar around the world. There is a need for information and support from nurses, therefore, the nursing sympathy, information and knowledge is essential in creating a safe environment.

The association between serum estradiol levels and sperm DNA integrity

In men from the general population, BMI has been associated with a lower sperm DNA fragmentation index (DFI). We wondered whether this could be due to estradiol, which is associated with BMI and reported important for sperm function. Our objective was to investigate the association between estradiol and DFI. In 2008–2010, we recruited 284 young men from the general population to deliver samples of semen and blood and answer questionnaires. Serum concentrations of reproductive hormones and DFI were analyzed, the latter using the Sperm Chromatin Structure Assay. Associations were studied using general linear models. The first model utilized metric values of estradiol, whereas the second model compared men with high and low levels, dichotomized by the median value. A possible interaction between estradiol and testosterone was also examined. When investigating metric estradiol levels and DFI, an inverse association was seen without adjustments (p =.02), but the statistical significance was lost at adjustments for potential confounders (p =.08). Men with lower estradiol levels (<88 pmol/L, mean 71 pmol/L) had a statistically significantly higher DFI than men with higher levels of estradiol (≥88 pmol/L, mean 110 pmol/L). Mean ratio difference was 1.21 (p =.002) without adjustments and 1.18 (p =.01) with adjustments. A statistically significant difference in DFI was observed in men with testosterone levels below median when comparing high and low estradiol (p <.001). This study supports the idea that serum estradiol levels are protective for sperm DNA integrity, at least at lower testosterone levels

Exposure to polycyclic aromatic hydrocarbons and nicotine, and associations with sperm DNA fragmentation

Background: Tobacco smoking has been reported to cause DNA fragmentation and has been suggested to cause mutations in spermatozoa. These effects have been ascribed to the action of polycyclic aromatic hydrocarbons (PAH) present in the smoke. Simultaneously, DNA fragmentation has been associated with mutagenesis. Objective: The aim of this study was to investigate whether levels of urinary biomarkers of PAH and nicotine exposure were associated with sperm DNA fragmentation. Methods: In the urine of 381 men recruited from two cohorts of young men (17–21 years old) from the general Swedish population, the PAH metabolites 1-hydroxypyrene and 2-hydroxyphenanthrene, as well as the nicotine metabolite cotinine, were measured. The sperm DNA fragmentation index (DFI) was analysed using the sperm chromatin structure assay. Associations between the DFI, and PAH metabolite levels as continuous variables as well as in quartiles, were studied by general linear models adjusted for abstinence time. A similar analysis was carried out for cotinine levels, according to which the men were categorised as “non-smoking” (n = 216) and “smoking” (n = 165). Results: No association was found between levels of any of the three biomarkers and DFI, either as a continuous variable (p = 0.87–0.99), or when comparing the lowest and the highest quartiles (p = 0.11–0.61). The same was true for comparison of men categorised as non-smoking or smoking (DFI 11.1% vs. 11.8%, p = 0.31). Discussion: We found no evidence of PAH or nicotine exposure to be associated with DFI, which does not exclude that these exposures may have other effects on sperm DNA. Conclusion: In these young men, levels of biomarkers of nicotine and PAH exposure were not associated with DFI

Association between follicle-stimulating hormone receptor polymorphisms and reproductive parameters in young men from the general population.

OBJECTIVE: Follicle-stimulating hormone (FSH) regulates gametogenesis through binding to its receptor (FSHR). In women, the Thr307Ala and Asn680Ser polymorphisms in the FSHR gene affect reproductive function, but it is not clear whether they have any impact on spermatogenesis and have mainly been investigated in infertile men of varying ages. The aim of the present study was therefore to examine whether these genetic variants of the FSHR influence reproductive parameters in men from the general population. METHODS: Men aged 17-20 years (n=313) were genotyped. All men provided a semen sample and a blood sample for hormonal measurements and DNA extraction. They underwent a medical examination and analyses of possible associations between Thr307Ala and Asn680Ser polymorphisms and hormonal and sperm parameters were subsequently carried out. RESULTS: Men homozygous for Thr307/Asn680 had a lower mean serum FSH concentration (3.07 vs. 3.65 IU/l, P=0.009), and higher mean serum estradiol (94.0 vs. 86.1 pmol/l, P=0.001), sex hormone-binding globulin (33.6 vs. 31.3 nmol/l, P<0.0001), and total testosterone (19.1 vs.17.9 nmol/l, P<0.0001) concentrations compared with men with other genotypes. In addition, sperm concentrations (71.9×10 vs. 70.8×10/ml, P=0.040) and the total sperm counts were higher (212×10 vs. 206×10, P<0.0001) and their testes volumes were larger (left: 11.5 vs. 11.0 ml, P<0.0001; right: 12.4 vs. 11.6 ml, P=0.002). CONCLUSION: As in women, the results from the present study indicate that variants of the FSHR influence reproductive parameters in men