Male infertility in Lebanon: A case control study.

Abstract

According to the World Health Organization, infertility affects more than 80 million people around the world, whereby one in ten couples experience primary or secondary infertility. Most of those who suffer from infertility, moreover, live in developing countries where infertility prevention or treatment services remain unavailable and/or inaccessible. According to the National Institute of Health, male infertility is the cause of approximately 40% of the 2.6 million infertile married couples in the United States. It has been estimated that one-half of these men actually experience irreversible infertility, when advanced reproductive technologies are disregarded as a treatment option. In the Middle East, 10-15% of all married couples are estimated to have infertility problems. The overall prevalence of male factor infertility is still unknown and not a relatively easy figure to determine. A case-control study was conducted to determine the impact of familial predispositions (i.e. genetic) to infertility, reproductive histories and infections, lifestyle factors (such as intake of drugs, alcohol, caffeine, cigarette smoking), war exposures and occupational exposures on male infertility. No studies have been conducted in the Middle East to understand the underlying causes, risk factors and etiologies of male infertility in that region. Furthermore, the breadth of available scientific literature pertaining to the context of this problem in the region has only been primarily focused on women. 220 male cases (n=120) and controls (n=100) of either Lebanese, Syrian or Lebanese-Palestinian descent were selected from two of the busiest in vitro fertilization (IVF) clinics located in Beirut, Lebanon (i.e., American University of Beirut-Medical Center and FIRST IVF). Cases all suffered from impaired sperm count and function, according to World Health Organization guidelines for semen analysis. Controls were the fertile husbands of infertile women attending these clinics. Data were collected using a semi-structured interview questionnaire, laboratory blood testing, and the results of most recent semen analysis. Univariate, bivariate and multivariate logistic regression analyses were used in data analysis, along with checks for effect modification and control of confounders. The study highlighted the importance of consanguinity and the clustering of male infertility cases within families, as well as reproductive illnesses and war exposures as independently significant risk factors for male infertility. The odds of having infertility problems in the immediate family was 2.6 times higher in cases than controls. The odds of reproductive illness was 2 times higher in cases than controls. The odds of war exposures (e.g., participating as a fighter, residence near areas of intense bombing) was 1.57 times higher in cases than controls. Occupational exposures, smoking and caffeine intake were not shown to be important risk factors in this case-control study, given similar rates of exposure among cases and controls. This case-control study suggests the importance of investigating the etiology of male infertility in Middle Eastern communities. It also suggests the need to expand research on male reproductive health in the Middle East, in order to improve the prevention and management of male infertility and other male reproductive health problems. This is especially true in the context of Lebanon, a country in clear epidemiologic transition, affected by 15 years of civil war and swamped by highly westernized-urbanized lifestyles.Dr.P.H.Health and Environmental SciencesPublic healthUniversity of Michigan, Horace H. Rackham School of Graduate Studies, School of Public Healthhttp://deepblue.lib.umich.edu/bitstream/2027.42/125794/2/3209093.pd