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      Lifestyle causes of male infertility

      research-article
      *
      Arab Journal of Urology
      Elsevier
      AAS, anabolic–androgenic steroids, APA, advanced paternal age, ASIH, anabolic steroid-induced hypogonadism, ART, assisted reproductive technology, BMI, body mass index, Chk1, checkpoint kinase 1, ECS, endogenous cannabinoid system, GnIH, gonadotropin-inhibitory hormone, HADS, Hospital Anxiety and Depression Score, HPA, hypothalamus–pituitary–adrenal, HPG, hypothalamus–pituitary–gonadal, IVF, in vitro fertilisation, ICSI, intracytoplasmic sperm injection, IUI, intrauterine insemination, MMP, mitochondrial membrane potential, ROS, reactive oxygen species, SOD, superoxide dismutase, Male infertility, Lifestyle, Risk factors, Semen quality, Sperm DNA fragmentation

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          Abstract

          Objective

          To examine the potential effects of lifestyle factors on male reproductive health. Evidence of a global decline in human sperm quality over recent decades has been accumulating. Environmental, occupational, and modifiable lifestyle factors may contribute to this decline. This review focuses on key lifestyle factors that are associated with male infertility such as smoking cigarettes, alcohol intake, use of illicit drugs, obesity, psychological stress, advanced paternal age, dietary practices, and coffee consumption. Other factors such as testicular heat stress, intense cycling training, lack of sleep and exposure to electromagnetic radiation from mobile phone use are briefly discussed.

          Materials and method

          A comprehensive literature search was performed to identify and synthesise all relevant information, mainly from within the last decade, on the major lifestyle factors associated with male infertility and semen quality. Database searches were limited to reports published in English only. A manual search of bibliographies of the reports retrieved was conducted to identify additional relevant articles.

          Results

          In all, 1012 articles were identified from the database search and after reviewing the titles and abstract of the reports, 104 articles met the inclusion criteria. Of these, 30 reports were excluded as the full-text could not be retrieved and the abstract did not have relevant data. The remaining 74 reports were reviewed for data on association between a particular lifestyle factor and male infertility and were included in the present review.

          Conclusion

          The major lifestyle factors discussed in the present review are amongst the multiple potential risk factors that could impair male fertility. However, their negative impact may well be mostly overcome by behaviour modification and better lifestyle choices. Greater awareness and recognition of the possible impact of these lifestyle factors are important amongst couples seeking conception.

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          Most cited references76

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          Evidence for decreasing quality of semen during past 50 years.

          To investigate whether semen quality has changed during the past 50 years. Review of publications on semen quality in men without a history of infertility selected by means of Cumulated Index Medicus and Current List (1930-1965) and MEDLINE Silver Platter database (1966-August 1991). 14,947 men included in a total of 61 papers published between 1938 and 1991. Mean sperm density and mean seminal volume. Linear regression of data weighted by number of men in each study showed a significant decrease in mean sperm count from 113 x 10(6)/ml in 1940 to 66 x 10(6)/ml in 1990 (p < 0.0001) and in seminal volume from 3.40 ml to 2.75 ml (p = 0.027), indicating an even more pronounced decrease in sperm production than expressed by the decline in sperm density. There has been a genuine decline in semen quality over the past 50 years. As male fertility is to some extent correlated with sperm count the results may reflect an overall reduction in male fertility. The biological significance of these changes is emphasised by a concomitant increase in the incidence of genitourinary abnormalities such as testicular cancer and possibly also cryptorchidism and hypospadias, suggesting a growing impact of factors with serious effects on male gonadal function.
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            Consistent age-dependent declines in human semen quality: a systematic review and meta-analysis.

            Reduced fertility typically occurs among women in their late 30s, but increasing evidence indicates that advanced paternal age is associated with changes in reproduction as well. Numerous studies have investigated age-based declines in semen traits, but the impact of paternal age on semen parameter values remains inconclusive. Using data from 90 studies (93,839 subjects), we conducted a systematic review and meta-analysis to quantify the effect of male age on seven ejaculate traits (semen volume, sperm concentration, total sperm count, morphology, total motility, progressive motility and DNA fragmentation). Age-associated declines in semen volume, percentage motility, progressive motility, normal morphology and unfragmented cells were statistically significant and results generally seemed to be robust against confounding factors. Unexpectedly, sperm concentration did not decline with increasing male age, even though we found that sperm concentration declined over time. Our findings indicate that male age needs more recognition as a potential contributor to the negative pregnancy outcomes and reduced offspring health associated with delayed first reproduction. We suggest that greater focus on collection of DNA fragmentation and progressive motility in a clinical setting may lead to better patient outcomes during fertility treatments of aging couples.
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              Effects of increased paternal age on sperm quality, reproductive outcome and associated epigenetic risks to offspring

              Over the last decade, there has been a significant increase in average paternal age when the first child is conceived, either due to increased life expectancy, widespread use of contraception, late marriages and other factors. While the effect of maternal ageing on fertilization and reproduction is well known and several studies have shown that women over 35 years have a higher risk of infertility, pregnancy complications, spontaneous abortion, congenital anomalies, and perinatal complications. The effect of paternal age on semen quality and reproductive function is controversial for several reasons. First, there is no universal definition for advanced paternal ageing. Secondly, the literature is full of studies with conflicting results, especially for the most common parameters tested. Advancing paternal age also has been associated with increased risk of genetic disease. Our exhaustive literature review has demonstrated negative effects on sperm quality and testicular functions with increasing paternal age. Epigenetics changes, DNA mutations along with chromosomal aneuploidies have been associated with increasing paternal age. In addition to increased risk of male infertility, paternal age has also been demonstrated to impact reproductive and fertility outcomes including a decrease in IVF/ICSI success rate and increasing rate of preterm birth. Increasing paternal age has shown to increase the incidence of different types of disorders like autism, schizophrenia, bipolar disorders, and childhood leukemia in the progeny. It is thereby essential to educate the infertile couples on the disturbing links between increased paternal age and rising disorders in their offspring, to better counsel them during their reproductive years.
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                Author and article information

                Contributors
                Journal
                Arab J Urol
                Arab J Urol
                Arab Journal of Urology
                Elsevier
                2090-598X
                2090-5998
                13 February 2018
                March 2018
                13 February 2018
                : 16
                : 1
                : 10-20
                Affiliations
                Discipline of Physiology, Faculty of Medicine, Sungai Buloh Campus, Universiti Teknologi MARA, Selangor, Malaysia
                Author notes
                [* ]Address: Discipline of Physiology, Faculty of Medicine, Sungai Buloh Campus, Universiti Teknologi MARA, Jalan Hospital, 47000 Sungai Buloh, Selangor, Malaysia. Fax: +60 3 6126 5224. damayanthi@ 123456salam.uitm.edu.my damayanthi.d@ 123456gmail.com
                Article
                S2090-598X(18)30006-8
                10.1016/j.aju.2017.12.004
                5922227
                29713532
                23a6fdf1-de0e-47c5-b346-0c5aa7b4bcee
                © 2018 Production and hosting by Elsevier B.V. on behalf of Arab Association of Urology.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 12 November 2017
                : 5 December 2017
                : 12 December 2017
                Categories
                Etiology

                aas, anabolic–androgenic steroids,apa, advanced paternal age,asih, anabolic steroid-induced hypogonadism,art, assisted reproductive technology,bmi, body mass index,chk1, checkpoint kinase 1,ecs, endogenous cannabinoid system,gnih, gonadotropin-inhibitory hormone,hads, hospital anxiety and depression score,hpa, hypothalamus–pituitary–adrenal,hpg, hypothalamus–pituitary–gonadal,ivf, in vitro fertilisation,icsi, intracytoplasmic sperm injection,iui, intrauterine insemination,mmp, mitochondrial membrane potential,ros, reactive oxygen species,sod, superoxide dismutase,male infertility,lifestyle,risk factors,semen quality,sperm dna fragmentation

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