The social construction of male infertility: a qualitative questionnaire study of men with a male factor infertility diagnosis

Although recent research has highlighted the distressing impact of infertility for men, fertility issues are still routinely seen as a ‘women's issue’ – even when male factor infertility is highlighted. This article reports findings from a qualitative questionnaire study focusing on a sample of men with a male factor infertility diagnosis; an under-researched and marginalised group in the context of reproductive medicine. Our analysis suggests that male factor infertility is viewed by men as a failure of masculinity, as stigmatising and silencing, and as an isolating and traumatic experience. It is also clear that these themes are shaped by wider societal discourses which present men as (unproblematically) fertile, uninvested in parenthood and stoic in their approach to emotional distress. Such norms also ensure that reproduction continues to be presented as a ‘women's issue’ which burdens women and marginalises men. In understanding male factor infertility experiences, the damaging nature of the social construction of male fertility is then more clearly illuminated.     

Case-control study of leatherwork and male infertility

OBJECTIVES—To test the hypothesis that leatherwork is associated with male infertility mediated through the development of oligozoospermia. The basis of any association was postulated, at the outset, to be with exposure to the solvents used in leatherwork.
METHODS—All new referrals with infertility presenting in Leicestershire hospital clinics between November 1988 and September 1992 and Kettering District General Hospital from August 1990 were eligible to participate; 88.5% agreed to be interviewed. Exposure to leatherwork and work with solvents was defined by job title. Comparisons were made with fertile controls and in an analysis within men from infertile couples with oligozoospermia as the primary outcome. Effects on sperm motility and deformity were investigated secondarily. Analyses used logistic regression for binary outcomes and multilevel modelling for continuous outcomes.
RESULTS—1906 men were interviewed. Compared with the fertile controls the men from infertile couples were 1.10 times (95% confidence interval (95% CI) 0.46 to 2.63; p=0.99) more likely to be leatherworkers and 1.73 times (95% CI 1.26 to 2.38; p<0.001) more likely to work with solvents. Compared with other men, leatherworkers were 1.20 times (95% CI 0.43 to 3.33; p=0.73) more likely to present with oligozoospermia and 1.65 times (95% CI 0.37 to 7.30; p=0.51) more likely to present with teratozoospermia. Being a leatherworker was associated with only a 6% reduction in sperm concentration; motility and deformity were similarly unaffected by this exposure. Work with solvents did not statistically, nor clinically, increase the risk of oligozoospermia, teratozoospermia, or asthenozoospermia.
CONCLUSIONS—There was little evidence to support the hypothesis that leatherwork is associated with an increased risk of presenting with infertility or oligozoospermia. There was limited evidence that leatherwork is a risk factor for teratozoospermia. Workers with solvents were at an increased risk of presenting with infertility, although this was not mediated through effects on standard measures of semen quality; this finding merits further investigation.


Keywords: leatherwork; solvents; male infertility     

Treatment of male infertility

Male factor infertility is a general term that describes a situation in which the inability to conceive is associated with an alteration identified in the male partner. This dysfunction may be associated with low sperm concentration (oligozoospermia), poor sperm motility (asthenozoospermia) or abnormal sperm morphology (teratozoospermia); however, generally, a disturbance of all these variables, oligoasthenoteratozoospermia, is mostly frequent in male subfertility. For many andrological disorders, it is not possible to find a reasonable cause and various uncontrolled treatments have been applied to infertile men, often just on an empirical basis. More recently, after the explosive development of modern assisted reproduction techniques (ARTs), feasible with a single spermatozoon [intracytoplasmic sperm injection (ICSI)], the treatment of male infertility has received new meaning and andrologists are no longer expected to achieve a quantitative increase in sperm number but are instead asked to improve the fertility potential of the single sperm cell in order to achieve better results in both in vitro fertilization and ICSI. Additional prospective studies are needed to better understand the possible role of therapy in ART candidate patients.     

遗传与环境因素对双生姊妹性激素影响

目的探讨女性青春期发育前后血清雌二醇（E2）和睾酮（T）的变化趋势．评价遗传与环境因素相对效应。方法以学校登记为基础募集6～18岁女性双生子180对，其中同卵双生子（MZ）132对，异卵双生子（DZ）48对，按Tanner标准进行青春发育分期，放免法测定空腹血清雌二醇（E2）和睾酮（T）浓度。结果血清E2和T浓度随青春期进程而增高，Tanner Ⅳ期达高峰．Tanner Ⅴ期略有下降；遗传效应分析显示。双生子血清E2和T偶内平均差、偶内方差为MZ〈DZ（P〈0．05）．组内相关系数为MZ〉DZ；表型方差中归因于加性遗传因素的部分分别为40％（E2）和47％（T）；分期估计遗传度显示E2和T均为已来潮组遗传度高于乳房未发育组和未来潮组。结论青春期女性血清E2和T同时受遗传和环境因素的影响。月经来潮后遗传因素的作用显著。     

Occupational exposure to solvents and male infertility

OBJECTIVES—To determine whether, in a case-referent study of infertility patients, cases with low motile sperm count were more likely than referents to have had exposure to organic solvents.
METHODS—Occupations of men attending fertility clinics in Canada were assigned codes reflecting probable exposure to organic solvents, at four grades of intensity, using a job exposure matrix previously developed. A case referent design was used, with cases being defined as men with <12×10⁶/ml motile sperm. Information from 656 men in manual work attending a single clinic in Montreal in 1972-91 was used for the main study. A separate analysis was conducted with information for 574 men in manual work attending 10 further clinics across Canada in 1984-7.
RESULTS—In the Montreal series a significant association was found between intensity of exposure to solvents and clinical findings of <12×10⁶/ml motile sperm. Odds ratios (ORs), after allowing for confounding, were 2.07 (95% confidence interval (95% CI) 1.24 to 3.44) for moderate exposure to solvents and 3.83 (95% CI 1.37 to 10.65) for high exposure. In the second series of 568 men, the effect was confirmed at high exposure to solvents (OR 2.90, 95% CI 1.01 to 8.34) but not at moderate exposure (OR 1.01, 95% CI 0.53 to 1.92).
CONCLUSIONS—Exposure to organic solvents is common both at work and in recreational pursuits. The results of this study suggest that efforts should be made to identify the compounds hazardous to male fertility, and if the risk is confirmed, to regulate their use.


Keywords: infertility; solvents; male manual workers     

A robust and unified framework for estimating heritability in twin studies using generalized estimating equations

The ‘heritability’ of a phenotype measures the proportion of trait variance due to genetic factors in a population. In the past 50 years, studies with monozygotic and dizygotic twins have estimated heritability for 17,804 traits;¹ thus twin studies are popular for estimating heritability. Researchers are often interested in estimating heritability for non-normally distributed outcomes such as binary, counts, skewed or heavy-tailed continuous traits. In these settings, the traditional normal ACE model (NACE) and Falconer's method can produce poor coverage of the true heritability. Therefore, we propose a robust generalized estimating equations (GEE2) framework for estimating the heritability of non-normally distributed outcomes. The traditional NACE and Falconer's method are derived within this unified GEE2 framework, which additionally provides robust standard errors. Although the traditional Falconer's method cannot adjust for covariates, the corresponding ‘GEE2-Falconer’ can incorporate mean and variance-level covariate effects (e.g. let heritability vary by sex or age). Given a non-normally distributed outcome, the GEE2 models are shown to attain better coverage of the true heritability compared to traditional methods. Finally, a scenario is demonstrated where NACE produces biased estimates of heritability while Falconer remains unbiased. Therefore, we recommend GEE2-Falconer for estimating the heritability of non-normally distributed outcomes in twin studies.     

Condemned to be meaningful: Non-response in studies of men and infertility

Male infertility has been under-researched, and in part this seems due to a strong reticence by men to talk to researchers about infertility. Rather than suggest possible features of male infertility that might lead to this reticence, this paper explores how researchers have themselves accounted for the high non- response rates. The analysis details the way in which social scientific reasoning about non-response incorporates both existing knowledge about infertility and everyday reasoning about health and illness. It is suggested that this process is a variant of a pervasive form of commonsense reasoning - the documentary method of interpretation. The interesting upshot of applying this method to non-response, is that an absence of information is ‘condemned to be meaningful’.     

染色体多态性与男性不育的关系分析

目的探讨染色体多态性与男性不育的关系。方法对297例临床诊断为少精子症、无精子症的男性不育患者按常规技术方法制备外周血染色体,并对染色体核型进行分析。结果 297例患者中有68例染色体核型异常,异常检出率为22.90%。其中,多态性变异12例,占异常核型的17.65%,包括次缢痕增长3例,9号染色体倒位2例,D/G组随体变异1例,Y染色体变异6例。结论染色体多态性与男性不育存在明显关系,不能忽视其临床效应。     

Univariate genetic analyses of epilepsy and seizures in a population-based twin study: The Virginia twin registry

The purpose of this study was to examine the roles of genetic and environmental factors in the etiology of epilepsy and seizures in twins ascertained from the Virginia Twin Registry. Health history information on twins was collected by questionnaire. Concordance rates were calculated and used to estimate degree of concordance for seizure types in monozygotic (MZ) and dizygotic (DZ) twin pairs. Univariate twin analyses were performed for each epilepsy and seizure type to determine models which best explained observed variation. Health history information concerning epilepsy and febrile seizure occurrences was provided by members of 8,655 twin pairs; 6,684 of these supplied additional information reporting absence, complex partial, tonic-clonic, and unspecified seizures. Models including additive genetic and unique environmental factors best explained febrile seizures, epilepsy, complex partial seizures, and unspecified seizures. For complex partial seizures, however, the contributions of genetic and environmental effects did not vary across gender. These results show that, under univariate analysis methods, genetic factors played an important role in the expression of seizures in epilepsy, febrile seizures, unspecified seizures, and complex partial seizures. Additional support for these findings was provided by the concordance results for all categories except male twins reporting complex partial seizure occurrence. However, environmental influences still remained an important factor in seizure expression in these specific categories. Genet. Epidemiol. 15:33–49,1998. © 1998 Wiley-Liss, Inc.     

CLOCK基因多态性与原发性男性不育相关性

目的 探讨生物钟基因（CLOCK）多态性与原发性男性不育之间的关系。方法 以2005-2010年就诊于江苏省南京医科大学附属医院男性不育门诊的478例患者为病例组,同时选择就诊于其他门诊的有正常生育史的194名男性为对照组。取5 mL外周血检测血清睾酮（T）和促卵泡激素（FSH）水平,PCR检测CLOCK的rs1801260、rs3817444和rs3749474位点。结果 在rs3749474位点携带TT基因型和TC+CC基因型的受试者中病例组血清FSH浓度明显高于对照组（P=0.0266）,携带CC基因型的受试者中病例组血清T浓度明显高于对照组（P=0.0466）;在rs1801260位点携带AA基因型的受试者中病例组血清FSH和T浓度均明显高于对照组（P分别为0.0016、0.0451）;在rs3817444位点携带CC基因型和CA+AA基因型的受试者中病例组血清FSH浓度均明显高于对照组（P分别为0.0016、0.0430）。结论 CLOCK基因多态性与原发性男性不育存在关联。     

不孕症夫妇家庭暴力发生情况及影响因素分析

目的探讨家庭暴力中男女各方的影响因素,家庭暴力与男性性功能障碍、女性怀孕之间的关系.方法采用现状调查.2003年被诊断为不孕症的夫妇中抽取510对,对不孕症的情况、性功能障碍发生情况、家庭暴力发生情况及相关的知识态度进行问卷调查.结果有7.6%的丈夫发生了性功能障碍,实施过家庭暴力的丈夫中21.1%的人患有性功能障碍,未实施过家庭暴力的丈夫只有5.2%的人患有性功能障碍.有26.9%的妻子在最近一年遭受过家庭暴力.有24.6%的妻子在过去一年怀孕,其中遭受过精神暴力的妻子怀孕率为16.1%,未遭受过精神暴力的妻子怀孕率为26.3%.结论造成家庭暴力女方的因素有年龄、结婚年限、文化程度、经济收入、是否与公婆一起居住.造成家庭暴力的男方因素有年龄、是否出外打工、男性性功能障碍、家庭暴力知识态度的情况.家庭暴力可以引起男性性功能障碍和不孕,精神暴力可以引起女性不孕.要促进生殖健康就应该防止家庭暴力的发生.     

Genetic variation of hormone sensitive lipase and male infertility

Hormone sensitive lipase (HSL) is a triacylglycerol hydrolase and cholesterol esterase that is essential for male fertility. The aim of the study was to investigate the distribution of C-60G polymorphism of HSL gene and alleles in fertile and infertile males living in Hamadan, Iran. In addition, lipase activity was determined in these two groups. The HSL genotype was determined by PCR-RFLP and the lipase activity was detected by turbidometery in 164 fertile and 169 infertile males. A significant difference in HSL genotype distribution was observed between groups (χ2 = 8.1, df = 2, p =? 0.017). Infertile males showed a higher percentage of CC as well as a lower percentage of CG and GG genotype compared with fertile individuals. The presence of CC to CG?+?GG genotype conferred a 2.4-fold risk for male infertility (odds ratio?=?2.4 (1.3 - 4.5), p?=?0.006). In addition, lipase activity was remarkably higher (p < 0.001) in fertile males (94 ± 66 U/L) compared to the infertile subjects (50.6 ± 49 U/L). This suggests that genetic variation of HSL may be a risk factor for male infertility.     

化学发光法检测男性不育血清FSH、T的结果分析

目的:探讨化学发光法在男性不育临床诊断上的应用价值。方法:随机选取某医院门诊男性不育患者100例,健康体检者80例,应用化学发光法对其进行血清FSH(促卵泡激素)、T(睾酮)检测,比较两组检测结果。结果:男性不育患者组FSH水平为8.4±6.5IU/L,T水平为14.7±9.2nmol/L;健康对照组FSH水平为5.3±3.4IU/L,T水平为25.3±14.1nmol/L,男性不育患者血清中FSH有显著性改变,T与健康对照组相比显著降低。结论:男性不育患者血清中FSH、T有异常改变,化学发光检测法灵敏度高、重复性好、操作简便,是用于男性不育临床检验的好方法。     

转基因雄性小鼠不育原因分析

目的研究转基因雄性小鼠不育的主要原因。方法以野生型C57BL／6J作为对照，比较检测健康性成熟雄性转基因小鼠的睾丸、附睾、前列腺、提肛肌的脏器系数和精子数、精子活动度、活精率、精子畸形率；观察睾丸组织病理学变化及睾丸组织葡萄-6-磷酸脱氢酶（G-6-PD）、乳酸脱氢酶（LDH）、乳酸脱氢酶同工酶（LDH-X）及琥珀酸脱氢酶（SDH）的活性。结果与正常非转基因对照鼠相比，转基因鼠睾丸的脏器系数与正常对照鼠相接近，附睾、提肛肌的脏器系数显著降低。精子数、直线运动精子数显著降低（P〈0．01）；转基因鼠睾丸组织曲细精管变薄，生精细胞排列不整齐，层次减少（2层），上皮部分有变性，精原细胞、初级精母细胞分裂异常，精子形成减少；G-6-PD、LDH、LDH-X及SDH的活性均显著低于对照鼠。结论外源基因整合后，引起睾丸组织酶活性下降，影响各细胞的生理、生化功能，进而引起睾丸发育严重障碍，精子减少和活动能力降低而导致不育。     

The controversial efficacy of vitamin E for human male infertility

Vitamin E (VE) is major lipophilic chain-breaking antioxidant which protects tissue polyunsaturated fatty acids (PUFA) against peroxidation, a property that could be beneficial in the male reproductive physiology because the membranes of germ cells and spermatozoa are very sensitive to oxidation because of their high content of PUFA. Some of the available data on the efficacy of VE as an oral drug for male infertility or as an additive during in vitro manipulations of spermatozoa were reviewed here, observing that they are often contradictory, possibly because: (1) antioxidant therapy could be ineffective in certain studies not concentrated on men in whom oxidative stress is implicated as an infertility factor, and (2) the VE antioxidant therapy is a double-edged sword strictly depending on the dosage or the in vitro concentration of the vitamin. Thus, further laboratory and clinical studies with better-defined experimental conditions should be performed to establish the in vitro and in vivo efficacy of VE for human male infertility.     

Indigenous knowledge systems and attitudes towards male infertility in Mhondoro-Ngezi,Zimbabwe

Male impotence and infertility are health and social problems that have resulted in significant suffering to men the world over. From an African perspective, and in Zimbabwe in particular, the taboo nature of male impotence and infertility carries a lot of mystique. Based on evidence from focus-group discussions, in-depth and key-informant interviews, this study reveals rural Shona people to have indigenous knowledge systems that trigger the investigatation of signs of impotence (perceived as associated with male infertility) at infancy, puberty and after marriage. Male infertility carries overtones of failure, frustration, pain, social ostracism, stigma, marital instability, discomfiture and suicide. Intervention strategies to remedy perceived problems were exclusively sociocultural, involving the administration of traditional herbs and traditional healers' divination. Given the existence of indigenous knowledge systems for the investigation and mediation of male impotence and infertility, it is worth incorporating traditional healers in future strategies targeting these emasculating conditions.     

Mutations of the Cyclin A1 Gene are Not a Common Cause of Male Infertility

Cyclin A1 is essential for meiosis as shown by its essential role in mouse spermatogenesis, suggesting that changes in the gene may also alter male fertility in humans. In the present study, we performed a mutation screening of the cyclin A1 gene in order to investigate the possible association between the mutations of the gene and human impaired spermatogenesis using denaturing high performance liquid chromatography (DHPLC) in 347 infertile patients with azoospermia or severe oligozoospermia and 210 fertile controls. Four point mutations, c.321T>C, IVS3 +32G>C, IVS5+38A>G and c.1158G>A, were identified, but no association of these with spermatogenesis impairment was detected, suggesting that these cyclin A1 gene mutations are unlikely a common genetic cause for impaired human spermatogenesis.     

遵义市农村地区男性不育影响因素的病例对照研究

目的探讨遵义农村地区男性不育的影响因素。方法于2014年11月—2015年8月,选择在遵义下辖的3个乡镇街头偶遇的成年已婚育男性181人作为对照组(生育组);选择在遵义医学院附属医院生殖中心做检查的农村不育男性患者212人作为病例组(不育组)。采用现场问卷调查,调查内容包括一般情况、个人生活习惯等,并进行多因素logistic回归分析。结果被动吸烟、熬夜、每周使用电脑是遵义农村地区男性不育的主要危险因素,OR值(95%CI)分别是1.795(1.079~2.984)、2.516(1.638~3.862)、1.629(1.070~2.482)。结论被动吸烟、熬夜、每周使用电脑是男性不育症的危险因素,均可能降低男性生殖健康水平。     

Eating behaviors and attitudes in women with infertility: a controlled study

OBJECTIVE: Infertility arises from a complex pathogenic process in which it is often difficult to identify etiology. Psychological and behavioral factors may play a role in some cases of infertility. The extent to which eating behaviors and attitudes contribute to infertility is unknown. METHOD: In this study, 120 subjects with infertility, 80 fertile women, and 90 patients suffering from anorexia nervosa, restricting subtype (AN-R), were assessed with the Eating Disorder Inventory (EDI-2). RESULTS: The EDI-2 highlights differences among patients with AN-R and fertile and infertile subjects. Infertile patients had higher scores on the Interpersonal Distrust, Interoceptive Awareness, and Maturity Fears EDI-2 subscales than fertile subjects. Logistic regression identifies the independent variables of interpersonal distrust, interoceptive awareness, maturity fears, and asceticism as predictors of infertility. DISCUSSION: Infertile patients without eating disorders share some psychological features of women with AN. These features do not include disturbed eating attitudes and behaviors, but rather feelings of inadequacy, insecurity, and maturity fears.