Characterizing trends in semen indicators and potential risk factors for a male cohort seeking subfertility care in Dhaka, Bangladesh Open Access

Abstract

Alarming decreases in global trends of sperm quality indicators - sperm concentration, percentage of sperm motility, sperm density, and normal sperm morphology - have been observed over the last few decades. Because comprehensive research on male reproductive function in Bangladesh is lacking, the purpose of this study is to characterize infertility in Bangladeshi males through temporal trajectories of semen parameters and risk factor assessment. Retrospective, cross-sectional semen data was collected at the Centre for Assisted Reproduction (CARE) of BIRDEM General Hospital from 2000 to mid-2016 (n = 13811). Additionally, a mixed-methods approach informed risk factor influence on semen analysis reports from May-August 2016 (n = 72). Age distribution was significantly correlated with annual changes in median sperm count and motility over time (p < .0001). Adjusted median regression analyses for total motility and rapid linear (RL) motility indicate strong effects of confounding from age and duration of abstinence (p < .0001). When concentration diagnosis frequencies were adjusted by WHO 2010 parameters, normozoospermia frequency increased from 66.7% to 68.1%, while mild oligozoospermia decreased from 4.4% to 3.1%. Multiple regression analyses for the risk factors showed significant association of secondary subfertility with semen parameters: concentration (48.9[15.1-82.7], p < 0.006), RL motility (14.4[4-24.8], p < 0.01), and total motility (20.3[8.9-31.7], p < 0.001). Hormonal imbalance impacted total motility with a regression coefficient of -28.8[-53.5- -4.1], p < 0.026. Participants aged 42-64 years had significantly lower concentration values than participants of all other ages (-64.8[-104.9,-24.7], p < 0.003). RL motility among participants aged 33-35 years was significantly different than those in other age groups (p < 0.01). Findings from this study indicate a relationship between increasing age and decreasing semen quality, as well as the existence of a temporal decline in semen parameters for Bangladeshi males seeking subfertility care. While this study sets the foundation for similar work in South Asia, future studies could be improved by quantifying risk factor measurements more effectively by conducting assays on biospecimens in addition to semen analysis. Moreover, expanding testing to male partners in couples facing normal fertility outcomes would provide substantial data to be used as a control.

Table of Contents

Table of Contents Page Acknowledgements - i Definition of Key Terms and Abbreviations - ii List of Tables and Figures - iv I. Chapter I: Introduction Background of the Problem - 1 Purpose and Aims of the Study - 3 Significance Statement - 3 II. Chapter II: Review of Literature Aging - 5 History of Illnesses and Procedures - 6 Drug Use: Tobacco and Alcohol - 7 Endocrine Disruptors from Environmental and Occupational Exposures - 9 III. Chapter III: Methods Study Participants - 12 Semen Analysis Procedures - 12 Study Design - 14 Statistical Analysis - 15 IV. Chapter IV: Results SECTION A: Manuscript - Decline in semen parameters of Bangladeshi males attending in tertiary care hospital from 2000-2016†Author Contributions - 17 Abstract - 17 Introduction - 18 Materials and Methods - 20 Results - 22 Discussion - 27 Manuscript References - 31 SECTION B: Risk Factor Analysis - 33 V. Chapter V: Culminating Discussion Discussion - 36 Limitations & Biases - 37 Implications & Recommendations - 40 Conclusion - 41 VI. References - 42 VII. Appendix - Additional Tables & Figures - 53

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, General
Keyword	azoospermia male infertility semen analysis assisted reproduction Bangladesh urology sperm quality andrology sperm motility
Committee Chair / Thesis Advisor	Rochat, Roger, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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