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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