Stefan S. du Plessis Ashok Agarwal Edmund S. Sabanegh Jr. Editors Male Infertility A Complete Guide to Lifestyle and Environmental Factors 123 Male Infertility Stefan S. du Plessis (cid:129) Ashok Agarwal Edmund S. Sabanegh Jr. Editors Male Infertility A Complete Guide to Lifestyle and Environmental Factors Editors Stefan S. du Plessis, BSc (Hons), MSc, Ashok Agarwal, PhD, HCLD, (ABB), MBA, PhD (Stell) ELD (ACE) Division of Medical Physiology Center for Reproductive Medicine Department of Biomedical Sciences Andrology Center Faculty of Medicine and Health Sciences Glickman Urological and Kidney Institute Stellenbosch University Cleveland Clinic Tygerberg , South Africa Cleveland, OH , USA Edmund S. Sabanegh Jr., MD Glickman Urological and Kidney Institute Cleveland Clinic Cleveland , OH , USA ISBN 978-1-4939-1039-7 ISBN 978-1-4939-1040-3 (eBook) DOI 10.1007/978-1-4939-1040-3 Springer New York Heidelberg Dordrecht London Library of Congress Control Number: 2014944131 © Springer Science+Business Media New York 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher’s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. T he use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Foreword Male infertility is on the rise. Most providers are familiar with the well-k nown causes of infertility, such as varicoceles. Lifestyle and environment, although postulated in having a role in the etiology of male infertility, has not been well studied. This book seeks to bring to light the various factors that can impact male fertility and sperm function. The editors, Drs. Du Plessis, Agarwal, and Sabanegh, have assembled a wide range of experts to contribute to this unique text. Topics include epidemiology, the impact of smoking and alcohol, obesity, exercise, vitamins and supplements, illegal drugs, heat, STIs, psychological stress, electronic devices, pesticides, endocrine disruptors, radiation, iatrogenic treatment, and age. These are all areas that have been implicated at some time with male infertility for which convincing evidence is lacking or confl icting. The editors have done a fi ne job of bringing together all of these varied topics and presenting balanced views of the literature regarding their potential impact on male fertility. Each of the editors is well known for their contributions to the fi eld of andrology and infertility, and their expertise, along with that of their chosen authors, makes this book unique. This book should add to the armamentarium of all providers who see patients of reproductive age. Milwaukee, WI, USA Jay I. Sandlow, MD Professor and Vice-Chairman Department of Urology Medical College of Wisconsin v Pref ace Male infertility is on the upsurge worldwide, thereby contributing progressively more to couple infertility. There is growing evidence supporting causal links between the environment, lifestyle choices, general male health, systemic disease, and male reproductive health. Due to increased environmental pres- sures and unhealthy modern lifestyle choices, this combined set of factors can accumulate over time and contribute signifi cantly to adverse impact on male reproductive issues. With the advent of ICSI these concerns may be circumvented and margin- alized. However, ART procedures do not address the root of the problem and it is important to focus on environmental and lifestyle issues such as pesti- cides, dietary habits, sexually transmitted infections, cell phone radiation, alcohol, tobacco, and recreational drug use to name but a few. With this fi rst of a kind textbook we aim to provide a comprehensive yet concise review of various environmental and lifestyle factors which impact male infertility with specifi c emphasis on the mechanisms contributing to decreased sperm production and impaired function. The book consists of 16 different yet applicably themed topics. Each chapter was written by interna- tionally recognized scientists and clinicians in an easy to follow, informal yet scientifi c style thereby making the text ideal for those seeking to increase their general knowledge of the fi eld. We hope that this book will have a broad and global appeal as it would be used not only as a reference for basic scien- tists, andrologists, and embryologists, but may also act as a clinical guideline for physicians and infertility experts. W e would like to thank all of the contributing authors for their inputs and are especially grateful to Michael D. Sova (developmental editor) for his tire- less efforts in reviewing and preparing each of the manuscripts for production. We would also like to acknowledge the Division of Medical Physiology at Stellenbosch University and the Glickman Urological Institute at the Cleveland Clinic for their institutional support towards this endeavor. Finally we would like to express our gratitude towards our families for their support and patience in allowing us to complete this book. We trust that this book will become an important resource for reproductive professionals around the world. Tygerberg, South Africa Stefan S. du Plessis Cleveland, OH Ashok Agarwal Cleveland, OH Edmund S. Sabanegh Jr. vii Contents 1 Epidemiology and Evidence of Declining Male Fertility ........... 1 Marcello Cocuzza and Sandro C. Esteves Part I Lifestyle/Personal Factors 2 The Effect of Smoking on Male Infertility .................................. 19 Omar Haque, Joseph A. Vitale, Ashok Agarwal, and Stefan S. du Plessis 3 BMI and Obesity ........................................................................... 31 Karishma Khullar, Ashok Agarwal, and Stefan S. du Plessis 4 The Impact of Physical Exercise on Male Fertility .................... 47 Diana Maria Vaamonde Martin, Marzo Edir Da Silva- Grigoletto, Asghar Abbasi, and Juan Manuel García Manso 5 The Importance of Diet, Vitamins, Malnutrition, and Nutrient Defi ciencies in Male Fertility ................................ 61 Landon W. Trost, Ahmet Gudeloglu, Edmund Y. Ko, and Sijo J. Parekattil 6 The Effect of Alcohol Consumption on Male Infertility ............ 8 3 Edson Borges Jr. and Fábio Firmbach Pasqualotto 7 Drugs: Recreational and Performance Enhancing Substance Abuse ............................................................................ 93 Fanuel Lampiao, Taryn Lockey, Collins E. Jana, David Moon Lee, and Stefan S. du Plessis 8 Testicular Heat Stress and Sperm Quality .................................. 105 Damayanthi Durairajanayagam, Rakesh K. Sharma, Stefan S. du Plessis, and Ashok Agarwal 9 Sexual Issues: Role of Sexually Transmitted Infections on Male Factor Fertility.............................................. 127 William B. Smith II, Landon W. Trost, Yihan Chen, Amanda Rosencrans, and Wayne J. G. Hellstrom 10 Psychological Stress and Male Infertility.................................... 141 S. C. Basu ix