Massachusetts General Hospital Fertility Center Research Articles

Antioxidants intake and semen quality in men attending a fertility clinic

To evaluate whether the intake of the antioxidant vitamins A, C and E and carotenoids is associated with semen quality parameters in a population of men seeking fertility evaluation. Cross-sectional study. Male partners of couples attending the Massachusetts General Hospital Fertility Center were invited to participate in the study. Intakes of vitamins A, C and E and carotenoids were assessed using a previously validated food frequency questionnaire. Semen quality was assessed manually and by computer-aided semen analysis. 99 men with complete semen analysis and diet data were included in the analysis. Linear regression was used to analyze the association of each micronutrient with semen quality parameters adjusting for total energy intake, age, race/ethnicity, body mass index, smoking, intakes of alcohol and caffeine, abstinence time and previous infertility exam. Age was positively associated with higher intakes of vitamins A, C, E and carotenoids. Men with previous infertility exams were more likely to use vitamin A supplements. Vitamin A intake was significantly associated with lower sperm motility and morphology (P=0.01, 0.005 respectively) and moderately associated with lower sperm concentration (P=0.06).These associations were driven by intake of supplements. Vitamin A intake from foods sources alone was unrelated to semen quality. Men in the highest quartile of alpha carotene intake had 2% (-3.7%, -0.4%) fewer morphologically normal spermatozoa than those in the lowest quartile (p-trend = 0.02).There was no association between vitamin C and E with semen quality. Dietary intakes of vitamins A, C and E were unrelated to semen quality parameters. There is a suggestive association between alpha carotene intake and inferior sperm morphology.

Trans–fatty acid levels in sperm are associated with sperm concentration among men from an infertility clinic

We measured the sperm fatty acid composition using gas chromatography in anonymized semen samples of 33 men undergoing infertility evaluation at an academic medical center. Trans-fatty acids were present in human sperm and were related inversely to sperm concentration (r = -0.44).

Dietary fats and semen quality among men attending a fertility clinic

OBJECTIVE: To investigate the relation between dietary fats and semen quality parameters. DESIGN: Cross-sectional study. MATERIALS AND METHODS: Men attending the Massachusetts General Hospital Fertility Center were invited to participate in the study. Semen quality was analyzed manually and by computer-aided semen analysis. Intakes of fat and major fatty acid groups were assessed with a previously validated food frequency questionnaire. Data from 91 men with complete dietary and semen quality data were analyzed. Fatty acid levels in sperm and seminal plasma were measured using gas chromatography in a subgroup of men (n=21). Linear regression was used to determine the association between fat intake and semen quality parameters while adjusting for total energy intake, age, abstinence time, BMI, smoking status and intakes of caffeine and alcohol. RESULTS: Total fat intake was inversely related to sperm concentration (p, trend = 0.03). This association was driven by intakes of saturated and monounsaturated fats. Men in the highest third of saturated fat intake had 41% (11% - 61%) fewer sperm than men in the lowest third (p, trend = 0.02). Likewise, men in the highest third of monounsaturated fat intake had 46% (20% - 63%) fewer sperm than men in the lowest third (p, trend = 0.003). Levels of saturated fatty acids in sperm were also inversely related to sperm concentration (r = -0.53) but saturated fat intake was unrelated to sperm levels (r = 0.03). In addition, higher intake of omega-6 polyunsaturated fats was associated with greater sperm motility (p, trend= 0.02) and higher intake of omega-3 polyunsaturated fats was related to more favorable sperm morphology (p, trend= 0.04). CONCLUSION: Intake of saturated and monounsaturated fats are inversely related to sperm concentration whereas intake of polyunsaturated fatty acids is positively related to sperm motility and morphology.

Urinary bisphenol A concentrations and ovarian response among women undergoing IVF

Bisphenol A (BPA) is a synthetic chemical used in the manufacture of materials present in many common consumer products. In experimental animals, BPA caused oocyte aneuploidy and reduced production of oestradiol. In a prospective cohort study, we investigated the association between urinary BPA concentrations and ovarian response among women undergoing in vitro fertilization (IVF) at the Massachusetts General Hospital (MGH) Fertility Center. The geometric mean of two specific-gravity (SG) adjusted urinary BPA concentrations collected during each IVF cycle was used as the cycle-specific BPA exposure level. BPA concentrations were measured using online solid phase extraction coupled to isotope dilution-high-performance liquid chromatography-tandem mass spectrometry. Peak serum oestradiol was measured using the Elecsys Estradiol II immunoassay kit. Multivariable mixed effect models and Poisson regression models adjusting for correlation between multiple IVF cycles in the same woman were used to evaluate the association between urinary BPA concentrations and ovarian response, adjusting for age, BMI and day 3 follicle stimulating hormone (FSH) levels, a clinical measure of ovarian reserve. Urinary BPA concentrations were measured in 84 women (mean age 35.6 years) undergoing 112 IVF cycles; 23 women (27%) contributed more than one IVF cycle. BPA concentrations ranged from <0.4 to 25.5 microg/L (geometric mean 2.52 +/- SD 3.2); 15% of urine samples had concentrations <0.4 microg/L. Peak serum oestradiol levels correlated with the total number of oocytes retrieved per cycle (r = 0.65, p < 0.001). For each log unit increase in SG-BPA, there was an average decrease of 12% (95% CI: 4, 23%; p = 0.007) in the number of oocytes retrieved and an average decrease of 213 pg/ml (95% CI: -407, -20; p = 0.03) in peak oestradiol. BPA was detected in the urine of the majority of women undergoing IVF, and was inversely associated with number of oocytes retrieved and peak oestradiol levels.

Urinary Bisphenol A concentrations and human semen quality

OBJECTIVE: Bisphenol A is used to manufacture polymeric materials and can be found in a wide variety of consumer products. These include polycarbonate plastic baby and water bottles, epoxy resins which may be used as the lacquer lining of food and beverage cans and some dental sealants and composites. Recent data from the CDC found BPA in 93% of urine samples from a reference population of U.S. citizens (NHANES 2003-2004). Because of demonstrated widespread human exposure and reproductive and developmental effects at low levels in experimental animals, there has been an increase in concern over potential adverse effects of BPA on human health. Rodent studies have shown an association between exposure to environmentally relevant low doses of BPA and decreased semen quality. In these animal studies, daily sperm production and sperm count decreased by up to 40%. Sperm motility decreased and abnormal spermatids increased. DESIGN: A prospective cohort study. MATERIALS AND METHODS: The study population included 71 male partners of couples from the Massachusetts General Hospital Fertility Center. Each man provided at least one semen and urine sample; thity nine men (55%) provided more than one urine and semen sample. Ninety-six percent of the urine samples were collected within 7 days of the semen sample, with only six urine samples collected within 8 or more days (maximum was 27 days) of the semen sample. RESULTS: The mean total urinary BPA level for the 142 urine samples was 2.41mg/L (range <0.4 (below LOD) – 18.70 mg/L). Analysis of the association of urinary BPA with semen parameters (sperm concentration, motility and morphology) is in progress. The semen parameters will be analyzed as both a continuous variable and dichotomized using WHO reference values for sperm concentration (<20million/mL) and motility (<50% motile) and Strict criteria for morphology (<4% normal).As expected, there was high intra-individual variability of both urinary BPA concentrations and semen parameters. In preliminary analyses, there were not strong associations of BPA with semen quality parameters. CONCLUSIONS: The lack of an association of urinary BPA concentrations with semen parameters should be interpreted cautiously due to the small sample size. Future statistical analyses will include additional men.

Soy food and isoflavone intake in relation to semen quality parameters among men from an infertility clinic

High isoflavone intake has been related to decreased fertility in animal studies, but data in humans are scarce. Thus, we examined the association of soy foods and isoflavones intake with semen quality parameters. The intake of 15 soy-based foods in the previous 3 months was assessed for 99 male partners of subfertile couples who presented for semen analyses to the Massachusetts General Hospital Fertility Center. Linear and quantile regression were used to determine the association of soy foods and isoflavones intake with semen quality parameters while adjusting for personal characteristics. There was an inverse association between soy food intake and sperm concentration that remained significant after accounting for age, abstinence time, body mass index, caffeine and alcohol intake and smoking. In the multivariate-adjusted analyses, men in the highest category of soy food intake had 41 million sperm/ml less than men who did not consume soy foods (95% confidence interval = -74, -8; P, trend = 0.02). Results for individual soy isoflavones were similar to the results for soy foods and were strongest for glycitein, but did not reach statistical significance. The inverse relation between soy food intake and sperm concentration was more pronounced in the high end of the distribution (90th and 75th percentile) and among overweight or obese men. Soy food and soy isoflavone intake were unrelated to sperm motility, sperm morphology or ejaculate volume. These data suggest that higher intake of soy foods and soy isoflavones is associated with lower sperm concentration.

Single-blastocyst transfer decreases twin gestation without affecting pregnancy outcome

To compare the respective pregnancy outcomes of cycles undergoing fresh elective single-blastocyst transfer (eSBT) and double-blastocyst transfer (DBT) after IVF. Retrospective medical record review. Academic medical center. Couples undergoing fresh blastocyst transfer after IVF. One thousand, four hundred, ninety-nine consecutive IVF cycles from January 1, 2002 through March 31, 2006 at the Massachusetts General Hospital Fertility Center were reviewed. Patients undergoing fresh blastocyst transfer (eSBT, n = 52; DBT, n = 187) were identified. Respective pregnancy outcomes and the trend in twin gestations in all cycles undergoing blastocyst transfer, before and after the introduction of the eSBT program. Statistically similar rates of biochemical pregnancy (76.9% vs. 77.6%), clinical pregnancy (61% vs. 63.4%), live birth (53.8% vs. 54.4%), and pregnancy loss (20% vs. 18.6%) per embryo transfer were observed for fresh eSBT and DBT cycles, respectively. Twin rates for eSBT were statistically significantly lower than for DBT cycles (3.1% vs. 51%). Fresh eSBT and DBT cryopreserved 2.8 vs. 1.7 blastocysts per cycle, respectively. Twenty-four months after the start of eSBT, the twin rate per transfer for all cycles undergoing blastocyst transfer (1, 2, or 3 blastocysts) was statistically significantly reduced from 47.2% to 22.9%, whereas the twin rate per transfer for all embryo transfers in women younger than 35 years of age was statistically significantly reduced from 28.8% to 15.6%. Given the promising potential of eSBT to markedly reduce the risk of twin gestation without a significant compromise to pregnancy outcomes, an active attempt should be made to consider and use eSBT in the young, favorable-prognosis patient who has good-quality embryos available for transfer and cryopreservation.