1 A AJAYI B AFOLABI V AJAYI I
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A. AJAYI, B. AFOLABI, V. AJAYI, I. OYETUNJI, O. BIOBAKU, S. ARATI, O. SAANU Presented at AFRH 2017 ABUJA, NIGERIA By DR. VICTOR AJAYI NORDICA FERTILITY CENTRE, LAGOS, NIGERIA SYNERGISTIC EFFECT OF PATERNAL AGE AND BMI ON SEMEN QUALITY AND QUANTITY IN A SUB-SAHARAN BLACK AFRICAN POPULATION.
SYNOPSIS �Introduction �Objective �Methods and Material �Results �Discussion �Conclusion �References
Introduction � 30 -50% of infertility is related to the male. �This is a significant contribution to infertility �There have been reports especially in the female on age and BMI and infertility. �Fathering children at an advanced age of over 50 years is not rare among black African men
Introduction �Men may gain weight as they age with increasing sedentary lifestyles and probably affluence. �Not much has been reported especially in black Africans on the possible synergistic effect of age and BMI on semen parameters.
Introduction � In a study published in the journal Fertility and Sterility, researchers interviewed nearly 2, 000 women to find out how long it took them to conceive. Among women 35 years and older, those whose male partners were 45 years and older took five times longer to conceive than those whose partners were 25 years and younger.
Objective �To investigate the influence of the synergy of Age and BMI on semen parameters of black African men consulting for Assisted Reproduction in Nigeria on account of infertility.
Methods and Materials �A descriptive, analytic and cross-sectional study. �Conducted at Nordica Fertility Centre, Lagos Nigeria between Jan 2010 and Dec 2015 � 907 men who presented on account of infertility were included in the study
Methods and Materials �Their ages in years were categorised into <45 and ≥ 45 and BMI (kg/m 2) into underweight (<18. 5), Normal (18. 5 -24. 9), overweight (2529. 9) obese (≥ 30) �Semen was collected by masturbation and analysed within 30 minutes of production according to WHO Guidelines (2010). �Statistical analysis was done using STATA 13 and level of significance was set at P ≤ 0. 05
Results �The mean (± SD) of age, BMI and Sperm concentration (106/ml) were 42. 67 (7. 11), 27. 05 (3. 63) and 22. 26 (23. 08) respectively. � 76% never used cigarettes/tobacco smoking �The semen volume (ml) of men aged <45 years (2. 28 ± 1. 40) was significantly higher than (t = 3. 37; P value = 0. 0004) that of men ≥ 45 years (2. 05 ± 1. 58). �The mean pus cells was significantly higher in older men (1. 54) than in younger (1. 35) men (t =2. 88, P = 0. 002)
Table 1. Anthropometric characteristics and some features of seminal fluid analysis of 907 sub-fertile Nigerian men Variable Anthropometry Quantitative aspect Features Category Age BMI Volume (ml. ) of ejaculate Sperm concentration x 10 6 Liquefaction time (min. ) Progressive motility Viscosity Qualitative aspect MPM Others Pus cells Normal Moderate High None Poor Fair Good 0 1 -2 ≥ 3 Mean 42. 67 27. 05 2. 26 22. 26 30. 78 38. 18 Frequency 881 9 17 34 181 512 180 1 840 66 Std. Dev 7. 11 3. 63 1. 47 23. 08 8. 50 21. 51 % 97. 1 1. 0 1. 9 3. 7 20. 0 56. 5 19. 8 0. 1 92. 6 7. 3 . Range 23 -73 18. 3 -48. 7 0. 1 -16. 0 01 -120 20 -95 0 -90
Results �Compared to normal weight men: mean semen volume (t=-1. 59, P-value=0. 05), liquefaction time (t=-1. 78, P-value=0. 04), sperm concentration (t=-2. 02, P-value=0. 02) progressive motility (t=-2. 95, P-value=0. 002) were significantly lower in obese men �BMI played a role in all the above
Results �Compared to their younger counterparts, mean semen volume was significantly lower in normal weight (t=2. 00, P-value=0. 02), overweight (t=2. 31, P-value=0. 01) and obese (t=1. 57, P-value=0. 05) Older men �Regardless of weight, age played a significant role in reduced semen volume/lower in older men
Results �Mean liquefaction time was significantly longer (t=-1. 60, P-value=0. 05) in older men. �Mean pus cell quantity was significantly higher (t=-2. 16, P-value=0. 02) in older than younger obese men.
Results �Overweight men aged ≥ 45 years were approximately 2½ times more likely to produce semen <1. 5 ml, were 1. 06 times more likely to produce sperm concentration <15 x 106/ml and 1. 08 times more likely to have progressive motility <32%. Than overweight men < 45 years old.
Results Figure 1. Synegistic effect of age and BMI on sperm progressive motility 43 Percent progressive motility 41 39 37 35 33 31 BMI 18. 5 -24. 9 BMI 25. 0 -29. 9 Age <45 Age 45+ BMI 30+
Results Figure 2. Synegistic effect of age and BMI on sperm concentration 25 Mean sperm concentration 20 15 10 5 0 BMI 18. 5 -24. 9 BMI 25. 0 -29. 9 Age <45 Age 45+ BMI 30+
Results �Multivariate regression analysis (Table 5) showed that, synergistically, age and BMI gave stronger explanation of the differences observed in semen volume (R 2=0. 0223, F=10. 31, P-value=0. 000001) and in progressive motility (R 2=0. 0140, F=6. 43, Pvalue=0. 0017) than either age alone (R 2=0. 0216, F=20. 03, Pvalue=0. 0001; R 2=0. 0016, F=1. 46, P-value=0. 228 respectively) or BMI alone (R 2=0. 0025, F=2. 231, P-value=0. 136; R 2=0. 0125, F=11. 460, P-value=0. 001).
Results �In the synergy between age and BMI, �Age provided a stronger correlation with semen volume than BMI (coef. = -0. 030, t=4. 45, P-value=0. 00001) �While BMI provided a stronger correlation with sperm concentration (coef. = -0. 411, t=1. 98, P-value=0. 048) and with progressive motility (coef. = -0. 668, t=-3. 47, Pvalue=0. 00001) than age.
Table 2. Multivariate regression analysis with seminal fluid volume (ml. ), sperm concentration (x 106) and progressive motility as dependent variable and age, BMI and synergistic age/BMI as independent variables. Equation Ob s. Volume Sperm concentration Motility 907 0. 0216 Age Fstatistic s 20. 03 0. 0002 0. 16 0. 000 1 0. 690 0. 0016 1. 46 0. 228 R 2 BMI FP-value statistics R 2 Age and BMI FP-value statistics Pvalue R 2 0. 0025 2. 231 0. 136 0. 0223 10. 31 0. 0050 4. 514 0. 034 0. 0051 2. 31 0. 00000 1 0. 100 0. 0125 11. 460 0. 001 0. 0140 6. 43 0. 0017
Table 3. Correlation coefficients between age, BMI, synergistic age/BMI and volume, sperm concentration and progressive motility. Variables Dependent Volume Sperm concentration Progressive motility Coef. SE t P-value 95% CI -0. 031 -0. 043 -0. 121 -0. 021 -0. 447 -0. 662 -0. 029 -0. 019 -0. 035 -0. 446 -0. 118 -0. 657 0. 007 0. 100 0. 013 0. 210 0. 195 0. 007 0. 013 0. 108 0. 211 0. 100 0. 195 -4. 48 -0. 40 -1. 21 -1. 49 -2. 12 -3. 39 -4. 28 -1. 43 -0. 32 -2. 12 -1. 18 -3. 36 0. 0001 0. 690 0. 228 0. 136 0. 034 0. 001 0. 00001 0. 153 0. 746 0. 034 0. 239 0. 001 -0. 04, -0. 02 -0. 25, 0. 17 -0. 32, 0. 07 -0. 05, 0. 01 -0. 86, -0. 03 -1. 04, -0. 28 -0. 04, -0. 02 -0. 05, 0. 01 -0. 25, 0. 17 -0. 86, -0. 03 -0. 31, 0. 08 -1. 04, -0. 27 Independent Age BMI
Discussion �Mean semen volume of men aged 45 years and above was significantly reduced than those aged below 45 years. �Seminal vesicle inadequacy or prostate atrophy have been suggested as causes �Different authors have reported similar findings in studies conducted in other parts of the world.
Discussion �Mean semen volume of obese men was significantly lower than that of normal weight men. �The means of semen volume of normal weight men, overweight men and obese men of age 45 years and above were also significantly lower than that of their younger counterparts �Indicating that age is more significant than BMI in the production of lower semen volume. �This finding contradicts what other studies have reported.
Discussion �However, our findings that overweight and obese infertile men produced lower volume of semen when compared to normal weight infertile men agrees with the findings reported in other studies.
Discussion. �Liquefaction time was longer in older than in younger overweight patient �The observed longer duration of liquefaction time in older overweight men might be a factor for male subfertility, especially in overweight people aged 45 years and above
Discussion � Compared to their younger counterparts, normal weight, overweight and obese men aged 45 years and above were 1. 58, 2. 49 and 1. 47 more likely to produce seminal fluid <1. 5 ml. �Seemed to be driven by overweight men aged 45 years and older
Discussion. �Many studies have reported on either age or . BMI as a risk factor in the production of low sperm concentration alone rather than both as we did in this study.
Discussion �In our study we found that, in some cases, age plays a primary role while BMI plays a secondary role �At other circumstances, it is BMI that plays the major while age plays a minor role
Discussion �In the final analysis, there were ample statistical proofs in this study that the synergy of age and BMI were more influential in the variability of semen volume produced and in sperm cell progressive motility,
Conclusion �Age and BMI, as separate units and in synergy are associated with some undesirable effects on sperm quality and quantity. �In this synergy, age, more than BMI, plays a leading role in the reduction observed in volume of semen, �Age and BMI function in tandem in the reduction observed in sperm concentration �BMI more than age plays the primary role in reduced motility
Recommendations �More studies in larger clinic setting and in the general population. �Further studies in other sub-Sahara African countries are encouraged.
Limitations �Facility/Clinic based so generalisation is limited �Retrospective and confounders could not all be addressed like alcohol use, use of herbal concoctions, exact occupations etc �Information from patients may be unreliable for example days of abstinence and the effect of this on semen volume �Not enough underweight men
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