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Wednesday, June 15, 2011

Gynecology research takes the measure of a man's fertility

Gynecology research takes the measure of a man's fertility

By: W. Gifford-Jones MD

How would you react if your doctor said, "Remove your pants and bend over," then picked up a ruler and measured the distance from the middle of the anus to the base of the scrotum, the anal-genital distance (AGD)? You might decide this doctor is wacky, and quickly find another physician.

Dr. Shanna Swan, professor of obstetrics and gynecology at the University of Rochester, New York, reports an unusual finding in the journal Environmental Health Perspectives. Swan and her colleagues discovered pregnant rats exposed to phthalates, commonly used chemicals suspected of having adverse effects on hormones, produced infertile offspring.

But Swan obviously has a fertile brain. She also noticed the baby rats had a decreased anal-genital distance. It's not a measurement researchers would normally think worthy of study.

But what about human males? Swan's team measured 126 males, most 19 years old. Her study found an average anal-genital distance of 52 millimeters. Men with a shorter AGD were seven times more likely to be sub-fertile with decreased sperm counts, less active sperm, low sperm concentration and an increased number of abnormal sperm. This is not a good recipe for parenthood.

Swan made another surprising finding: nearly one-quarter of these young men had low sperm counts!

What does this discovery mean? Dr. Swan did not inquire whether the mothers of the young men had been exposed to phthalates, nor did she test the volunteers' hormone levels. But her result suggests decreased AGD indicates a lower exposure to testosterone in the womb that may affect full development of the male genital tract. It may also be due to environmental toxins or other unknown factors.

Dr. Sheela Sathyanaryay, assistant professor of pediatrics at the University of Washington, says, "We don't have good ways to predict male fertility unless there are major abnormalities." The AGD simply adds another way to gauge male fertility.

It does give pause for thought for those contemplating marriage. Many couples want to ensure they're in good health before marriage. This usually means each partner agrees to be checked for sexually transmitted disease and other problems.

Most contemplating marriage also want children. This research poses a delicate question. How much will it take for her to say, "Make sure the doctor measures your anal-genital length." She may as well add other requests: "Darling, make sure the doctor checks the length of your legs, your waist circumference and remind him to examine the ear lobe crease."

Dr. Kate Tilling measured the leg length of 12,252 men aged 44 to 65 years of age. Tilling discovered that people with longer legs had less buildup of cholesterol deposits in coronary arteries and those supplying the brain. This increased blood supply decreased the risk of heart attack and stroke.

Dr. Jean-Pierre Despres, professor of human nutrition at Laval University in Quebec City, reports that men with a waistline of over 100 centimeters have an increased risk of heart disease. This fat produces cytokines causing inflammation of blood vessels and increased risk of coronary attack.

In another report, Dr. William Elliott at the University of Chicago examined 1,000 patients suffering from coronary heart disease. He discovered that an easily seen ear lobe crease was associated with increased risk of heart attack. The crease starts where the ear lobe attaches to the head and angles back towards the lower edge of the ear.

Thus, the message for women contemplating marriage is simple. Measurements can make a huge difference in fertility and other medical matters.

That's the long and short of it.

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