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slide1

Why is Infertility Growing in Europe?

Is there a link between different disorders of

male reproductive organs and exposure to

chemical compounds?

Henrik Leffers University Department of Growth & Reproduction, Rigshospitalet, Copenhagen

reproductive health problems
Reproductive health problems
  • Human reproductive health problems are very common, some are increasing
  • The man sitting next to you has probably more than 80% morphologically abnormal sperms (>90 %, if he is a young Dane)
  • High demand for ART: almost 8 % of all Danish children were in 2007 born after IVF, ICSI, homolog or donor insemination
  • In most cases the etiology is really not known, although we use terms as ”oligozoospermia” and ”ovarian failure”
  • Do endocrine disrupters play a role?
gene expression in cis cells in relation to germ cell differentiation
Gene expression in CIS cells in relation to germ cell differentiation

Puberty

Birth

CIS:

Infantile

sp-gonium

ESC

PGC

Gonocyte

Sp-gonium

Spermatocytes

Spermatids

NANOG:

OCT-4:

AP-2

TRA-1-60:

PLAP:

KIT:

p53:

Cyclin D2:

CHK-2 :

TSPY:

MAGE A4:

NY-ESO-1:

DAZL 1:

Hiwi:

VASA:

IMP-1:

Pluripotency, self-renewal, survival in undifferentiated stage

Regulation of cell cycle,

DNA repair (mitotic division)

Germ cell specific

e.g. RNA processing

lessons from recent biological and epidemiological research on testis cancer
Lessons from recent biological and epidemiological research on testis cancer
  • Testis cancer is a sensor for poor reproductive health (incl. cryptorchidism, poor semen quality)
  • Testis cancer is of fetal origin. Therefore, a search for causal factors should be directed towards adverse effects on the fetal testis
  • Increasing incidence of testis cancer. Other male reproductive problems are also becomming more common!
perinatal exposure of rats to phthalates dehp dbp
Perinatal exposure of Rats to Phthalates (DEHP, DBP)

May cause a ”phthalate syndrome” in male offspring, including

  • Leydig cell abnormalities
  • Dysgenesis of Leydig cells and seminiferous tubules
  • Hypospadias
  • Undescended testis
  • Spermatogenic failure and infertility

(Several papers from Paul Foster’s, Earl Gray’s, Rao Veeramachaneni’s and Richard Sharpe’s groups)

phthalate effects on testis
Phthalate Effects on Testis

Dysgenetic areas in the testes on d4 postnatal after in utero exposure to DBP (500 mg/kg/day) Fisher et al. Hum Reprod, 2003)

Control

DBP

Brown = smooth muscle actin

does chemical exposure affect the human fetus
Does Chemical Exposure Affect the Human Fetus?
  • Association between excretion of phthalates in pregnant women’s urine and ano-genital distance in newborn boys, Swan et al. 2005
does chemical exposure affect the fetus
Does Chemical Exposure Affect the Fetus?
  • Association between excretion of phthalates in pregnant women’s urine and ano-genital distance in newborn boys, Swan et al. 2005
  • Association between Phthalate levels in breats milk and subtle changes in hormone levels in 3 month old boys, Main et al. 2006
collection of breast milk
Collection of breast milk
  • Breast milk: post nataly month 1, n=130
  • Serum samples from the children at 3 months, n= 96
changes in boys hormone levels associated with 10 fold higher phthalate levels in the milk
Changes in boys hormone levels associated with 10 fold higher phthalate levels in the milk
  • mEP, mBP:
  • mBP:
  • mMP, mEP, mBP:
  • miNP:

+ 15,+8 % SHBG

- 15% free testosterone

+ 26, +19, +18 % LH /free testosterone ratio

+ 97% LH

Main KM et al. EHP 2006

does chemical exposure affect the fetus17
Does Chemical Exposure Affect the Fetus?
  • Association between excretion of phthalates in pregnant women’s urine and ano-genital distance in newborn boys, Swan et al. 2005
  • Association between Phthalate levels in breats milk and subtle changes in hormone levels in 3 month old boys, Main et al. 2006
  • Persistent pesticides in breast milk and cryptorchidism in the sons, Damgaard et al. 2006
  • Flameretardants in breast milk and chryptorchidism in the sons, Main et al. 2007
ongoing project uptake of phthalates and parabens through skin
Ongoing project: Uptake of phthalates and parabens through skin
  • Comparisons between applications of ”basis lotion” with and without 2% phthalates and 2% parabens
  • Bloodsampling during 24 hours
mono butyl phthalate in serum during 24 hours
Mono-butyl-phthalate in serum during 24 hours

Janjua NR, Mortensen GK, Skakkebæk NE, Wulf HC, Andersson AM, 2008.

slide20

It seems safe to conclude….

  • The phthalates DEP, DBP, and BuP are rapidly taken up through the skin after topical application.
  • Although these compounds have a high clearance rate some accumulation by every day use can occur.
  • Normal use of cosmetics and skin care products containing these compounds is likely to result in recurrent serum spikes of the parent compounds and their metabolites.

Janjua NR, Mortensen GK, Skakkebæk NE, Wulf HC, Andersson AM, 2008.

effects of mixtures of endocrine disrupting substances

Effects of Mixtures of Endocrine Disrupting Substances

Ulla Hass

Dept. of Toxicology and Risk Assessment, National Food Institute, Danish Technical University, Denmark

design of eden studies
Design of EDEN studies

Anti-androgen alone

or in mix

Young adults: Malformations, semen quality, behaviour

Via milk

Via placenta

Birth

Pups: AGD, nipple retention, reproductive organs, gene expression

something from nothing
Something from Nothing

0% + 0% + 0% ~ 60%

Christiansen et al 2008, Int. J. Androl. 31

slide26

Differences in prevalence of genital abnormalities between Denmark and Finland (From Boisen et al. Lancet 2004;Boisen et al. JCEM 205)

Denmark

Finland

geographic association between abnormalities in male reproductive health
Geographic association between abnormalities in male reproductive health
  • Finland
  • Low incidence of testicular cancer
  • Low prevalence of cryptorchidism
  • Low prevalence of hypospadias
  • High sperm counts
  • Bigger testes as newborns and higher inhibin-B levels

Denmark

  • High incidence of testicular cancer
  • High prevalence of cryptorchidism
  • High prevalence of hypospadias
  • Low sperm counts
  • Smaller testes as newborns and lower inhibin-B levels
slide28
Can Different Environmental Exposures between Denmark and Finland explain the Different Reproductive Health Patterns?
  • More Danish women smoke and drink during pregnancy (Jensen et al. Am J Epidemiol. 2004)
  • Associations to different exposures to EDs?
conclusions
Conclusions
  • We are all exposed to a mixture of endocrine disrupters
  • ”Antiandrogenic” agents may be as important as chemicals with estrogenic actions
  • Evidence that testicular cancer, cryptorchidism, hypospadias and poor semen quality can be linked through a fetal mechanism causing testicular dysgenesis (TDS syndrome)
  • We are beginning to see associations between fetal exposures of humans to some endocrine disrupters and symptoms of TDS
  • Causal relationships between EDs and reproductive symptoms have been established in experimental animals, but not in humans
  • Current ED research is focussed on the issue of possible additive effects of mixtures of different chemicals with different actions
thanks to
Thanks to
  • Niels E. Skakkebæk, Niels Jørgensen, Katharina Main, Anna-Maria Andersson, Ewa Rajpert-De Meyts, Anders Juul and several of their Ph.D. students
  • Jorma Toppari, Finland
  • Other European collaborators
  • And many others
slide32

Testicular Dysgenesis Syndrome

Environmental factorsincl. endocrine disrupters

REDUCED SEMEN QUALITY

DISTURBEDSERTOLI CELLFUNCTION

IMPAIREDGERM CELLDIFFEREN-TIATION

TESTICULAR CANCER

CIS

TESTICULAR DYSGENESIS

HYPOSPADIAS

DECREASEDLEYDIG CELLFUNCTION

ANDROGENINSUFFICIENCY

Genetic defectsincl. 45,X/46,XY and point mutations

TESTICULAR MALDESCENT