Objectives To determine the association between environmental and occupational exposures, semen parameters and lead (Pb) and cadmium (Cd) levels in seminal plasma of men investigated for infertility.Methods Data were collected from 300 men investigated for infertility using an interviewer administered questionnaire. Seminal fluid analysis and classification was done according to WHO guidelines. Positive exposure was defined as environmental or occupational exposure to agro or industrial chemicals, heavy metals and living in areas within 50m of potential sources of pollution for three months or more. Seminal plasma lead and cadmium levels were estimated by graphite furnace atomic absorption spectrophotometry after digestion with nitric acid. The means of sperm parameters, Pb and Cd concentrations between exposed and non exposed groups were compared using t-test.Results Mean age was 34.8 (95% CI 34.2-35.4) years BMI was 24.3 (95% CI 23.8-24.7) kg/m 2 and duration of the infertility was 45.7 (41.7-49.6) months. In this study, 54.6% were exposed to toxins through environmental or occupational sources. All sperm parameters were lower in the exposed group when compared to the non exposed. Lead and cadmium were detected in 38.3% and 23% of men respectively. The distance from the source of possible environmental or occupational exposure was negatively correlated to seminal plasma Pb (r=0.06, p>0.05) and Cd (r=0.26, p<0.05) concentrations. In the exposed, mean IntroductionGlobally, human fecundity appears to be on the decline with decrease in semen quality and male infertility being on the rise [1,2]. Environmental pollutants, occupational exposures and life style factors have been explored as possible contributors [3]. Toxicants affecting the reproductive system are broadly categorised as petroleum products, agrochemicals, industrial chemicals and heavy metals. The effects of exposure to toxicants and male infertility have been reported by many investigators [4]. However the results vary according to the study population, the methods used in the assessment of exposure and the biological end point.Of the heavy metals known to impair semen quality, lead (Pb) and cadmium (Cd) are the two most prevalent Ceylon Medical Journal 2015; 60: 52-6 lead concentration was 17.7 (95% CI 15.0-20.4) µg/dl and 13.5 (95% CI 11.2-15.7) µg/dl in non exposed and cadmium concentration in exposed was 1.2 (95% CI 1.1-1.4) µg/dl and 1.1 (0.9-1.3) µg/dl in non-exposed.Conclusions Environmental and occupational exposures were associated with reduced sperm count motility, viability, normal forms and detectable levels of lead and cadmium in seminal plasma.

Seminal oxidative stress plays an important role in male factor infertility (MFI), worldwide. A study was thus undertaken for the first time to establish seminal reactive oxygen species (ROS) as a clinical marker of MFI in a cohort of Sri Lankan males. The nitro blue tetrazolium (NBT) assay for ROS estimation and modified Endtz test for detecting leucocytes were carried out on semen samples (N = 102) of subfertile males. Age-matched individuals (N = 30) with proven past paternity served as controls. Significantly higher ROS production was evident in individuals with asthenozoospermia and unexplained infertility (Mann-Whitney U-test, P = 0.000), than in the fertile and the other subfertile groups tested. Receiver operating characteristic plot analysis established cut-off points of 40.57 and 42.02 μg formazan/10(7) spermatozoa for ROS to distinguish fertile males from asthenozoospermics (71.4% sensitivity: 70% specificity; AUC = 0.82), and from unexplained infertile males (74.1 % sensitivity: 73.3% specificity; AUC = 0.85) respectively. As ROS appear to be a potential marker of male infertility, it is imperative to validate this test as a simple, cost-effective hence a widely accessible diagnostic tool to be included in MFI investigations in the developing world.

Objective: The study aimed to determine the association between environmental and occupational exposure to toxicants and semen parameters of men investigated for infertility. Methods: Exposure information was obtained using interviewer administered questionnaire with informed consent. WHO guidelines and cut off values were used in analyzing the sperm parameters. The parametric and non-parametric data were analysed using t-test and chisquare test respectively. Mean semen parameters between groups exposed to different toxicants were compared using one way ANOVA. Results: In the study population, 53.9% of men were exposed to toxicants through environmental or occupational sources. Exposures were mainly to petroleum products (30.2%), industrial chemicals (16.9%) and agrochemicals (6.8%).The mean values of sperm concentration, progressive motility, normal forms and viability of subjects exposed to petroleum products were lower compared to non exposed group with significant differences in normal morphological forms [31.1 (18.46)%] vs. [38.1 (17.90)%] (p=0.02) and viability [46.6 (22.26)%] vs. [55.2 (19.50)%] (p=0.02). All the sperm parameters were lower in the exposed group, with a significant difference in sperm morphology [33.5 (17.1)%] vs. [38.1(17.9)%] (p=0.03) and sperm viability [49.3 (19.4)%] vs. [55.2 (19.5)%] (p=0.02) compared to non exposed group. Conclusion: Occupational and environmental exposure to reproductive toxicants is associated with poor semen quality with significant reduction in normal forms and viability of sperm.

Recent clinical and epidemiological studies worldwide suggest an increasing incidence of male factor infertility (MFI). Paucity of information on the biochemical analysis of seminal fluid in Sri Lanka prompted undertaking a pilot study to establish a clinical marker for the male fertility status in Sri Lanka based on the level of the cytokine, macrophage migration inhibitory factor (MIF) in seminal fluid, an area hitherto unexplored locally. The analysis was carried out on the semen samples of infertile males (N = 61) where age matched individuals (N = 30) with proven past paternity served as controls. D-dopachrome tautomerase assay was performed to assess the MIF level in semen while other seminal fluid parameters were assessed according to the standard WHO criteria. The present study revealed an abnormal biphasic profile of MIF in the seminal fluid of individuals with impaired sperm parameters, which was either significantly below or above the range of MIF tautomarase activity typical of normal fertile men (p < 0.000). This is the first report in a Sri Lankan population. The receiver operating characteristic (ROC) plot analysis established a cutoff point of 3.375 µg MIF/mL of semen (at 90 % sensitivity: 81.2 % specificity; 0.923 accuracy) to differentiate fertile from infertile males (excluding azoospermics and severe oligozoospermics). The MIF concentrations significantly correlated with the semen pH in the azoospermic and severe oligozoospermic group. As MIF was clearly indicative of the male fertility status by estimates of sensitivity and specificity of the D-dopachrome tautomerase assay, MIF may be developed as a potential marker of male infertility in Sri Lanka.