Available online 28 March 2024, 102782

Author links open overlay panel, , , , , AbstractBackground

Infertility has been defined as a failure to conceive for at least 12 months of regular unprotected sexual intercourse. The male factors are responsible for about 50% of cases. Various factors such as endocrine, immunological, genetic, exposure to toxicants, and idiopathic factors are involved in male infertility. Recently, the role of PTEs in reproductive performance has been explored by various studies.

Objectives

Current systematic review and meta-analysis have been carried out to compile and statistically analyze the findings of relevant studies and reach some conclusion.

Methodology

A literature search was done according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines in three scientific literature databases; PubMed, Google Scholar, and Science Direct. Meta-analysis was performed using Review Manager 5.4 software. The study's protocol was registered in PROSPERO (CRD42023465776).

Results

Meta-analysis of lead in the blood of infertile cases and healthy controls indicated a significant association with male infertility, observed standard mean difference (SMD) was 0.67 at 95% confidence interval (CI) (0.07, 1.28), and p = 0.03. In the case of lead analysis in semen, the values are as follows: SMD = 1.19 at 95% CI (0.42, 1.96) with p = 0.002. Significant association appears for cadmium in semen with SMD 0.92 at 95% CI (0.54, 1.29) and p < 0.00001. No significant association was observed for arsenic, barium, and mercury in blood.

Conclusion

Most of the studies focus on the detection of PTE in semen samples followed by blood as sample type. Lead and cadmium exposure is significantly associated with male infertility. However, non-significant results for arsenic, barium, and mercury are observed.

Section snippetsBackground

Infertility has been defined as a failure to conceive after 12 months or more of regular unprotected sexual intercourse [1]. Couples might be unable to achieve any pregnancy, known as primary pregnancy, or may be unable to conceive after a previous successful pregnancy, known as secondary pregnancy. As per the World Health Organization (WHO) estimation around 80 million couples worldwide suffer from infertility; the prevalence of which varies across various regions of the world [2], half of

Literature search strategy

This systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines as represented in Supplementary Table 1 (Prospero registration number: CRD42023465776). A literature search was done using three scientific literature databases; PubMed, Google Scholar, and Science Direct. The last search was updated on 5th October, 2023. Following keywords, alone or in combination, were used to identify studies: ("PTEs"

Characteristics of selected studies

In this systematic review and meta-analysis, we summarized various epidemiological studies investigating the role of exposure to PTEs and male infertility. A total of 1550 research papers were found after PubMed, Google Scholar, and Science Direct search. The majority of studies were drawn from different regions of Europe and Asia. A total of 20 eligible studies were included for analysis of PTEs exposure (Table 1). Out of 20 eligible studies describing different PTEs (lead, cadmium, arsenic,

Discussion

Environmental exposure and genetic susceptibility, both are crucial factors in determining the etiology of male infertility. Common methods to detect elements include atomic absorption spectrometry (AAS), inductively coupled plasma mass spectrometry (ICP-MS), and inductively coupled plasma emission spectrum analysis (ICP-AES) [39]. The results from the meta-analysis showed that levels of lead and cadmium are significantly higher in cases in comparison to controls. The high content of lead and

Conclusion

Lead and cadmium exposure is significantly associated with male infertility. However, non-significant results for arsenic, barium, and mercury is observed. The majority of the investigating studies had focused on semen samples for the detection of PTE followed by blood sample types.

Funding

This project is funded by Indian Council for Medical Research (ICMR), New Delhi, proposal ID: 2020-9200.

Author contribution

RK and PK conceived and designed the analysis; MK, AG, and KC collected the data; MK, AG and HK performed the initial analysis and wrote the first draft; RK, HK, and PK checked and finalized the final draft. Each author has read and approved the manuscript.

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Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon request.

Acknowledgements

We are sincerely thankful to the Computer Department of Central University of Punjab, Bathinda and Punjabi University, Patiala for providing internet facility.

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