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Urinary haloacetic acid concentrations and asthenozoospermia risk: a case-control study in China
Long Ge1,2, Min Zhang1,2,3, Yan-Ling Deng1,2,4
1Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
Background:
Disinfection byproducts (DBPs), particularly haloacetic acids (HAAs), exhibit male reproductive toxicity. However, their associations with asthenozoospermia remain unclear.
Objective:
To investigate associations of urinary trichloroacetic acid (TCAA) and dichloroacetic acid (DCAA), the predominant HAAs, with asthenozoospermia risk, and further to evaluate their joint effects.
Methods:
An age-matched case-control study (135 asthenozoospermia cases and 270 controls) nested within the TREE cohort was conducted. Repeated measurements of urinary HAAs were utilized to improve exposure assessment. Associations were assessed using conditional logistic regression, and additive and multiplicative interactions analyses.
Results:
Higher levels of urinary DCAA and TCAA were associated with an increased risk of asthenozoospermia (OR = 2.05; 95% CI: 1.10, 3.83; P for trend = 0.04 and OR = 2.13; 95% CI: 1.11, 4.09; P for trend = 0.05 for the highest vs. lowest quartiles of urinary DCAA and TCAA, respectively). Co-exposure to high levels of both DCAA and TCAA had a 2.62-fold (95% CI: 1.48, 4.69) higher risk of asthenozoospermia relative to low both such exposures, with evidence of multiplicative (P = 0.01) and additive interactions (RERI = 1.98, 95% CI: 0.61, 4.40; AP = 0.76, 95% CI: 0.29, 1.04).
Significance:
Exposures to TCAA and DCAA are individually associated with increased risk of asthenozoospermia, and co-exposure to such two compounds suggest an additive effect. These findings highlight the importance of assessing joint effects of two HAA biomarkers on male reproduction.
Impact:
DBPs are the ubiquitous contaminants formed during drinking water treatment, and human exposure is unavoidable. This age-matched case-control study among men undergoing ART treatment provides novel human evidence that exposures to DCAA and TCAA are individually associated with increased risk of asthenozoospermia, a major contributor to male infertility. Co-exposure to DCAA and TCAA is associated with an additive increase in the risk of asthenozoospermia. These findings emphasize the need to reduce HAA levels in drinking water and also offer important clues for clinical decision-making and public health strategies.
