STUDY QUESTION Does male alcohol consumption affect fecundability? SUMMARY ANSWER In data pooled across Danish and North American preconception cohort studies, we found little evidence of an association between male alcohol consumption and reduced fecundability. WHAT IS KNOWN ALREADY Experimental and clinical studies have shown that alcohol affects male reproductive physiology, mainly by altering male reproductive hormones and spermatogenesis. However, few epidemiologic studies have examined the association between alcohol consumption and male fertility. STUDY DESIGN, SIZE, DURATION Data were collected from two ongoing prospective preconception cohort studies: the Danish ‘SnartForaeldre’ (SF) study (662 couples) and the North American ‘Pregnancy Study Online’ (PRESTO) (2017 couples). Participants included in the current analysis were enrolled from August 2011 through June 2019 (SF) and from June 2013 through June 2019 (PRESTO). PARTICIPANTS/MATERIALS, SETTING, METHODS Eligible men were aged ≥18 years in SF and ≥21 years in PRESTO, in a stable relationship with a female partner and not using contraception or receiving fertility treatment. In both cohorts, alcohol consumption/serving size was self-reported as number of beers (330 mL/12 oz.), glasses of white or red wine (120 mL/4 oz. each), dessert wine (50 mL/2 oz.) and spirits (20 mL/1.5 oz.). Overall alcohol consumption was categorized as none, 1–5, 6–13 and ≥14 standard servings per week. Total menstrual cycles at risk were calculated using data from female partners’ follow-up questionnaires, which were completed every 8 weeks until self-reported pregnancy or 12 menstrual cycles, whichever came first. Analyses were restricted to couples that had been trying to conceive for ≤6 cycles at study entry. Proportional probability regression models were used to compute fecundability ratios (FRs) and 95% confidence interval (CIs). We adjusted for male and female age, female partner’s alcohol consumption, intercourse frequency, previous history of fathering a child, race/ethnicity, education, BMI, smoking and consumption of sugar-sweetened beverages and caffeine. MAIN RESULTS AND THE ROLE OF CHANCE The cumulative proportion of couples who conceived during 12 cycles of follow-up were 1727 (64.5%). The median (interquartile range) of total male alcohol consumption was 4.5 (2.0–7.8) and 4.1 (1.0–8.6) standard servings per week in the SF and PRESTO cohorts, respectively. In pooled analyses, adjusted FRs for male alcohol consumption of 1–5, 6–13 and ≥14 standard servings per week compared with no alcohol consumption were 1.02 (95% CI: 0.90–1.17), 1.10 (95% CI: 0.96–1.27) and 0.98 (95% CI: 0.81–1.18), respectively. For SF, adjusted FRs of 1–5, 6–13 and ≥14 standard servings per week compared with no alcohol consumption were 0.97 (95% CI: 0.73–1.28), 0.81 (95% CI: 0.60–1.10) and 0.82 (95% CI: 0.51–1.30), respectively. For PRESTO, adjusted FRs of 1–5, 6–13 and ≥14 standard servings per week compared with no alcohol consumption were 1.02 (95% CI: 0.88–1.18), 1.20 (95% CI: 1.03–1.40) and 1.03 (95% CI: 0.84–1.26), respectively. LIMITATIONS, REASONS FOR CAUTION Male alcohol consumption was ascertained at baseline only, and we did not distinguish between regular and binge drinking. In addition, we had insufficient numbers to study the effects of specific types of alcoholic beverages. As always, residual confounding by unmeasured factors, such as dietary factors and mental health, cannot be ruled out. Comorbidities thought to play a role in the reproductive setting (i.e. cancer, metabolic syndrome) were not considered in this study; however, the prevalence of cancer and diabetes was low in this age group. Findings for the highest categories of alcohol consumption (6–13 and ≥14 servings/week) were not consistent across the two cohorts. WIDER IMPLICATIONS OF THE FINDINGS Despite little evidence of an association between male alcohol consumption and reduced fecundability in the pooled analysis, data from the Danish cohort might indicate a weak association between reduced fecundability and consumption of six or more servings per week. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the National Institutes of Health (R01-HD060680, R01-HD086742, R21-HD050264, R21-HD072326, R03-HD090315), the Novo Nordisk Foundation, Oticon Fonden, Politimester J.P.N. Colind og hustru Asmine Colinds mindelegat and Erna og Peter Houtveds studielegat. PRESTO receives in-kind donations from FertilityFriend.com, Kindara.com, Swiss Precision Diagnostics and Sandstone Diagnostics for the collection of data pertaining to fertility. Dr Wise serves as a consultant on uterine leiomyomata for AbbVie.com. All other authors declare no conflict of interest.
Background Lung protective ventilation with low tidal volume (TV) and increased positive end-expiratory pressure (PEEP) can have unfavorable effects on the cardiovascular system. We aimed to investigate whether lung protective ventilation has adverse impact on hemodynamic, renal and hormonal variables. Methods In this randomized, single-blinded, placebo-controlled study, 24 patients scheduled for robot-assisted radical prostatectomy were included. Patients were equally randomized to receive either ventilation with a TV of 6 ml/IBW and PEEP of 10 cm H2O (LTV-h.PEEP) or ventilation with a TV of 10 ml/IBW and PEEP of 4 cm H2O (HTV-l.PEEP). Before, during and after surgery, hemodynamic variables were measured, and blood and urine samples were collected. Blood samples were analyzed for plasma concentrations of electrolytes and vasoactive hormones. Urine samples were analyzed for excretions of electrolytes and markers of nephrotoxicity. Results Comparable variables were found among the two groups, except for significantly higher postoperative levels of plasma brain natriuretic peptide (p = 0.033), albumin excretion (p = 0.012) and excretion of epithelial sodium channel (p = 0.045) in the LTV-h.PEEP ventilation group compared to the HTV-l.PEEP ventilation group. In the combined cohort, we found a significant decrease in creatinine clearance (112.0 [83.4;126.7] ml/min at baseline vs. 45.1 [25.4;84.3] ml/min during surgery) and a significant increase in plasma concentrations of renin, angiotensin II, and aldosterone. Conclusion Lung protective ventilation was associated with minor adverse hemodynamic and renal effects postoperatively. All patients showed a substantial but transient reduction in renal function accompanied by activation of the renin-angiotensin-aldosterone system. Trial registration ClinicalTrials, NCT02551341. Registered 13 September 2015.
We aimed to investigate live birth rate (LBR), cumulative live birth rate (CLBR) for consecutive fresh and frozen-thawed in vitro fertilization (IVF) cycles, and CLBR after an entire IVF programme involving multiple ovarian stimulations using blastocyst transfer only. Study design: From January 1 st 2014 to December 31 st 2018, we included women aged 18-45 years who initiated IVF or intracytoplasmic sperm injection at Aagaard Fertility Clinic, Denmark. The primary outcome was live birth, and secondary outcomes were a positive hCG blood test and ongoing pregnancy confirmed by ultrasonography. All proportions were estimated for initiated and transferred cycles with 95 % confidence intervals (CI). We used a conservative strategy, assuming that none of the women who did not return for further treatments had a live birth. Results: 871 women contributed 2236 initiated/1670 transferred fresh and/or frozen-thawed cycles. LBRs for first fresh cycles were 22.8 % (95 %-CI: 19.8À26.0) and 35.7 % (95 %-CI: 31.4À40.2) for initiated and transferred cycles, respectively. LBRs for first frozen-thawed cycles were 30.6 % (95 %-CI: 26.4À35.1) and 31.7 % (95 %-CI: 27.4À36.3) for initiated and transferred cycles, respectively. CLBRs for consecutive cycles were 18.2 % (95 %-CI: 16.2À20.3) for fresh initiated cycles, 29.7 % (95 %-CI: 26.6À32.9) for fresh transferred cycles, 25.5 % (95 %-CI: 22.6À28.5) for frozen-thawed initiated cycles, and 26.4 % (95 %-CI: 23.5À29.6) for frozen-thawed transferred cycles. For 436 women who contributed with an entire IVF programme we found a CLBR of 64.0 % (95 %-CI: 59.3À68.5). Conclusion:Compared to other studies of CLBR after multiple ovarian stimulations using cleavage stage transfer, our study presents a considerable effect in the IVF success rate when using blastocyst transfer only. In a clinical setting, transfer of blastocysts seems to be a viable method.
INTRODUCTION AND OBJECTIVE: Intravaginal ejaculatory latency time (IELT) is important in the evaluation of premature ejaculation (PE). However, the stopwatch-measured IELT (SW-IELT) is inconvenient in clinics while the self-estimate IELT (E-IELT) is inaccurate. This study is to evaluate the number of intravaginal thrusts before ejaculation (NITBE) in the assessment of PE.METHODS: A prospective study which included PE patients (204 couples) and comparatives (106 couples) was performed from Sep 2015 to Mar 2016. SW-IELT, E-IELT and NITBE were collected and evaluated.RESULTS: Baseline characteristics were similar between two groups. The median SW-IELT was 47.6s vs 187.2s between PE patients and comparatives (p<0.001), and the median NITBE was 41.8 vs 152.4 (p<0.001). It's interesting that the average time of one thrust was similar (1.1AE0.2 s/time vs 1.2AE0.2 s/time, p>0.05) between the two groups. As for E-IELT, although patients with PE also exhibited much worse results (94.4s vs 447.5s, p<0.001), there's significant difference between E-IELT and SW-IELT (p<0.001) and NITBE was more correlated with SW-IELT with a person correlation of 0.989. By ROC curve, 75 times would be the best cut-off value with sensitivity of 81.1% and specificity of 88.2%.CONCLUSIONS: NITBE could be used as a convenient and reliable tool for PE assessment.
Background and Aims Acute kidney injury (AKI) is defined as a sudden decrease in kidney function and is associated with increased morbidity and mortality. The reported prevalence of AKI among hospitalized children is approximately 30% but varies widely depending on population characteristics and method used to define AKI. Little is known about the incidence of community-acquired AKI and potential temporal changes in AKI incidence among children. Such information is important for AKI prevention, resource allocation and future research. In this study, we aimed to examine overall temporal changes in the rate of hospital- and community-acquired pediatric AKI and to describe associated changes in potential underlying risk markers. Method In this population-based cohort study, we included children aged 0-17 years from 1 January 2007 to 31 December 2021 in Denmark. In 2021, the Danish population consisted of 1,168,222 children. We obtained clinical plasma creatinine measurements from the Danish laboratory databases to identify all KDIGO-defined AKI episodes within the study period. For each child, only the first AKI episode per year was included and we defined an AKI episode as a period of 30 days. AKI was defined as community-acquired if the plasma creatinine at time of AKI was taken in the outpatient clinic or the first day of admission/acute setting. We estimated the annual AKI rate as first AKI episodes in a year among children residing in an area covered by the laboratory databases divided by the number of children residing in this area in the same year. Unadjusted rates as well as sex- and age-standardized rates was reported. Using Danish medical databases, we identified potential risk markers for AKI, such as use of nephrotoxic medication, surgery, sepsis, and perinatal factors including low birth weight and preterm birth. Results In total, 14,262 children contributed with 16,492 AKI episodes. The average annual rate of AKI was 149 per 100,000 children and was stable throughout the study period (figure). Of the AKI episodes, 10,921 (66.2%) were community-acquired and 12,714 (77.1 %) were stage 1 AKI. No major changes were seen in the prevalence of risk makers among AKI episodes. Conclusion The rate of AKI among Danish children was stable from year 2007 to 2021 and potential risk markers were largely similar over time.
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