Arif Hanafi Bin Jalal, Despoina Chatzopoulou, Hani J Marcus, Anand S Pandit
Aids to improve understanding of statistical risk in patients consenting for surgery and interventional procedures: A systematic review
World journal of surgery
early signs metabolic disorder late adolescence associated features impaired testicular function many years majority seek parenthood adolescents features metabolic disorder 17 years insulin resistance ir 20 years age show impaired testicular function altered hormone levels compared without metabolic disorder controversial evidence suggests recent decline sperm production potentially linked environmental influences cause remains unclear concomitant increases obesity diabetes suggest lifestyle factors may contribute decline testicular function although obesity associated adverse testicular function studies remains unclear whether poor testicular function merely reflects causes poor metabolic health metabolic disorder present adolescence prior onset obesity may suggest metabolic disorder maybe precursor impaired testicular function western australian pregnancy cohort raine study longitudinal study children born 19891991 undergone detailed physical assessments since birth 1454 male infants born 17 years age 490 boys underwent hepatic ultrasound examination serum cytokine assessment n 520 metabolic assessment n 544 metabolic assessment performed 20 years n 608 testicular assessment performed 20 years 609 reproductive hormones measured 404 underwent testicular ultrasound 365 produced semen sample testicular volume estimated ultrasonography semen analysis performed according world health organization guidelines concentrations lh fsh inhibin b inhb serum measured immunoassay total testosterone liquid chromatographymass spectrometryat 17 years age liver ultrasound examination performed determine presence nonalcoholic fatty liver disease nafld serum analysed cytokines interleukin18 soluble tumour necrosis factor receptor 1 2 stnfr1 stnfr2at 17 20 years age fasting blood samples analysed serum liver enzymes insulin glucose triglycerides tg total cholesterol high density lipoprotein low density lipoprotein cholesterol high sensitivity creactive protein uric acid homoeostatic model assessment homa calculated approximated ir defined homa 4 anthropometric data collected dual energy xray absorptiometry measurement performed lean total fat mass young age prevalence metabolic syndrome expected low twostep cluster analysis used using waist circumference tgs insulin systolic blood pressure derive distinct highrisk group features consistent metabolic syndrome increased cardiometabolic risk men age 17 years increased cardiometabolic risk lower concentrations serum testosterone medians 40 versus 49 ngml inhb 1932 versus 2219 pgml p 0001 compared within low risk metabolic cluster men ultrasound evidence nafld n 45 98 reduced total sperm output medians 680 versus 12600 million p 0044 testosterone 40 versus 47 ngml p 0005 inhb 2091 versus 2184 pgml p 0032 compared men without nafldmen higher concentrations stnfr1 17 years age lower sperm output serum concentration inhb increase lh fsh p 005 adjustment age bmi abstinence history cryptorchidism varicocele cigarette smoking alcohol drug use compared without elevated stnfr1 multivariable regression analysis adjusting confounders demonstrated men highrisk metabolic cluster 20 years lower serum testosterone inhb p 0003 p 0001 respectively homair 4 associated lower serum testosterone p 0001 inhb p 0010 increase serum fsh p 0015 study limited sample size multiple comparisons causality cannot proven observational study due 3year interval metabolic assessments assessment testicular function cannot exclude introduction bias study participants testicular function fully mature 17year assessment irrespective proven causation study findings important significant minority men prior seeking parenthood presented coexistent features metabolic disorder signs testicular impairment particular note presence nafld 17 years age although present minority men associated almost 50 reduction sperm output 20 years age presence ir 20 years associated 20 reduction testicular volume study supported australian nhmrc grant numbers 634457 35351417 403981 received support raine medical research foundation telethon kids institute university western australia women infants research foundation curtin university edith cowan university dad jed nm laa rch tam jko ljb nothing declare rjh medical director fertility specialists western australia equity interests western ivf received grant support msd merckserono ferring pharmaceuticals rmcl equity interests monash ivf group rjn equity interests fertilitysa received grant support merck serono ferring pharmaceuticals djh received institutional grant funding personal income investigatorinitiated testosterone pharmacology studies lawley besins healthcare provided expert testimony antidoping tribunals testosterone litigationthis abstract awarded fertility society australia clinical exchange award oral presentation eshre barcelona 2018