跳到主要內容

臺灣博碩士論文加值系統

(44.221.70.232) 您好!臺灣時間:2024/05/21 05:08
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

: 
twitterline
研究生:李清仁
研究生(外文):Ching-Jen Li
論文名稱:男性精液品質之環境危險因子探討
論文名稱(外文):Study of environmental risk factor in semen quality of male
指導教授:簡伶朱簡伶朱引用關係
指導教授(外文):Ling-Chu Chien
學位類別:博士
校院名稱:臺北醫學大學
系所名稱:公共衛生學系暨研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2016
畢業學年度:104
語文別:中文
論文頁數:91
中文關鍵詞:精液品質ROC 曲線
外文關鍵詞:semen qualityleadROC curve
相關次數:
  • 被引用被引用:0
  • 點閱點閱:264
  • 評分評分:
  • 下載下載:19
  • 收藏至我的研究室書目清單書目收藏:0
研究背景:
精液品質是男性生育力的關鍵指標,研究指出精液品質近數十年來出現下滑的趨勢,而且會因地區、種族、環境及生活型態不同而有所差異。臺灣為高度工商業化且近數十年生活型態有劇烈變化的國家。本研究希望藉由收集近十年男性精液品質資料,分析血液中重金屬及賀爾蒙濃度瞭解臺灣男性精液品質的現況及造成低精液品質與低生育力之相關風險因子。
研究目的:
1. 瞭解北臺灣2000-2010年男性精液品質現況與變化趨勢。
2. 探討男性低精液品質與鉛暴露之關係。
3. 探討精液品質、鉛暴露與男性生育力之關係,並提供台灣男性精液品質參數的參考。
材料與方法:
第一部分收集生殖醫學中心2000-2010年數據,分析北台灣男性精液品質的變化趨勢,第二部分採橫斷式研究,以結構式問卷調查受試者的基本人口學資料、社經狀況、工作史及醫療史,並採集血液樣本分析血中重金屬與賀爾蒙的濃度,同時分析男性精液品質,探討男性低精液品質與鉛暴露的關係。第三部分為病例對照研究法,病例組為低生育力男性,對照組為正常生育力組以結構式問卷調查受試者的基本人口學資料、社經狀況、工作史、醫療史及生育情況,採集血液樣本分析血中重金屬與賀爾蒙的濃度,探討男性生育力與鉛暴露的關係,並利用以ROC(Receiver operator characteristics)曲線分析,以提供台灣男性精液品質參數的參考。
結果:
臺灣男性近十年精液品質有隨年齡下降的的趨勢,包括:精液量、精子活動力(向前活動力及快速向前活動力)及精子正常型態比例。精液品質也隨年代有下降的趨勢。血中鉛濃度升高時會增加低精液品質的風險,高血中鉛濃度的男性(>5 μg/dL)較低血中鉛濃度的男性(≤5 μg/dL)有11倍的低精液品質的風險。此外,精子活動力(全活動力與向前活動力)低於World Health Organization (WHO)參考值的男性,有顯著的低生育力,其他精液品質參數與男性生育力間無顯著相關性。利用ROC曲線分析台灣男性正常與低生育力之最佳切點為65%,而當男性精子正常型態低於65%時,會有11倍的低生育力的風險。
討論與結論:
本研究發現精子活動力有年齡與世代效應,即精子活動力均回隨著年齡或世代的增加而下降,而在個案血中鉛濃度都低於美國CDC的建議值且FSH都在正常範圍之下,仍然可以發現血中鉛與FSH濃度都與低精液品質有顯著的負相關。另外也發現低總活動力與低向前活動力精子比例是低生育力的危險因子,並發現臺灣男性當正常精子型態比例低於65%時會增加低生育力的風險,建議未來應該收集更大樣本數繼續探討,以找出適合臺灣男性之正常精子品質參數的參考值。本研究結果希望可以提供臨床應用與公共衛生上提供臺灣男性精液品質資料的參考。

Semen quality is a key indicator of the male reproductive ability. The decline in semen quality has been debated for several decades. However, this decline might be inconsistent given factors such as geographical area, ethnicity, environmental exposure, and lifestyle changes. Taiwan is an urbanized and industrialized island, where pollution is a pressing problem. In addition, lifestyle-related factors, such as dietary patterns and obesity, have changed tremendously in recent years. This study aimed to provide information on the semen quality of Taiwanese men by analyzing semen parameters between 2001 and 2010. In addition, we evaluate the levels of heavy metals and reproductive hormones in the blood to clarify the relationship between these factors and semen quality or subfertilty.
Objective:
1. To understand the status and trends of semen quality from 2000 to 2010 in North Taiwan men.
2. To understand the relationship between lead and low semen quality.
3. To understand the relationship among metal, semen parameters, and fertility, and determine the values of suitable sperm parameters for Taiwanese men.
Method:
We recruited 7187 male participants between 2001 and 2010 from a reproductive medical center to provide information on the semen quality of Taiwanese men. In cross-sectional study, we collected demography information and measured the levels of metals and reproductive hormones in the blood. To determine the association between blood lead levels and low semen quality. In case-control study, we examined the blood lead (Pb) levels and semen quality in the fertile and subfertile men. In addition, receiver operating characteristic (ROC) curve analysis was used to determine the cutoff values of suitable sperm parameters for Taiwanese men to achieve spontaneous pregnancy.
Result:
Increasing age (per year) was significantly and negatively associated with semen volume, progressive sperm motility, rapid progressive sperm motility, and sperm with normal morphology. In addition, all semen parameters were reduced with year by year of recruitment. We observed that the increased blood Pb levels were significantly and positively associated with low semen quality. High blood Pb levels ( 5 g/dL) had an 11-fold risk of low semen quality. Our data also suggest that low percentages of total and progressively motile sperms were significant risk factors for subfertility. In addition, the percentage of sperms with normal morphology had a higher ROC curve area (0.87), and the new cutoff point for the percentage of sperms with normal morphology was determined to be 65% and those having <65% of sperms with normal morphology had an 11.35-fold higher risk of subfertility.
Disscision and Conclusion:
In this study, age and cohort effect on reduced the progressive and rapid progressive sperm motility. Even blood Pb levels lower than the reference level of the CDC and FSH levels were within the normal recommended range, we observed that the increased blood Pb levels were significantly and positively associated with low semen quality. In addition, low percentages of total and progressively motile sperms were significant risk factors for subfertility. Moreover, the new cutoff point for the percentage of sperms with normal morphology (65%) should be determinated with larger sample size in future. This information will be of use in clinical practice and public health investigations of the male reproductive health.

摘要 I
Abstract III
圖目錄 X
第壹章、前言 1
第一節 背景與動機 1
第二節 研究目的 3
第貳章、文獻探討 4
第一節 男性生育力 4
2.1.1 男性生育力情況 4
2.1.2 男性精液品質參考值 6
2.1.3 精液品質下滑趨勢 6
2.1.4 精液品質參考值與生育力的關係 8
第二節 鉛 10
2.2.1 鉛的用途與暴露途徑 10
2.2.2 鉛的生理影響 10
2.2.3 鉛對精液品質的影響 11
2.2.4 鉛對等待懷孕時間(Time to pregnancy, TTP)的影響 13
2.2.5 其他金屬對精液品質及TTP的影響 14
第三節 賀爾蒙 16
2.3.1卵泡刺激素(Follicle-stimulating hormone, FSH) 16
2.3.2 睪固酮(Testosterone) 16
第四節 生活型態與生育力之關係 17
2.4.1 飲酒 17
2.4.2 吸菸 17
第參章、材料與方法 18
第一節:瞭解北臺灣2000-2010年男性精液品質現況與變化趨勢 18
3.1.1研究個案的選取 18
3.1.2 精液品質分析 18
3.1.3 統計分析 19
第二節:探討男性低精液品質與鉛暴露之關係 21
3.2.1 研究個案的選取 21
3.2.2 問卷 21
3.2.3 生殖荷爾蒙的測定 22
3.2.4 血液中金屬元素的測定 22
3.2.5 測量分析的品質管制 23
3.2.6 統計方法與分析 23
第三節:探討男性低生育力與精液品質及鉛暴露之關係,並提供台灣男性精液品質的參考 24
3.3.1 研究個案選取 24
3.3.2 生育問卷 24
3.3.3 生殖荷爾蒙的測定 24
3.3.4 血液與精液中鉛的測定 24
3.3.5 測量分析的品質管制 24
3.3.6 接收者操作特徵曲線(Receiver operator characteristics curve, ROC curve) 25
3.2 7統計方法與分析 26
第肆章、結果 27
第一節:瞭解北臺灣2000-2010年男性精液品質現況與變化趨勢 27
4.1.1 研究個案 27
4.1.2 精液品質資料 27
4.1.3 年齡對精液品質的影響 27
4.1.4 年代對精液品質的影響 27
4.1.5 年齡、期間及世代對精液品質的影響 28
第二節:探討男性低精液品質與鉛暴露之關係 34
4.2.1 研究個案人口學特性描述 34
4.2.2 精液品質、金屬元素及賀爾蒙之相關性 34
4.2.3 影響精液品質/參數的危險因子 34
第三節:探討男性低生育力與精液品質及鉛暴露之關係,並提供台灣男性精液品質的參考 44
4.3.1 研究個案的基本人口學特性 44
4.3.2 精液品質、金屬元素及賀爾蒙分佈 44
4.3.3低生育力的危險因子 44
第伍章、討論 53
第一節 精液品質下降趨勢-年齡效應 53
第二節 精液品質下降趨勢-世代效應 53
第三節 金屬對精液品質、生育力的影響-鉛 54
第四節 金屬對精液品質、生育力的影響-硒 55
第五節 賀爾蒙對精液品質、生育力的影響-FSH 56
第六節 賀爾蒙對精液品質的影響- testosterone 56
第七節 生活型態對精液品質的影響 57
第八節 精液品質參考值 57
第九節 研究優點與缺點 57
第陸章、結論與建議 59
參考文獻: 60
附錄1:問卷 68
附錄2:產出論文 74

表2-1 各國不孕症盛行率(Boivin et al., 2007) 5
表4-1. 各年齡層精液品質參數值 (n = 7187) 29
表4-2. 各年代精液品質參數值(n = 7187) 30
表4-3. 年齡、年代與精液品質的相互關係 (n= 7187) 32
表4-4 研究個案之人口學特性 36
表4-5 研究個案精液品質、金屬元素及賀爾蒙之特性 37
表4-6低精液品質或低精液品質參數之羅吉斯回歸分析 38
表4-7低精液品質或低精液品質參數之羅吉斯複回歸分析(n=152) 40
表4-8高血中鉛(>5 μg/dL)對低精液品質或低精液品質參數之羅吉斯複回歸分析(n=152) 43
表4-9 研究個案之人口學特性 47
表4-10 研究個案精液品質、金屬元素及賀爾蒙之特性 48
表4-11低生育力之羅吉斯回歸分析 49
表4-12低生育力之羅吉斯複回歸分析(n=162) 50
表4-13低生育力之羅吉斯複回歸分析 (精液品質參數二分化) (n=162) 51


圖1-1 研究架構圖 3
圖3-1 收集精液檢體的流程 20
圖4-1 APC模式-向前活動力(A)及快速向前活動力(B)的精子比例. 33
圖4-2 正常型態精子比例之ROC curve 52

Agency for Toxic Substances and Disease Registry, A., 2005. Toxicological Profile for Lead. US Department of Health and Human Services, Atlanta.
Anis, T. H., et al., 2007. Chronic lead exposure may be associated with erectile dysfunction. The journal of sexual medicine. 4, 1428-34; discussion 1434-6.
Apostoli, P., et al., 2000. The effect of lead on male fertility: a time to pregnancy (TTP) study. Am J Ind Med. 38, 310-5.
Assennato, G., et al., 1987. Sperm count suppression without endocrine dysfunction in lead-exposed men. Arch Environ Health. 42, 124-7.
Auger, J., et al., 1995. Decline in semen quality among fertile men in Paris during the past 20 years. N Engl J Med. 332, 281-5.
Becker, S., Berhane, K., 1997. A meta-analysis of 61 sperm count studies revisited. Fertil Steril. 67, 1103-8.
Behne, D., et al., 1996. Effects of selenium deficiency on testicular morphology and function in rats. J Reprod Fertil. 106, 291-7.
Benetou-Marantidou, A., et al., 1988. Neurobehavioral estimation of children with life-long increased lead exposure. Arch Environ Health. 43, 392-5.
Boivin, J., et al., 2007. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod. 22, 1506-12.
Bonde, J. P., et al., 1998. Relation between semen quality and fertility: a population-based study of 430 first-pregnancy planners. Lancet. 352, 1172-7.
Canfield, R. L., et al., 2003. Intellectual impairment in children with blood lead concentrations below 10 microg per deciliter. N Engl J Med. 348, 1517-26.
Carlsen, E., et al., 1992. Evidence for decreasing quality of semen during past 50 years. BMJ. 305, 609-13.
CDC, Adult Blood Lead Epidemiology and Surveillance (ABLES). US Department of Health and Human Services, CDC, National Institute for Occupational Safety and Health, Cincinnati, OH, 2013.
Chew, K. K., et al., 2009. Is the relationship between cigarette smoking and male erectile dysfunction independent of cardiovascular disease? Findings from a population-based cross-sectional study. J Sex Med. 6, 222-31.
Chia, S. E., et al., 1994. Effect of cadmium and cigarette smoking on human semen quality. Int J Fertil Menopausal Stud. 39, 292-8.
Chowdhury, Male reproductive impairment by lead exposure. ICOH International Congress on Occupational Health, Nice, 1993.
Cocuzza, M., et al., 2008. Age-related increase of reactive oxygen species in neat semen in healthy fertile men. Urology. 71, 490-4.
Condra, M., et al., 1986. Prevalence and significance of tobacco smoking in impotence. Urology. 27, 495-8.
Department for Environment Food and Rural Affairs, D., Environment Agency, E., 2002. Contaminants in Soil: Collation of Toxicological Data and Intake Values for Humans. Lead. . R&D Publications.
Dostal, L. A., et al., 1988. Testicular toxicity and reduced Sertoli cell numbers in neonatal rats by di(2-ethylhexyl)phthalate and the recovery of fertility as adults. Toxicol Appl Pharmacol. 95, 104-21.
El-Zohairy, E. A., et al., 1996. Reproductive hazards of lead exposure among urban Egyptian men. Reprod Toxicol. 10, 145-51.
Eliasson, G., et al., 1970. Empfehlungen zur Nomenklatur in der Andrologie. Andrologie. 2.
Elzanaty, S., 2007. Association between age and epididymal and accessory sex gland function and their relation to sperm motility. Arch Androl. 53, 149-56.
Eskenazi, B., et al., 2003. The association of age and semen quality in healthy men. Hum Reprod. 18, 447-54.
Falq, G., et al., 2011. Blood lead levels in the adult population living in France the French Nutrition and Health Survey (ENNS 2006-2007). Environ Int. 37, 565-71.
Fatima, P., et al., 2010. Relationship of blood and semen lead level with semen parameter. Mymensingh Med J. 19, 405-14.
Figa-Talamanca, I., et al., 2000. Fertility of male workers of the italian mint. Reproductive toxicology (Elmsford, N Y ). 14, 325-30.
Gao, J., et al., 2013. Relationship between sexual dysfunction and psychological burden in men with infertility: a large observational study in China. J Sex Med. 10, 1935-42.
Gaskins, A. J., et al., 2012. Dietary patterns and semen quality in young men. Hum Reprod. 27, 2899-907.
Gennart, J. P., et al., 1992. Fertility of male workers exposed to cadmium, lead, or manganese. Am J Epidemiol. 135, 1208-19.
Gollenberg, A. L., et al., 2010. Semen quality in fertile men in relation to psychosocial stress. Fertil Steril. 93, 1104-11.
Gordetsky, J., et al., 2012. Redefining abnormal follicle-stimulating hormone in the male infertility population. BJU Int. 110, 568-72.
Greenhall, E., Vessey, M., 1990. The prevalence of subfertility: a review of the current confusion and a report of two new studies. Fertil Steril. 54, 978-83.
Guo, Y. L., et al., 2000. Semen quality after prenatal exposure to polychlorinated biphenyls and dibenzofurans. Lancet. 356, 1240-1.
Guzick, D. S., et al., 2001. Sperm morphology, motility, and concentration in fertile and infertile men. N Engl J Med. 345, 1388-93.
Hassan, A., et al., 2009. Seminal plasma cotinine and insulin-like growth factor-I in idiopathic oligoasthenoteratozoospermic smokers. BJU Int. 103, 108-11.
Hernandez-Ochoa, I., et al., 2005. Low lead environmental exposure alters semen quality and sperm chromatin condensation in northern Mexico. Reprod Toxicol. 20, 221-8.
Hjollund, N. H., et al., 1998. A follow-up study of male exposure to welding and time to pregnancy. Reprod Toxicol. 12, 29-37.
Hosni, H., et al., 2013. Semen quality and reproductive endocrinal function related to blood lead levels in infertile painters. Andrologia. 45, 120-7.
Hsu, J. F., et al., 2009. Evaluation of background persistent organic pollutant levels in human from Taiwan: polychlorinated dibenzo-p-dioxins, dibenzofurans, and biphenyls. Environ Int. 35, 33-42.
Huang, L. P., et al., 2011. The association between semen quality in workers and the concentration of di(2-ethylhexyl) phthalate in polyvinyl chloride pellet plant air. Fertil Steril. 96, 90-4.
Huang, Y. L., et al., 2001. In vitro effects of metal ions (Fe2+, Mn2+, Pb2+) on sperm motility and lipid peroxidation in human semen. J Toxicol Environ Health A. 62, 259-67.
Hull, M. G., et al., 1985. Population study of causes, treatment, and outcome of infertility. Br Med J (Clin Res Ed). 291, 1693-7.
Hung, I. J., 1980. Lead poisoning in two families. Taiwan Yi Xue Hui Za Zhi. 79, 740-8.
Inglis, J. A., et al., 1978. The pathology and pathogenesis of chronic lead nephropathy occurring in Queensland. J Pathol. 124, 65-76.
Jeng, H. A., et al., 2014. Association of cigarette smoking with reproductive hormone levels and semen quality in healthy adult men in Taiwan. J Environ Sci Health A Tox Hazard Subst Environ Eng. 49, 262-8.
Jensen, T. K., et al., 1997. Inhibin B as a serum marker of spermatogenesis: correlation to differences in sperm concentration and follicle-stimulating hormone levels. A study of 349 Danish men. J Clin Endocrinol Metab. 82, 4059-63.
Jensen, T. K., et al., 2006. The influence of occupational exposure on male reproductive function. Occup Med (Lond). 56, 544-53.
Joffe, M., et al., 2003. Time To Pregnancy and occupational lead exposure. Occup Environ Med. 60, 752-8.
Jones, H. W., Jr., Toner, J. P., 1993. The infertile couple. N Engl J Med. 329, 1710-5.
Jorgensen, N., et al., 2001. Regional differences in semen quality in Europe. Hum Reprod. 16, 1012-9.
Jurasovic, J., et al., 2004. Semen quality and reproductive endocrine function with regard to blood cadmium in Croatian male subjects. Biometals. 17, 735-43.
Kidd, S. A., et al., 2001. Effects of male age on semen quality and fertility: a review of the literature. Fertil Steril. 75, 237-48.
Kunzle, R., et al., 2003. Semen quality of male smokers and nonsmokers in infertile couples. Fertil Steril. 79, 287-91.
Kuo, H. W., et al., 1997. Semen quality in workers with long-term lead exposure: a preliminary study in Taiwan. Sci Total Environ. 204, 289-92.
Lerda, D., 1992. Study of sperm characteristics in persons occupationally exposed to lead. Am J Ind Med. 22, 567-71.
Li, C. J., et al., 2015. Biomonitoring of blood heavy metals and reproductive hormone level related to low semen quality. J Hazard Mater. 300, 815-822.
Li, Y., et al., 2009. Semen quality of 1346 healthy men, results from the Chongqing area of southwest China. Hum Reprod. 24, 459-69.
Li, Y., et al., 2012. Effects of manganese on routine semen quality parameters: results from a population-based study in China. BMC Public Health. 12, 919.
Lin, J.-L., et al., 2003. Environmental lead exposure and progression of chronic renal diseases in patients without diabetes. The New England journal of medicine. 348, 277-86.
Lin, S., et al., 1996. Fertility rates among lead workers and professional bus drivers: a comparative study. Ann Epidemiol. 6, 201-8.
Liu, T. Y., et al., 2016. Do Taiwanese people have greater heavy metal levels than those of Western countries? Singapore Med J.
Lu, Y. Y., et al., 2007. Daily intake of 4-nonylphenol in Taiwanese. Environ Int. 33, 903-10.
Lung, S. C., et al., 2003. Exposure of Taiwan residents to polychlorinated biphenyl congeners from farmed, ocean-caught, and imported fish. Environ Sci Technol. 37, 4579-85.
Martini, A. C., et al., 2004. Effects of alcohol and cigarette consumption on human seminal quality. Fertil Steril. 82, 374-7.
Meeker, J. D., et al., 2007. Relationships between serum hormone levels and semen quality among men from an infertility clinic. J Androl. 28, 397-406.
Meeker, J. D., et al., 2008. Cadmium, lead, and other metals in relation to semen quality: human evidence for molybdenum as a male reproductive toxicant. Environ Health Perspect. 116, 1473-9.
Meeker, J. D., et al., 2009. Multiple metals predict prolactin and thyrotropin (TSH) levels in men. Environ Res. 109, 869-73.
Merzenich, H., et al., 2010. Decreasing sperm quality: a global problem? BMC Public Health. 10, 24.
Mielke, H. W., et al., 2005. Multiple metal accumulation as a factor in learning achievement within various New Orleans elementary school communities. Environmental research. 97, 67-75.
Mocarelli, P., et al., 2008. Dioxin exposure, from infancy through puberty, produces endocrine disruption and affects human semen quality. Environ Health Perspect. 116, 70-7.
Mortensen, J. T., 1988. Risk for reduced sperm quality among metal workers, with special reference to welders. Scand J Work Environ Health. 14, 27-30.
Mukhopadhyay, D., et al., 2010. Semen quality and age-specific changes: a study between two decades on 3,729 male partners of couples with normal sperm count and attending an andrology laboratory for infertility-related problems in an Indian city. Fertil Steril. 93, 2247-54.
Nelson, C. M., Bunge, R. G., 1974. Semen analysis: evidence for changing parameters of male fertility potential. Fertil Steril. 25, 503-7.
Nemsadze, K., et al., 2009. Mechanisms of lead-induced poisoning. Georgian Med News. 92-6.
Nieschlag, E., et al., 1999. Role of FSH in the regulation of spermatogenesis: clinical aspects. Clin Endocrinol (Oxf). 51, 139-46.
Paasch, U., et al., 2010. Obesity and age affect male fertility potential. Fertil Steril. 94, 2898-901.
Pacifici, R., et al., 1993. Nicotine, cotinine, and trans-3-hydroxycotinine levels in seminal plasma of smokers: effects on sperm parameters. Ther Drug Monit. 15, 358-63.
Pajarinen, J., et al., 1997. Incidence of disorders of spermatogenesis in middle aged finnish men, 1981-91: two necropsy series. BMJ. 314, 13-8.
Pan, B. C., et al., 2013. [Impact of perceived male infertility factors on penile erectile function]. Zhonghua Nan Ke Xue. 19, 1087-90.
Pandya, C., et al., 2012. Effect of lead and cadmium co-exposure on testicular steroid metabolism and antioxidant system of adult male rats. Andrologia. 44 Suppl 1, 813-22.
Pieczynska, J., Grajeta, H., 2014. The role of selenium in human conception and pregnancy. J Trace Elem Med Biol.
Pillai, P., et al., 2012. Biochemical and reproductive effects of gestational/lactational exposure to lead and cadmium with respect to testicular steroidogenesis, antioxidant system, endogenous sex steroid and cauda-epididymal functions. Andrologia. 44, 92-101.
Ramlau-Hansen, C. H., et al., 2007. Is smoking a risk factor for decreased semen quality? A cross-sectional analysis. Hum Reprod. 22, 188-96.
Rao, M., et al., 2015. Evaluation of semen quality in 1808 university students, from Wuhan, Central China. Asian J Androl. 17, 111-6.
Rayman, M. P., 2000. The importance of selenium to human health. Lancet. 356, 233-41.
Robins, T. G., et al., 1997. Semen quality and fertility of men employed in a South African lead acid battery plant. Am J Ind Med. 32, 369-76.
Rybar, R., et al., 2011. Male obesity and age in relationship to semen parameters and sperm chromatin integrity. Andrologia. 43, 286-91.
Sallmen, M., et al., 2005. Has human fertility declined over time?: why we may never know. Epidemiology. 16, 494-9.
Schwartz, D., et al., 1983. Semen characteristics as a function of age in 833 fertile men. Fertil Steril. 39, 530-5.
Scinicariello, F., et al., 2011. Association of low-level blood lead and blood pressure in NHANES 1999-2006. Environ Res. 111, 1249-57.
Scott, R., et al., 1998. The effect of oral selenium supplementation on human sperm motility. Br J Urol. 82, 76-80.
Sharpe, R. M., 2000. Lifestyle and environmental contribution to male infertility. Br Med Bull. 56, 630-42.
Shiau, C. Y., et al., 2004. Decreased fecundity among male lead workers. Occup Environ Med. 61, 915-23.
Singh, N. P., et al., 2003. Effects of age on DNA double-strand breaks and apoptosis in human sperm. Fertil Steril. 80, 1420-30.
Skakkebaek, N. E., et al., 2006. Is human fecundity declining? Int J Androl. 29, 2-11.
Sloter, E., et al., 2006. Quantitative effects of male age on sperm motion. Hum Reprod. 21, 2868-75.
Sokol, R. Z., et al., 1985. Lead toxicity and the hypothalamic-pituitary-testicular axis. Biol Reprod. 33, 722-8.
Staessen, J. A., et al., 1992. Impairment of renal function with increasing blood lead concentrations in the general population. The Cadmibel Study Group. N Engl J Med. 327, 151-6.
Swan, S. H., et al., 1997. Have sperm densities declined? A reanalysis of global trend data. Environ Health Perspect. 105, 1228-32.
Swan, S. H., et al., 2000. The question of declining sperm density revisited: an analysis of 101 studies published 1934-1996. Environ Health Perspect. 108, 961-6.
Telisman, S., et al., 2007. Reproductive toxicity of low-level lead exposure in men. Environ Res. 105, 256-66.
Telisman, S., et al., 2000. Semen quality and reproductive endocrine function in relation to biomarkers of lead, cadmium, zinc, and copper in men. Environ Health Perspect. 108, 45-53.
Templeton, A., 1995. Infertility-epidemiology, aetiology and effective management. Health Bull (Edinb). 53, 294-8.
Thoreux-Manlay, A., et al., 1995. Lead affects steroidogenesis in rat Leydig cells in vivo and in vitro. Toxicology. 103, 53-62.
Uhler, M. L., et al., 2003. Relationship between sperm characteristics and hormonal parameters in normal couples. Fertil Steril. 79 Suppl 3, 1535-42.
Umeyama, T., et al., 1986. A comparative study of seminal trace elements in fertile and infertile men. Fertil Steril. 46, 494-9.
Van Waeleghem, K., et al., 1996. Deterioration of sperm quality in young healthy Belgian men. Hum Reprod. 11, 325-9.
Viskum, S., et al., 1999. Improvement in semen quality associated with decreasing occupational lead exposure. Am J Ind Med. 35, 257-63.
Vujkovic, M., et al., 2009. Associations between dietary patterns and semen quality in men undergoing IVF/ICSI treatment. Hum Reprod. 24, 1304-12.
Wadi, S. A., Ahmad, G., 1999. Effects of lead on the male reproductive system in mice. J Toxicol Environ Health A. 56, 513-21.
Walker, W. H., 2010. Non-classical actions of testosterone and spermatogenesis. Philos Trans R Soc Lond B Biol Sci. 365, 1557-69.
Wang, J. D., et al., 1992. Lead contamination around a kindergarten near a battery recycling plant. Bull Environ Contam Toxicol. 49, 23-30.
Wedeen, R. P., et al., 1979. Detection and treatment of occupational lead nephropathy. Arch Intern Med. 139, 53-7.
Weyandt, T. B., et al., 1996. Semen analysis of military personnel associated with military duty assignments. Reprod Toxicol. 10, 521-8.
WHO, 1995. International Programme on Chemical Safety (IPCS) Lead. World Health Organisation., Geneva.
WHO, 2000. Safety evaluation of certain food additives and contaminants. . WHO, Geneva.
WHO, 2010. WHO laboratory manual for the examination and processing of human semen. Geneva.
WHO., 1999. WHO Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction.
Wong, W. Y., et al., 2000. Cigarette smoking and the risk of male factor subfertility: minor association between cotinine in seminal plasma and semen morphology. Fertil Steril. 74, 930-5.
Wu, S. J., et al., 2011. Trends in nutrient and dietary intake among adults and the elderly: from NAHSIT 1993-1996 to 2005-2008. Asia Pac J Clin Nutr. 20, 251-65.
Wu, T. N., et al., 1995. Establishment of an occupational diseases surveillance system to monitor blood lead levels in Taiwan. Prev Med. 24, 85-8.
Yeh, C. J., et al., 2011. Time trend of obesity, the metabolic syndrome and related dietary pattern in Taiwan: from NAHSIT 1993-1996 to NAHSIT 2005-2008. Asia Pac J Clin Nutr. 20, 292-300.
Zhu, Q. X., et al., 2011. Turning point of age for semen quality: a population-based study in Chinese men. Fertil Steril. 96, 572-6.
Zinaman, M. J., et al., 2000. Semen quality and human fertility: a prospective study with healthy couples. J Androl. 21, 145-53.
Zirkin, B. R., 1998. Spermatogenesis: its regulation by testosterone and FSH. Semin Cell Dev Biol. 9, 417-21.
台灣生殖醫學會. 1995.
林佳谷, 陳叡瑜, 1993. 台灣地區職業性鉛危害分佈研究. 勞工安全衛生研究所季刊. 2, 93-112.

QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top