Risk of prostate cancer for men fathering through assisted reproduction: nationwide population based register studyBMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5214 (Published 25 September 2019) Cite this as: BMJ 2019;366:l5214
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Re: Risk of prostate cancer for men fathering through assisted reproduction: nationwide population based register study
Although, your findings are not surprising, the announcement of your findings could be of great help in making gynaecologists think twice abput their responsibilities when consulting for assisted reproduction techniques, and in sensitizing men in the preventive checkup, already by adolescence (and not only after the age of 50).
Although reproduction in humans is achieved by the “collaboration” of both sexes, this collaboration is not met in the field of assisted reproduction. We all agree that gynaecologists may not be able to diagnose a varicocele, a prostate cancer, an epididymitis or a testicular tumour. Despite the fact that these pathologies are only some of the many that may affect or even be the cause of weak semen, gynaecologists do not usually advise infertile men that they may have to consult a urologist.
Undeniably, the source of all evil is the fact that men do not uually consult a urologist. As a result, when it comes to fertility, it is always the woman who consults her gynaecologist. In the absence of his urologist (similarly to the lack of urologists in the WHO), it is her gynaecologist who asks for a semen analysis. Therefore, the semen analysis becomes the gynaecologist’s tool to deal with the couple’s fertility. Since the gynaecologist is not able to perform a clinical examination of her partners genital tract, he is not interested in her partner’s health. He is only interested in getting his client pregnant. This way the semen is just the material with which she will become pregnant. Since it is her gynaecologist dealing with it, he will study the semen’s ability to fertilize her.
As I explained earlier, this approach is threatening men’s health. It is threatening the health condition of at least half of the World’s population. ‘At least’, because women’s health is threatened, too. For example, if semen motility is low because of an urogenital tract infection, IVF may succeed, but the pregnancy might be compromised because of the infection, especially in the case of Chlamydia tr. or the Ureaplasmas. Moreover, she undergoes an IVF treatment, instead of taking an antibiotic. Apart from the economic consequences of these unnecessary IVF treatments, consider the fact that, even when a baby is delivered at home after a successful IVF treatment, his prostate is compromised because of the infection that will remain untreated for years. We all know that chronic inflammations (often caused by an infection) in an organ may increase the risk of cancer development in that organ.
It becomes therefore obvious that if weak semen is due to a urogenital tract infection, the infection will become chronic (since it will remain untreated), increasing this way the risk of prostate cancer.
I cannot deny that the increase you observed may be also linked to genes in the Y chromosome, but male tract infections are by far more frequent.
Your conclusion is correct, i.e. that men who undergone ICSI or IVF should be more sensitized on the importance of the preventive checkup of their prostate already at a younger age (not only after the age of 50). Moreover, I would add that every man should be sensitized in the preventive checkup of his genital tract especially for the following reason:
Irregularities in the menstrual cycle notify a woman about a malfunction of her ovaries. Moreover, genital infections are usually symptomatic in women, who consult their gynaecologist regularly, anyway.
Men can hardly perceive an infection of their prostate (because urogenital infections are usually asymptomatic in men) or a malfunction of their testicles (because they do not have a menstrual cycle, nor is the frequency of ejaculations indicative).
I have conducted a study on the semen of over 1000 men. This study led me to describe the physiological values for human semen. Keep in mind that the WHO denotes that the reference values the WHO defined for fertility shall not be used for diagnostic purposes or as a criterion from certifying bodies.
Competing interests: No competing interests