Table 3.
Epidemiology studies of semen parameters.
| Included | Reference | Study description | Includes metabolites of: | Study evaluation | ||||||||||||
| Population | Exposure | Outcome | DEHP | DINP | DBP | DIBP | BBP | DEP | Exposure | Outcome | Selection | Confounding | Analysis | Overall confidence | ||
| (Axelsson et al., 2015a) (Axelsson et al., 2015b) | Cross-sectional (N=314) in Sweden; men entering military | Single urine sample; subset with prenatal sample available | Concentration, motility, morphology by WHO guidelines | ✓ | ✓ | ✓ | ✓ | ✓ | A/P | A | A | A | A | Medium | ||
| (Bloom et al., 2015) | Cohort (N=375) in U.S.; men from couples trying to conceive | Single urine sample | Concentration, motility, morphology by WHO guidelines in two samples | ✓ | ✓ | ✓ | ✓ | ✓ | A/P | A | A | A | A | Medium | ||
| (Den Hond et al., 2015) | Case-control (N=40 cases reduced semen quality/80 controls) in Belgium | Single urine sample | Concentration, motility, morphology by WHO guidelines | ✓ | ✓ | ✓ | ✓ | ✓ | A/P | G | P | P | A | Low | ||
| (Han et al., 2014) | Cross-sectional (N=232) in China; general population | Single urine sample | Concentration, motility, morphology by WHO guidelines | ✓ | ✓ | ✓a | ✓ | A/P | G | P | A | A | Medium | |||
| (Hauser et al., 2006) | Cross-sectional (N=463) in U.S.; men from couples seeking infertility workup | Single urine sample | Concentration, motility, morphology by WHO guidelines | ✓ | ✓ | ✓ | ✓ | A/P | G | A | A | A | Medium | |||
| (Herr et al., 2009) | Cross-sectional (N=349) in Germany; men from couples seeking infertility workup | Single urine sample | Concentration, motility, morphology by WHO guidelines | ✓ | P | A | P | P | P | Low | ||||||
| (Huang et al., 2013) (Huang et al., 2011) | Cross-sectional (N=62) in Taiwan; factory workers and students | Single urine sample, occupational, air sampling | Concentration, motility, morphology by WHO guidelines | ✓ | A | A | A | P | A | Medium | ||||||
| (Jonsson et al., 2005) | Cross-sectional (N=234) in Sweden; men entering military | Single morning urine sample | Concentration, motility, morphology by WHO guidelines | ✓a | ✓ | ✓ | ✓ | A | A | A | P | A | Medium | |||
| (Jurewicz et al., 2013) | Cross-sectional (N=269) in Poland; men at infertility clinic | Single morning urine sample | Concentration, motility, morphology by WHO guidelines | ✓ | ✓ | ✓ | ✓ | ✓ | A/P | A | P | A | A | Medium | ||
| (Liu et al.,2012) | Cross-sectional (N=125) in China; men seeking fertility assessment | Two urine samples several days apart | Concentration, motility, morphology by WHO guidelines | ✓ | ✓ | ✓a | ✓ | G | G | P | P | A | Medium | |||
| (Pan et al., 2016); Pan et al., (2015) | Cross-sectional (N=1,066) in China; men seeking fertility assessment | Single urine sample | Concentration, motility, morphology by WHO guidelines | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | A/P | A | A | A | A | Medium | |
| (Specht et al., 2014) (Lenters et al., 2014) | Cross-sectional (N=589) in Greenland, Poland, Ukraine; men from couples at antenatal visit | Single blood sample (only used for secondary metabolites) | Concentration, motility, morphology by WHO guidelines | ✓ | ✓ | P | P | G | A | A | Medium | |||||
| Thurston et al. (2016) | Cross-sectional sample (N=420) of male partners from pregnancy cohort in U.S. | Single urine sample | Concentration, motility, morphology by WHO guidelines | ✓ | ✓ | ✓ | ✓ | A/P | G | A | A | G | Medium | |||
| (Wang et al., 2015b) | Cross-sectional (N=1,040) in China; men seeking semen analysis | Two urine samples collected same day | Concentration, motility, morphology by WHO guidelines | ✓ | ✓ | ✓ | ✓ | G | G | A | A | G | Medium | |||
| (Wirth et al., 2008) | Cross-sectional (N=45) in U.S.; men seeking fertility assessment | Single morning urine sample | Concentration, motility, morphology by WHO guidelines | ✓ | ✓ | ✓a | ✓ | ✓ | A/P | P | P | A | A | Medium | ||
| Total Studies per Phthalate | 14 | 4 | 12 | 4 | 11 | 12 | ||||||||||
| Exclu | Reference | Reason for Exclusion | ||||||||||||||
| (Joensen et al., 2012) | Results not presented for individual phthalate metabolites | |||||||||||||||
| (Kranvogl et al., 2014) | Critical deficiencies in multiple evaluation categories | |||||||||||||||
| (Pan et al., 2011) | Critical deficiency in exposure measure (exposure based on measures in semen) | |||||||||||||||
| (Pant et al., 2008) | Critical deficiency in exposure measure (exposure based on measures in semen) | |||||||||||||||
| (Pant et al., 2014) | Critical deficiency in exposure measure (exposure based on measures in semen) | |||||||||||||||
| (Toshima et al., 2012) | Critical deficiency in outcome measure; limited in other categories | |||||||||||||||
| (Wang et al., 2015a) | Critical deficiency in exposure measure (exposure based on measures in semen) | |||||||||||||||
| (Wang et al., 2016b) | Critical deficiency in exposure measure (exposure based on measures in semen); subset of study in Wang et al. (2015b) | |||||||||||||||
| (Zhang et al., 2006) | Critical deficiency in exposure measure (exposure based on measures in semen) | |||||||||||||||
G = good; A = adequate; D = deficient; A/D = adequate for short chain phthalates, deficient for long chain phthalates; WHO=World Health Organization.
a
Study was considered critically deficient for this phthalate due to a high percent below the LOD.