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. 1993 Jul;101(Suppl 2):65–71. doi: 10.1289/ehp.93101s265

Evidence for increasing incidence of abnormalities of the human testis: a review.

A Giwercman 1, E Carlsen 1, N Keiding 1, N E Skakkebaek 1
PMCID: PMC1519947  PMID: 7902273

Abstract

Recent reports have suggested that the incidence of genitourinary abnormalities in human males has increased during the past 50 years, including congenital abnormalities such as cryptorchidism and hypospadia, which seem to be occurring more commonly. Also, the incidence of testicular cancer has increased 3- to 4-fold since the 1940s. This increase seems to be worldwide including countries with a very high frequency of testicular neoplasia as well as those in which this cancer is rather uncommon. It has also been postulated that semen quality has been decreasing for the last half century. A recent study showed that the average sperm density has decreased significantly from 113 million/mL in 1940 to 66 million/mL in 1990. The mean seminal volume has also declined, indicating that the decrease in the total sperm count is even more pronounced than the fall in sperm density would indicate. The remarkable increase in frequency of testicular abnormalities over a relatively short period of time may be due to environmental rather than genetic factors. There is an epidemiological link between the occurrence of different testicular abnormalities. Therefore, common prenatally acting etiological factors with adverse effects on the fetal male gonad might be suspected. However, postnatal influences may also have a deleterious effect on male fertility. From the reproductive point of view, an increased impact on the human male gonad is of concern.

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Selected References

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  1. Abyholm T. An andrological study of 51 fertile men. Int J Androl. 1981 Dec;4(6):646–656. doi: 10.1111/j.1365-2605.1981.tb00747.x. [DOI] [PubMed] [Google Scholar]
  2. Aribarg A., Kenkeerati W., Vorapaiboonsak V., Leepipatpaiboon S., Farley T. M. Testicular volume, semen profile and serum hormone levels in fertile Thai males. Int J Androl. 1986 Jun;9(3):170–180. doi: 10.1111/j.1365-2605.1986.tb00880.x. [DOI] [PubMed] [Google Scholar]
  3. Badenoch D. F., Evans S. J., McCloskey D. J. Sperm density measurement: should this be abandoned? Br J Urol. 1989 Nov;64(5):521–523. doi: 10.1111/j.1464-410x.1989.tb05291.x. [DOI] [PubMed] [Google Scholar]
  4. Baird D. D., Wilcox A. J. Future fertility after prenatal exposure to cigarette smoke. Fertil Steril. 1986 Sep;46(3):368–372. [PubMed] [Google Scholar]
  5. Barratt C. L., Dunphy B. C., Thomas E. J., Cooke I. D. Semen characteristics of 49 fertile males. Andrologia. 1988 May-Jun;20(3):264–269. doi: 10.1111/j.1439-0272.1988.tb01068.x. [DOI] [PubMed] [Google Scholar]
  6. Bendvold E. Semen quality in Norwegian men over a 20-year period. Int J Fertil. 1989 Nov-Dec;34(6):401–404. [PubMed] [Google Scholar]
  7. Berthelsen J. G., Skakkebaek N. E. Gonadal function in men with testis cancer. Fertil Steril. 1983 Jan;39(1):68–75. [PubMed] [Google Scholar]
  8. Bhushan S., Pandey R. C., Singh S. P., Pandey D. N., Seth P. Some observations on human semen analysis. Indian J Physiol Pharmacol. 1978 Oct-Dec;22(4):393–396. [PubMed] [Google Scholar]
  9. Bonde J. P. Semen quality and sex hormones among mild steel and stainless steel welders: a cross sectional study. Br J Ind Med. 1990 Aug;47(8):508–514. doi: 10.1136/oem.47.8.508. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Borghi M. R., Asch R. H. Human sperm penetration in bovine cervical mucus. Clinical studies I. J Androl. 1983 Sep-Oct;4(5):316–318. doi: 10.1002/j.1939-4640.1983.tb02378.x. [DOI] [PubMed] [Google Scholar]
  11. Bostofte E., Serup J., Rebbe H. Has the fertility of Danish men declined through the years in terms of semen quality? A comparison of semen qualities between 1952 and 1972. Int J Fertil. 1983;28(2):91–95. [PubMed] [Google Scholar]
  12. Bostofte E., Serup J., Rebbe H. Relation between sperm count and semen volume, and pregnancies obtained during a twenty-year follow-up period. Int J Androl. 1982 Jun;5(3):267–275. doi: 10.1111/j.1365-2605.1982.tb00255.x. [DOI] [PubMed] [Google Scholar]
  13. Boyle P., Kaye S. B., Robertson A. G. Changes in testicular cancer in Scotland. Eur J Cancer Clin Oncol. 1987 Jun;23(6):827–830. doi: 10.1016/0277-5379(87)90286-0. [DOI] [PubMed] [Google Scholar]
  14. Brown L. M., Pottern L. M., Hoover R. N., Devesa S. S., Aselton P., Flannery J. T. Testicular cancer in the United States: trends in incidence and mortality. Int J Epidemiol. 1986 Jun;15(2):164–170. doi: 10.1093/ije/15.2.164. [DOI] [PubMed] [Google Scholar]
  15. Carlsen E., Giwercman A., Keiding N., Skakkebaek N. E. Evidence for decreasing quality of semen during past 50 years. BMJ. 1992 Sep 12;305(6854):609–613. doi: 10.1136/bmj.305.6854.609. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Chan S. Y., Wang C. Correlation between semen adenosine triphosphate and sperm fertilizing capacity. Fertil Steril. 1987 Apr;47(4):717–719. [PubMed] [Google Scholar]
  17. Coutinho E. M., Melo J. F. Clinical experience with gossypol in non-Chinese men: a follow-up. Contraception. 1988 Feb;37(2):137–151. doi: 10.1016/0010-7824(88)90124-2. [DOI] [PubMed] [Google Scholar]
  18. Dikshit R. K., Buch J. G., Mansuri S. M. Effect of tobacco consumption on semen quality of a population of hypofertile males. Fertil Steril. 1987 Aug;48(2):334–336. doi: 10.1016/s0015-0282(16)59369-8. [DOI] [PubMed] [Google Scholar]
  19. FALK H. C., KAUFMAN S. A. What constitutes a normal semen? Fertil Steril. 1950 Nov;1(6):489–503. doi: 10.1016/s0015-0282(16)30361-2. [DOI] [PubMed] [Google Scholar]
  20. Fram R. J., Garnick M. B., Retik A. The spectrum of genitourinary abnormalities in patients with cryptorchidism, with emphasis on testicular carcinoma. Cancer. 1982 Nov 15;50(10):2243–2246. doi: 10.1002/1097-0142(19821115)50:10<2243::aid-cncr2820501045>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
  21. Freund M., Davis J. E. Disappearance rate of spermatozoa from the ejaculate following vasectomy. Fertil Steril. 1969 Jan-Feb;20(1):163–170. doi: 10.1016/s0015-0282(16)36914-x. [DOI] [PubMed] [Google Scholar]
  22. Giblin P. T., Poland M. L., Moghissi K. S., Ager J. W., Olson J. M. Effects of stress and characteristic adaptability on semen quality in healthy men. Fertil Steril. 1988 Jan;49(1):127–132. doi: 10.1016/s0015-0282(16)59663-0. [DOI] [PubMed] [Google Scholar]
  23. Gill W. B., Schumacher G. F., Bibbo M., Straus F. H., 2nd, Schoenberg H. W. Association of diethylstilbestrol exposure in utero with cryptorchidism, testicular hypoplasia and semen abnormalities. J Urol. 1979 Jul;122(1):36–39. doi: 10.1016/s0022-5347(17)56240-0. [DOI] [PubMed] [Google Scholar]
  24. Glaub J. C., Mills R. N., Katz D. F. Improved motility recovery of human spermatozoa after freeze preservation via a new approach. Fertil Steril. 1976 Nov;27(11):1283–1291. doi: 10.1016/s0015-0282(16)42196-5. [DOI] [PubMed] [Google Scholar]
  25. Hamill P. V., Steinberger E., Levine R. J., Rodriguez-Rigau L. J., Lemeshow S., Avrunin J. S. The epidemiologic assessment of male reproductive hazard from occupational exposure to TDA and DNT. J Occup Med. 1982 Dec;24(12):985–993. [PubMed] [Google Scholar]
  26. Handelsman D. J., Conway A. J., Boylan L. M., Turtle J. R. Testicular function in potential sperm donors: normal ranges and the effects of smoking and varicocele. Int J Androl. 1984 Oct;7(5):369–382. doi: 10.1111/j.1365-2605.1984.tb00794.x. [DOI] [PubMed] [Google Scholar]
  27. Henderson B. E., Benton B., Jing J., Yu M. C., Pike M. C. Risk factors for cancer of the testis in young men. Int J Cancer. 1979 May 15;23(5):598–602. doi: 10.1002/ijc.2910230503. [DOI] [PubMed] [Google Scholar]
  28. Henderson B. E., Ross R. K., Pike M. C., Casagrande J. T. Endogenous hormones as a major factor in human cancer. Cancer Res. 1982 Aug;42(8):3232–3239. [PubMed] [Google Scholar]
  29. Henderson J., Baker H. W., Hanna P. J. Occupation-related male infertility: a review. Clin Reprod Fertil. 1986 Apr;4(2):87–106. [PubMed] [Google Scholar]
  30. Heussner J. C., Ward J. B., Jr, Legator M. S. Genetic monitoring of aluminum workers exposed to coal tar pitch volatiles. Mutat Res. 1985 Mar;155(3):143–155. doi: 10.1016/0165-1218(85)90133-8. [DOI] [PubMed] [Google Scholar]
  31. Hovatta O., Huhtaniemi I., Wahlström T. Testicular gonadotrophins and their receptors in human cryptorchidism as revealed by immunohistochemistry and radioreceptor assay. Acta Endocrinol (Copenh) 1986 Jan;111(1):128–132. doi: 10.1530/acta.0.1110128. [DOI] [PubMed] [Google Scholar]
  32. Ibrahim M. E., Moussa M. A., Pedersen H. Sperm chromatin heterogeneity as an infertility factor. Arch Androl. 1988;21(2):129–133. doi: 10.3109/01485018808986723. [DOI] [PubMed] [Google Scholar]
  33. Jackson M. B. The epidemiology of cryptorchidism. John Radcliffe Hospital Cryptorchidism Research Group. Horm Res. 1988;30(4-5):153–156. doi: 10.1159/000181052. [DOI] [PubMed] [Google Scholar]
  34. James W. H. Secular trend in reported sperm counts. Andrologia. 1980 Jul-Aug;12(4):381–388. doi: 10.1111/j.1439-0272.1980.tb00650.x. [DOI] [PubMed] [Google Scholar]
  35. Kirei B. R. Semen characteristics in 120 fertile Tanzanian men. East Afr Med J. 1987 Jul;64(7):453–457. [PubMed] [Google Scholar]
  36. LAMPE E. H., MASTERS W. H. Problems of male fertility. II. Effect of frequent ejaculation. Fertil Steril. 1956 Mar-Apr;7(2):123–127. doi: 10.1016/s0015-0282(16)32283-x. [DOI] [PubMed] [Google Scholar]
  37. Ladipo O. A. Seminal analysis in fertile and infertile Nigerian men. J Natl Med Assoc. 1980 Aug;72(8):785–789. [PMC free article] [PubMed] [Google Scholar]
  38. Laufer N., Margalioth E. J., Navot D., Shemesh A., Schenker J. G. Reduced penetration of zona-free hamster ova by cryopreserved human spermatozoa. Arch Androl. 1985;14(2-3):217–222. doi: 10.3109/01485018508988302. [DOI] [PubMed] [Google Scholar]
  39. Leto S., Frensilli F. J. Changing parameters of donor semen. Fertil Steril. 1981 Dec;36(6):766–770. doi: 10.1016/s0015-0282(16)45923-6. [DOI] [PubMed] [Google Scholar]
  40. Levin R. M., Latimore J., Wein A. J., Van Arsdalen K. N. Correlation of sperm count with frequency of ejaculation. Fertil Steril. 1986 May;45(5):732–734. doi: 10.1016/s0015-0282(16)49352-0. [DOI] [PubMed] [Google Scholar]
  41. Lewis E. L., Brazil C. K., Overstreet J. W. Human sperm function in the ejaculate following vasectomy. Fertil Steril. 1984 Dec;42(6):895–898. doi: 10.1016/s0015-0282(16)48262-2. [DOI] [PubMed] [Google Scholar]
  42. MACLEOD J., GOLD R. Z. The male factor in fertility and infertility. II. Spermatozoon counts in 1000 men of known fertility and in 1000 cases of infertile marriage. J Urol. 1951 Sep;66(3):436–449. doi: 10.1016/S0022-5347(17)74358-3. [DOI] [PubMed] [Google Scholar]
  43. McLachlan J. A., Newbold R. R., Bullock B. Reproductive tract lesions in male mice exposed prenatally to diethylstilbestrol. Science. 1975 Dec 5;190(4218):991–992. doi: 10.1126/science.242076. [DOI] [PubMed] [Google Scholar]
  44. Menkveld R., Van Zyl J. A., Kotze T. J., Joubert G. Possible changes in male fertility over a 15-year period. Arch Androl. 1986;17(2):143–144. doi: 10.3109/01485018608990186. [DOI] [PubMed] [Google Scholar]
  45. Meyer C. R. Semen quality in workers exposed to carbon disulfide compared to a control group from the same plant. J Occup Med. 1981 Jun;23(6):435–439. doi: 10.1097/00043764-198106000-00018. [DOI] [PubMed] [Google Scholar]
  46. Murature D. A., Tang S. Y., Steinhardt G., Dougherty R. C. Phthalate esters and semen quality parameters. Biomed Environ Mass Spectrom. 1987 Aug;14(8):473–477. doi: 10.1002/bms.1200140815. [DOI] [PubMed] [Google Scholar]
  47. Nelson C. M., Bunge R. G. Semen analysis: evidence for changing parameters of male fertility potential. Fertil Steril. 1974 Jun;25(6):503–507. doi: 10.1016/s0015-0282(16)40454-1. [DOI] [PubMed] [Google Scholar]
  48. Neuwinger J., Behre H. M., Nieschlag E. External quality control in the andrology laboratory: an experimental multicenter trial. Fertil Steril. 1990 Aug;54(2):308–314. [PubMed] [Google Scholar]
  49. Newbold R. R., Bullock B. C., McLachlan J. A. Testicular tumors in mice exposed in utero to diethylstilbestrol. J Urol. 1987 Dec;138(6):1446–1450. doi: 10.1016/s0022-5347(17)43672-x. [DOI] [PubMed] [Google Scholar]
  50. Nieschlag E., Lammers U., Freischem C. W., Langer K., Wickings E. J. Reproductive functions in young fathers and grandfathers. J Clin Endocrinol Metab. 1982 Oct;55(4):676–681. doi: 10.1210/jcem-55-4-676. [DOI] [PubMed] [Google Scholar]
  51. Nikkanen V. The effects of vasectomy on viscosity, pH and volume of semen in man. Andrologia. 1979 Mar-Apr;11(2):123–125. doi: 10.1111/j.1439-0272.1979.tb02170.x. [DOI] [PubMed] [Google Scholar]
  52. Nistal M., Paniagua R., Queizán A. Histologic lesions in undescended ectopic obstructed testes. Fertil Steril. 1985 Mar;43(3):455–462. doi: 10.1016/s0015-0282(16)48449-9. [DOI] [PubMed] [Google Scholar]
  53. Osegbe D. N., Amaku E. O., Nnatu S. N. Are changing semen parameters a universal phenomenon? Eur Urol. 1986;12(3):164–168. doi: 10.1159/000472607. [DOI] [PubMed] [Google Scholar]
  54. Osser S., Gennser G., Liedholm P., Ranstam J. Variation of semen parameters in fertile men. Arch Androl. 1983 May;10(2):127–133. doi: 10.3109/01485018308987553. [DOI] [PubMed] [Google Scholar]
  55. Osser S., Liedholm P., Ranstam J. Depressed semen quality: a study over two decades. Arch Androl. 1984;12(1):113–116. doi: 10.3109/01485018409161159. [DOI] [PubMed] [Google Scholar]
  56. Osterlind A. Diverging trends in incidence and mortality of testicular cancer in Denmark, 1943-1982. Br J Cancer. 1986 Apr;53(4):501–505. doi: 10.1038/bjc.1986.79. [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. Panidis D. K., Asseo P. P., Papaloucas A. C. Semen parameters in 114 fertile men. Eur J Obstet Gynecol Reprod Biol. 1984 Mar;16(6):411–420. doi: 10.1016/0028-2243(84)90022-4. [DOI] [PubMed] [Google Scholar]
  58. Polakoski K. L., Zahler W. L., Paulson J. D. Demonstration of proacrosin and quantitation of acrosin in ejaculated human spermatozoa. Fertil Steril. 1977 Jun;28(6):668–673. doi: 10.1016/s0015-0282(16)42621-x. [DOI] [PubMed] [Google Scholar]
  59. RUTHERFORD R. N., BANKS A. L., COBURN W. A., KLEMER R. H. SPERM EVALUATION AS IT RELATES TO , UNPLANNED PARENTHOOD. Fertil Steril. 1963 Sep-Oct;14:521–529. doi: 10.1016/s0015-0282(16)34987-1. [DOI] [PubMed] [Google Scholar]
  60. Rasmussen K., Sabroe S., Wohlert M., Ingerslev H. J., Kappel B., Nielsen J. A genotoxic study of metal workers exposed to trichloroethylene. Sperm parameters and chromosome aberrations in lymphocytes. Int Arch Occup Environ Health. 1988;60(6):419–423. doi: 10.1007/BF00381389. [DOI] [PubMed] [Google Scholar]
  61. Rehan N., Sobrero A. J., Fertig J. W. The semen of fertile men: statistical analysis of 1300 men. Fertil Steril. 1975 Jun;26(6):492–502. doi: 10.1016/s0015-0282(16)41169-6. [DOI] [PubMed] [Google Scholar]
  62. Rehewy M. S., Thomas A. J., Hafez E. S., Brown W. J., Moghissi K. S., Jaszczak S. Ureaplasma urealyticum (T-mycoplasma) in seminal plasma and spermatozoa from infertile and fertile volunteers. Eur J Obstet Gynecol Reprod Biol. 1978 Oct;8(5):247–251. doi: 10.1016/0028-2243(78)90073-4. [DOI] [PubMed] [Google Scholar]
  63. Roy S., Chatterjee S. Studies with cyproterone acetate for male contraception. J Steroid Biochem. 1979 Jul;11(1B):675–680. doi: 10.1016/0022-4731(79)90099-2. [DOI] [PubMed] [Google Scholar]
  64. Rui H., Oldereid N. B., Purvis K. Røyking og spermiekvalitet hos menn under fertilitetsutredning. Tidsskr Nor Laegeforen. 1989 Feb 20;109(5):573–575. [PubMed] [Google Scholar]
  65. Saint Pol P., Beuscart R., Leroy-Martin B., Hermand E., Jablonski W. Circannual rhythms of sperm parameters of fertile men. Fertil Steril. 1989 Jun;51(6):1030–1033. doi: 10.1016/s0015-0282(16)60738-0. [DOI] [PubMed] [Google Scholar]
  66. Santomauro A. G., Sciarra J. J., Varma A. O. A clinical investigation of the role of the semen analysis and postcoital test in the evaluation of male infertility. Fertil Steril. 1972 Apr;23(4):245–251. doi: 10.1016/s0015-0282(16)38881-1. [DOI] [PubMed] [Google Scholar]
  67. Santti R., Pylkkänen L., Newbold R., McLachlan J. A. Developmental oestrogenization and prostatic neoplasia. Int J Androl. 1990 Apr;13(2):77–80. doi: 10.1111/j.1365-2605.1990.tb00963.x. [DOI] [PubMed] [Google Scholar]
  68. Schrag S. D., Dixon R. L. Occupational exposures associated with male reproductive dysfunction. Annu Rev Pharmacol Toxicol. 1985;25:567–592. doi: 10.1146/annurev.pa.25.040185.003031. [DOI] [PubMed] [Google Scholar]
  69. Schwartz D., Mayaux M. J., Spira A., Moscato M. L., Jouannet P., Czyglik F., David G. Semen characteristics as a function of age in 833 fertile men. Fertil Steril. 1983 Apr;39(4):530–535. doi: 10.1016/s0015-0282(16)46946-3. [DOI] [PubMed] [Google Scholar]
  70. Shrivastav P., Swann J., Jeremy J. Y., Thompson C., Shaw R. W., Dandona P. Sperm function and structure and seminal plasma prostanoid concentrations in men with IDDM. Diabetes Care. 1989 Nov-Dec;12(10):742–744. doi: 10.2337/diacare.12.10.742. [DOI] [PubMed] [Google Scholar]
  71. Skakkebaek N. E., Berthelsen J. G., Giwercman A., Müller J. Carcinoma-in-situ of the testis: possible origin from gonocytes and precursor of all types of germ cell tumours except spermatocytoma. Int J Androl. 1987 Feb;10(1):19–28. doi: 10.1111/j.1365-2605.1987.tb00161.x. [DOI] [PubMed] [Google Scholar]
  72. Smith M. L., Luqman W. A., Rakoff J. S. Correlations between seminal radioimmunoreactive prolactin, sperm count, and sperm motility in prevasectomy and infertility clinic patients. Fertil Steril. 1979 Sep;32(3):312–315. [PubMed] [Google Scholar]
  73. Sobowale O. B., Akiwumi O. Testicular volume and seminal fluid profile in fertile and infertile males in Ilorin, Nigeria. Int J Gynaecol Obstet. 1989 Feb;28(2):155–161. doi: 10.1016/0020-7292(89)90476-1. [DOI] [PubMed] [Google Scholar]
  74. Stanwell-Smith R., Thompson S. G., Haines A. P., Ward R. J., Cashmore G., Stedronska J., Hendry W. F. A comparative study of zinc, copper, cadmium, and lead levels in fertile and infertile men. Fertil Steril. 1983 Nov;40(5):670–677. doi: 10.1016/s0015-0282(16)47429-7. [DOI] [PubMed] [Google Scholar]
  75. Sturde H. C., Glowania H. J., Böhm K. Vergleichende Ejaculatuntersuchungen bei Männern aus sterilen und fertilen Ehen. Arch Dermatol Forsch. 1971;241(4):426–437. [PubMed] [Google Scholar]
  76. Sultan Sheriff D. Setting standards of male fertility I. Semen analyses in 1500 patients--a report. Andrologia. 1983 Nov-Dec;15(6):687–692. doi: 10.1111/j.1439-0272.1983.tb00194.x. [DOI] [PubMed] [Google Scholar]
  77. Swanson R. J., Mayer J. F., Jones K. H., Lanzendorf S. E., McDowell J. Hamster ova/human sperm penetration: correlation with count, motility, and morphology for in vitro fertilization. Arch Androl. 1984;12 (Suppl):69–77. [PubMed] [Google Scholar]
  78. Tjoa W. S., Smolensky M. H., Hsi B. P., Steinberger E., Smith K. D. Circannual rhythm in human sperm count revealed by serially independent sampling. Fertil Steril. 1982 Oct;38(4):454–459. doi: 10.1016/s0015-0282(16)46580-5. [DOI] [PubMed] [Google Scholar]
  79. Wang C., Chan S. Y., Leung A., Ng R. P., Ng M., Tang L. C., Ma H. K., Tsoi W. L., Kwan M. Cross-sectional study of semen parameters in a large group of normal Chinese men. Int J Androl. 1985 Aug;8(4):257–274. doi: 10.1111/j.1365-2605.1985.tb00840.x. [DOI] [PubMed] [Google Scholar]
  80. Welch L. S., Schrader S. M., Turner T. W., Cullen M. R. Effects of exposure to ethylene glycol ethers on shipyard painters: II. Male reproduction. Am J Ind Med. 1988;14(5):509–526. doi: 10.1002/ajim.4700140503. [DOI] [PubMed] [Google Scholar]
  81. ZIMMERMAN S. J., MAUDE M. B., MOLDAWER M. FREEZING AND STORAGE OF HUMAN SEMEN IN 50 HEALTHY MEDICAL STUDENTS. A COMPARATIVE STUDY OF GLYCEROL AND DIMETHYLSULFOXIDE AS A PRESERVATIVE. Fertil Steril. 1964 Sep-Oct;15:505–510. doi: 10.1016/s0015-0282(16)35345-6. [DOI] [PubMed] [Google Scholar]

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