Air pollution, traffic fumes associated with infertility risk
Recent studies suggest that there is rise in number of Nigerian men that cannot achieve or maintain erection to sexually satisfy their partners, which is pushing some into suicidal tendencies.

The Guardian investigation reveals that some Nigerian men can take anything with the promise of boosting their libidos, from crude herbal preparations to medicines, without National Agency for Food and Drug Administration’s (NAFDAC) registration number.

In Nigeria, many men turn to over-the-counter (OTC) supplements to tackle sexual health problems. In fact they are even sold or rather hawked at bus stops, petrol filling stations and on the streets across Nigeria.

However, scientists have raised red alert on OTC dietary supplements and therapies sold to improve male sexual health.A report published in the Journal of Sexual Medicine, on Monday, said the supplements might be ineffective and even unsafe.

However, studies suggest that around 40 to 70 per cent of men experience sexual dysfunction at some time and that to avoid paying for prescription drugs, or the embarrassment of discussing such matters with their physicians, many men turn to OTC products.

In Nigeria, the products cost from N200 to N10,000 for a dose while in the United States (U.S.), the dazzling array of products, from horny goat weed to ginseng, costs from $0.83 to $5.77 per day. But lack of regulation on dosage, purity or ingredients, and limited information regarding health effects confuses patients and medical practitioners alike.

Also, a United States (U.S.) study suggests that women who live close to major highways where the air is polluted by traffic exhaust fumes may be slightly more likely to have fertility problems than women who live further away where the air is cleaner.

The study was published in the journal Human Reproduction.
Researchers followed more than 36,000 women from 1993 until 2003 and analyzed air pollution and traffic exhaust near their homes to see if what they breathed might be connected to their ability to conceive.

Over the study period, there were about 2,500 reported cases of infertility. Women who lived close to a major roadway – within 199 meters, or about a tenth of a mile – were 11 percent more likely to experience this problem than women who lived farther from a highway, the study found.

Meanwhile, the researchers from Wake Forest Baptist Medical Center in Winston-Salem, NC, U.S., reviewed the scientific evidence for the effectiveness and safety of the most common ingredients in top-selling men’s health products.

They wanted to provide urologists with a guide for counseling patients who present with sexual health problems and who are taking such supplements.

Prescription ingredients sold OTC
There was no scientific evidence to support claims that many products positively impact erectile function, libido and sexual performance, and some were likely to be unsafe.

Some products advertised as “natural” contain traces of phosphodiesterase-5-inhibitors (PDE5Is), the same class of medication that includes prescription drugs such as Viagra, which is used to treat erectile dysfunction. PDE5Is cannot be legally sold over the counter in the US, because using them without a physician’s supervision could be risky.

Patients with advanced heart disease or who take nitrates, such as nitroglycerin, should not use PDE5Is, as it may cause an unsafe drop in blood pressure.

PDE5Is should also be avoided by men with severe liver impairment or end-stage kidney disease. Those with enlarged prostates who take medications such as Flomax (tamsulosin), terazosin or doxazosin should only take it with supervision, as interactions may cause dizziness, leading to falls and fractures.

In one study, 81 per cent of OTC products purchased in the U.S. and Asia contained PDE5Is.
Pros and cons of popular ingredients

The findings on some of the best-selling products can be summarized as follows:
*DHEA is a hormone naturally made by the human body and produced in laboratories from chemicals found in wild yam and soy. While findings do not suggest a benefit, it appears to be relatively safe, as the impact on hormone levels is not significant
*Fenugreek features in one in three top-selling men’s health supplements. It may improve sexual arousal and orgasm, muscle strength, energy and well-being. There was no evidence of adverse effects
*Ginkgo biloba is taken for numerous conditions, but data does not support its use in erectile dysfunction. It can cause headache, seizures and significant bleeding, especially if taken alongside Coumadin
*Ginseng is the most common ingredient in top-selling men’s health supplements; it can cause headache, upset stomach, constipation, rash and insomnia. It can also lower blood sugar, risky in cases of diabetes
*Horny Goat Weed is generally safe with rare reports of toxicity leading to fast heart rate and hypomania; it has no apparent benefit for sexual function
*L-arginine is the top amino acid in men’s health supplements, featuring in one in three best sellers. It may improve erectile function in some patients and seems relatively safe. It has been associated with a drop in blood pressure but without significantly changing the heart rate
*Maca is the most common vegetable among top-selling men’s health supplements. Maca has been associated with increased sexual behavior in animals but not in humans. Rare cases of toxicity and a mild increase in liver enzymes and blood pressure have been reported.
*Tribulus promises to treat a range of conditions, but evidence is lacking to prove its effectiveness; two young men suffered liver and kidney toxicity after taking high doses. Yohimbine is a well-established product that may improve male sexual function, but it can also cause hypertension, headache, agitation, insomnia and sweating. Zinc appears to be safe but not beneficial.

How pure is my product?
Purity is a concern. Because dietary supplements are currently classified as foods rather than drugs, the manufacturers themselves are largely responsible for ensuring the safety, purity and efficacy of the products.

Four major retailers have recently been targeted by the New York attorney general for selling misleading or adulterated dietary supplements.

Dr. Ryan Terlecki, associate professor of urology and senior author, says: “While certain natural supplements we reviewed show promise for improving mild sexual dysfunction, they lack robust human evidence.”Terkecki adds that his team is unlikely to recommend the products to patients due to concerns that they are impure or ineffective.

Meanwhile, a prospective study that investigated the possible effects of Nigerian herbal remedies on semen quality involving 218 patients who attended the fertility unit of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, showed that 83.97 per cent of the patients with history of herbal intake had abnormal seminal fluid analysis while only 16.03 per cent of subjects with no history of herbal intake had abnormal result.The researchers from the Department of Medicine, Richmond University Medical Centre Staten Island, New York United States of America (USA); Department of Clinical Pharmacy, Toxicology Unit, University of Port Harcourt Rivers State; and Africa Education Initiative Research Group Nnamdi Azikiwe University Nnewi concluded: “This gives a clue of the possibility of male infertility from Nigerian herbal remedies. The reproductive health damage from consumption of Nigerian herbal remedies should be identified with in depth risk assessment.”

The study titled “Semen Abnormality And Nigerian Herbal Remedies: A Preliminary Investigation’ was published in The Internet Journal of Toxicology.

According to another recent report published in a recent issue of JAMA Internal Medicine, not only are many dietary supplements marketed for erectile dysfunction and other male sexual problems ineffective, they may not even be ‘natural.’
Pollution and infertility risk

To look at the link between infertility and air pollution, Mahalingaiah and colleagues examined data on what’s known as particulate matter – a mixture of solid particles and liquid droplets that can include dust, dirt, soot and smoke – near women’s homes and also assessed how close their residences were to major roads.

They focused on what’s known as primary infertility, when women try to conceive for at least a year without success, as well as secondary infertility, which refers to couples who struggle with conception after having at least one prior pregnancy.

When women lived close to major roads, they were five percent more likely to report primary infertility, an increase in risk that wasn’t statistically significant, meaning it might have been due to chance.

But these women were 21 percent more likely to report secondary infertility than women who lived farther away, and that increase was statistically significant, researchers report in the journal Human Reproduction.

This association was found even at relatively low concentrations of particulate matter, or less polluted air, although the connection became stronger as the pollution levels increased.

One limitation of the study, however, is that researchers didn’t know the exact dates when conception efforts started or infertility was diagnosed, making it difficult to closely examine how the timing of pollution exposure might influence the odds of pregnancy.

While the study is one of the first of its kind to follow so many women over such a long period of time, more research is needed before making medical recommendations based on the results, Mahalingaiah said.

Even so, the findings add to a growing body of evidence suggesting that pollution can negatively impact conception efforts, said Dr. Sajal Gupta, a researcher at Cleveland Clinic in Ohio who was not involved in the study.

“Couples suffering from infertility need to exercise caution especially if they are residing in areas with high ambient particulate matter,” Gupta said by email. “Relocating to areas with low contamination of particulate matter is an alternative to prevent adverse impact on fertility.”

Infertility is just one of many health problems tied to air pollution, noted Christopher Somers, a biology researcher at the University of Regina in Canada who wasn’t involved in the study.

“Air pollution is worse near major roads with high traffic volumes, so avoid living in these areas if you can,” Somers said by email. “If this is not an option, pay attention to air quality advisories and adjust outdoor activities accordingly.”