Cell Phone Use and Male Reproduction: Effects on Semen Quality

1. Ashok Agarwal Professor, Lerner College of Medicine Director, Center for Reproductive Medicine Director, Andrology Laboratory and Reproductive Tissue Bank Glickman Urological Institute Cleveland Clinic Foundation Cleveland, Ohio, USA EMF and Reproductive Health Risks EMF and Reproductive Health Risks Teleconference, May 21, 2012

2. Infertility represents one of the most common diseases and affects between 15 and 25% of reproductive-age couples 1 Of these, male factor infertility is responsible for approximately 50% of the infertility cases 2 1.Dunson DB, Baird DD, Colombo B. Increased infertility with age in men and women. Obstet Gynecol 2004;103:51-6. 2.World Health Organization DoRHaR. WHO laboratory manual for the examination and processing of human semen. Fifth Edition ed; 2010.

3. There are many factors that influence male fertility which deal with everyday life-style choices: • Cell Phone Use • Obesity • Tobacco Use • Environmental Pollutants • Occupational Hazards • Sauna and Hot Tubs • Choice of Garments • Alcohol use • Bicycle riding • Medications

4. How Cell Phones Work • Cell phone is a device emitting radiofrequency electromagnetic waves (RF-EMW). • Making a call: Voice Radio Waves Base Station • Receiving a call: Base Station Radio Waves Voice

6. Cell Phone Usage and Male Reproduction There is correlation between cell phone usage and decreased sperm parameters Cell Phone Usage Sperm Motility1 Normal Morphology2 Sperm DNA Damage3 • 1.Ashok Agarwal, Effect of cell phone usage on semen analysis in men attending infertility clinic: an observational study. Fertility and sterility, 2008 • 2.Wdowiak A, Wdowiak L, Wiktorh: Evaluation of the effect of using mobile phones on male fertility. Ann Agric Environ Med 2007, 14. 169-172 • 3.Eric Weterings and David J Chen, , The endless tale of non-homologous end-joining Cell Res 18 (1), 114 (2008)

7. Recent Cell Phone Studies - Supportive Study n/ species age/category exposure Parameters Notes Kesari '10 12/ Wistar rats 70 days old, RF-EMR 0.9 w/kg Reduction in Protein Significant ~200 g body SAR @ 2 Kinase C, increased decrease in weight h/day x 35 days apoptosis total sperm count as well De Iuliss '09 22/ human 24.1 1.1y. RF-EMR Motility & vitality Thermal normospermic 1.8 GHz @ significant decrease, effect 0.4 W/kg - 27.5 mitochondrial ROS minimized W/kg SAR. significant increased, via incubated at 8-OHdG significant incubation 21°C for 16 h increased for 2h Agarwal '09 32/ human 28.2  4.1y. RF-EMR 850 MHz Motility & viability Phones were Normospermic @ 1.46 W/kg. significantly decreased, kept in talk (23 men), and Exposed at increased ROS mode, no oliogospermic distance of level, decreased difference was (9 men) 2.5 cm for 60 min ROS-TAC score found in DNA damage Agarwal '08 361/ human 31.81  6.12y. [Retrospective] Decreased sperm Analyzed Normospermic (297), 4 groups: count, motility, difference between oligospermic (64) no use, little viability, and normospermic & use (<2h/day), morphology with oligospermic. mid use (2-4h/day), increased use. Found no difference. high use (>4h/day) effects are same

8. Cleveland Clinic’s Study • An Observational study • 361 men undergoing infertility evaluation divided in 4 groups by cell phone use. Group A: no use (n = 40); Group B: < 2 h a day (n = 107); Group C: 2 - 4 h a day (n = 100) and Group D: > 4 h a day (n = 114) • 8 sperm parameters (volume, liquefaction time, pH, viscosity, sperm count, motility, viability and morphology) evaluated Agarwal et al, Fertil Steril, 2008

10. 100 No use <2 hrs/day 2-4 hrs/day >4 hrs/day 80 60 Group mean 40 20 0 1 2 3 4 5 6 7 8 Sperm parameters Sperm parameter profile for cell phone use groups. The x-axis lists eight sperm parameters: 1 = volume; 2 = liquefaction time; 3 = pH; 4 =viscosity; 5 = sperm count; 6 = motility; 7 = viability; and 8 = percent normal morphology • Ashok Agarwal, Effect of cell phone usage on semen analysis in men attending infertility clinic: an observational study. Fertility and sterility, 2008

12. Our Conclusions • Use of cell phones by men is associated with a decrease in semen quality • Decrease in sperm count, motility, viability and normal morphology was related to the duration of cell phone use

13. Cell Phone Usage: Summary • There is a correlation between cell phone usage and decreased sperm parameters • Cell phones can affect sperm via microwaves, thermal increase, or a combination of both • Duration of cell phone possession and usage associated with decreased sperm mobility, increased DNA damage, and increased abnormal morphology • Substantial controversy surrounding cell phone study results due to lack of proper control group, non-standardized testing protocol, use of animal models with different geometry than humans and contradictory results • As the future brings more high tech mobile devices, their SAR and internal temperatures continue to increase, possibly creating a higher risk to the male user

14. Recommendations • Use your phone as little as possible, and only when you have no alternatives such as sending a text or using a landline instead • Keep your calls short • Try to avoid using your phone if the signal strength is low • Hands-free kit can reduce the SAR in the head while the person is on the phone but may increase SAR for the rest of his body