© 2004 by Oxford University Press
© 2004 Oxford University Press
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Fecundity and Twinning Rates as Measures of Fertility Before Diagnosis of Germ-Cell Testicular Cancer
Affiliations of authors: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (LR, ML); Unit of Cancer Epidemiology, Centro Ricerca Medicina Sperimentale (CeRMS) and Center for Oncologic Prevention, University of Turin, Turin, Italy (LR); Clinical Epidemiology Unit, Department of Medicine (OA, SMM, AE), Andrology Center, Department of Woman and Child Health (UK), Karolinska Hospital, Stockholm; Department of Epidemiology, Harvard School of Public Health, Boston, MA (AE).
Correspondence to: Lorenzo Richiardi, MD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, SE-171 77 Stockholm, Sweden (e-mail: lorenzo.richiardi{at}meb.ki.se)
Previous studies have suggested an association between subfertility and testicular cancer by using fecundity and semen characteristics to measure fertility. The occurrence of twinning in offspring may be used to investigate male reproductive health, because dizygotic twinning is reduced by male subfertility. We therefore assessed number of children and offspring twinning rates among 4592 Swedish patients with testicular cancer and 12 254 control subjects. Before diagnosis, case patients had a decreased number of children (for testicular cancer, odds ratio [OR] = 0.71, 95% confidence interval [CI] = 0.62 to 0.81; at least three children compared with no children), with a lower frequency of dizygotic twinning (for unlike-sex twins, OR for the father having testicular cancer = 0.49, 95% CI = 0.22 to 1.08). The ratio of unlike-sex to same-sex twins was 0.22 among children of case patients and 0.66 among children of control subjects (adjusted P = .03, two-sided Wald test). We also found an increased occurrence of twinning after diagnosis, probably attributable to treatment for iatrogenic subfertility. Our study strongly supports evidence of an association between subfertility and the subsequent risk for testicular cancer.
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