THE RISK OF MALE SUBFECUNDITY ATTRIBUTABLE TO WELDING OF METALS - STUDIES OF SEMEN QUALITY, INFERTILITY, FERTILITY, ADVERSE PREGNANCY OUTCOME AND CHILDHOOD MALIGNANCY

These studies were initiated by the results of two Danish investigations of infertility clients, which indicated the reduced fecundity of male metal welders. The objective was to refute or corroborate the effects of welding on male reproductive capability and - if there was any effect - to identify the causal exposures. The initial hypothesis postulated reduced spermatogenesis, spontaneous abortion, congenital malformation and childhood malignancy following exposure to hexavalent chromium among stainless steel welders. Subsequently, a hypothesis concern with the significance of exposure to radiant heat on reduced semen quality was put forward. These studies comprised a case-referent study of infertility, cross-sectional and longitudinal studies of semen quality and historical cohort studies of fertility, pregnancy outcome and cancer in offspring. Exposure to welding was reported with a higher frequency during periods of infertility than prior to conception in the case-referent study (OR 2.0, 95% CI 1.0-4.0). This finding is consistent with the main cross-sectional study showing reduced semen quality in welders [average reduction ranging from 8% (sperm penetration rate in eggwhite) to 28% (total sperm count)] and with the cohort study revealing reduced fertility in relation to welding (OR 0.89, 95% CI 0.83-0.97). However, reduced semen quality and fertility were not attributable to the welding of stainless steel but to the welding of mild steel; and no relationship was found between biological measures of exposure to chromium and parameters of semen quality. If the unexpected association between mild steel welding and reduced fecundity is causal, the biological mechanisms involved are obscure. A separate longitudinal study leaves little doubt that moderate radiant heat exposure may cause reversible deterioration of semen quality, but it is not justified to generalize this observation to the entire population of welders. Male-mediated effects on occurrence of congenital malformation and cancer in offspring from stainless steel welding are not indicated by the studies. Weak indications of an increased risk of spontaneous abortion among partners to stainless steel welders (OR 1.9, 95% CI 1.1-3.2) need to be refuted or corroborated in future studies. Suggested effects of mild steel welding on male fecundity should be corroborated by longitudinal controlled studies of semen quality examined before and during exposure and by prospective studies of fecundability in couples trying to conceive a child. On account of the present knowledge it is not possible to recommend rational preventative measures with the exception of elimination of radiant heat exposure in cases of infertility. Temporary transfer to jobs not involving welding work should be considered when cases of unexplained infertility are encountered in clinical practice.