Invited commentary: sleep disturbances--another threat to male fecundity?

In a cross-sectional study among 953 young Danish men (2008-2011), Jensen et al. reported that sleep disturbances showed inverse U-shaped associations with semen parameters and testis size (Am J Epidemiol. 2013;177(10):1027-1037). Sleep disturbances were associated with several factors likely to affect semen parameters (such as history of sexually transmitted infections) that cannot all be efficiently controlled for, leaving room for residual confounding. Future studies could adopt a longitudinal design and rely on objective personal measures of sleep quality and duration using accelerometers. Intervention studies would also be helpful to identify whether sleep disturbances (or improvement of sleep quality) can lead to short-term variations in semen parameters. This study adds another suspect to the list of factors possibly influencing male fecundity potential, which also includes overweight, exposure to tobacco smoke (in adulthood and in utero), exposure to specific persistent (lead, organic pollutants) and nonpersistent (some phthalates, bisphenol A) environmental pollutants, and exposure to atmospheric pollutants. Even if each of these factors has a weak impact at the individual level, the large number of factors and the relatively high prevalence of exposure in the general population make it likely that at the population level, lifestyle and environmental factors put a high burden on male fecundity potential.