Assessment of fertility among mustard-exposed residents of Sardasht, Iran: a historical Cohort study

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Abstract

Background: Mustard gas (HD) is an alkylating agent with mutagenic and carcinogenic effects. Previous reports have demonstrated the ability of this class of compounds to cause adverse reproductive effects, however as of the time of this writing, few correlations have been established between HD exposure and human infertility. In the present study we hypothesize that infertility among mustard-exposed individuals is higher than among the general population. Methods: 117 couples, 90 with at least one partner, and 27 with both partners exposed to HD in June 1987, were evaluated for occurrence of infertility (defined as the failure to conceive after 12 months of unprotected intercourse). Two groups of subjects were considered in order to establish dose-responsive effect of HD on fertility. One cohort was married at the time of exposure and were evaluated in a time period 12 months from that date. The second cohort married after the date of exposure and each couple was evaluated for a year during a period following marriage. Measurements of these subjects were compared with worldwide incidence of fertility. Results: A 7.5% rate of infertility was observed among couples who were married at the time of exposure; and a rate of 10.3% was noted among individuals single at exposure and subsequently married, for an overall rate of 8.3%, which compares with a worldwide rate of 10–15%. Conclusions: This study showed that within a population of HD-exposed individuals, elevated environmental levels of the agent during a time period in which couples were actively attempting to conceive, failed to correlate with increased risk of infertility. However, these results must be interpreted with caution based on experimental design which limits the definition of infertility to one 12 month time period.

Section snippets

Introduction:

Sulfur mustard [bis(2-chloro-ethyl) sulfide], designated HD and often referred to as mustard gas, is one of a class of chemical weapons known as “blister agents” that has seen wide tactical employment against military targets and has also been used by Iraqi forces during the Iran–Iraq war of the 1980s to terrorize civilian populations in both combatant nations. The acute and long-term effects of HD exposure have been studied extensively [1]. At the time of this writing, however, comparativley

Subjects

Subjects for this study were recruited from surviving residents of Sardasht who sustained exposure to sulfur mustard during the 1987 attack. Documents maintained by military and civil authorities in the Sardasht region confirm that approximately 4500 people in total were exposed to mustard agent as a result of the incident. Of these, records confirming early clinical manifestations of exposure and subsequent medical complications were available for 735 survivors. Demographic information on all

Results

The 115 couples participating in this study were evaluated for exposure to mustard based on gender and time of marriage relative to the attack of June 1987. When ratios of mustard-exposed to non-exposed subjects and their gender distribution were considered it was seen that in 88 of these cases only one partner had been exposed. In the remaining 27 couples both partners sustained exposure to the agent. Of the 230 individual participants, 142 were mustard-exposed; 96 (68%) of these male and 46

Discussion

In this report we describe reproductive trends among a population exposed to sulfur mustard, a lipophilic alkylating agent used extensively in the war between Iran and Iraq during the 1980s, against both Iranian combatants and its civil population, particularly in the border areas [7]. Previous investigations have established correlation between exposure to alkylating agents and infertility [8], [9], [10], [11]. Hence, we hypothesized that the1987 chemical attack by Iraqi forces on Sardasht

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