Can Crotch Length Predict Infertility in Men?
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Rating
Can Crotch Length Predict Infertility in Men?
Our Review Summary
It gets three stars because of the number of criteria it did address. But it’s how the story failed on key criteria – such as evaluating the evidence, discussing harms and benefits – that really matters.
This was a cross sectional study in small group of men in a referral center. This type of study design is fraught with flaws, especially that one cannot make causal inferences. Obviously the length of the list of limitations the researchers address dampens any conclusions about length of a crotch.
One wonders what the journal editors or peer reviewers were thinking. Did they conclude “As long as the researchers list all the flaws in this study in a paragraph on limitations, then we’ll publish it” ???
Why This Matters
At least the story ended with appropriate caution from an independent expert, who said:
“We would all like a simple, noninvasive way to predict potential problems with fertility in men, but unfortunately, this one is not ready for prime time. We have a long way to go before we can use anogenital distance as a determinant of future fertility in men.”
Then why was it worth the story?
Criteria
Not Applicable
Not applicable. The cost of such an approach is not in question.
Not Satisfactory
Benefits are not addressed – and this ties in to our comments in the “harms” criterion above. You don’t test unless you know what good it will do. And the story is silent on that potential benefit. It just raises the picture of more testing without any discussion of benefit.
Not Satisfactory
There was no discussion of harms. But this story promotes a “simple…noninvasive way to test testicular function and reproductive potential in adult men.” So presumably one would act on the basis of what this simple test shows. That opens questions about the sensitivity and specificity of this approach – neither of which are addressed and both of which raise issues of potential harm, overtesting and overtreatment for the man.
Maybe not so “simple” as described.
Not Satisfactory
The journal article itself lists all sorts of potential limitations to the study, none of which are mentioned in the story. For example:
- Certain limitations warrant mention. As a referral center for male infertility, it was not always possible to blind observers to the men’s diagnoses or fatherhood status which theoretically can lead to observer bias.
- the current method of AGD measurement in adult men has not been studied, thus its accuracy and reproducibility were difficult to assess other than the performed comparison of measurements between investigators.
- In addition, only men referred to and evaluated in our clinic were eligible for enrollment; therefore, it is possible that our patient population does not represent all infertile men.
- It is also important to note that the fertile controls were significantly older than the infertile patients. While age was not associated with AGD after accounting for fatherhood status and no evidence of effect modification by age was found, it possible that AGD could change with age.
- In addition, while all patients were measured in the same position, some men were measured at the time of surgery under general anesthesia while others were awake. It is conceivable that anesthesia may affect measurements.
This was a cross sectional study in small group of men in a referral center. This type of study design is fraught with flaws, especially that one cannot make causal inferences. Obviously the length of the list of limitations dampens any conclusions about length of a crotch.
Satisfactory
No overt disease mongering in the story.
Satisfactory
Two independent experts were quoted – although one is identified as doing research in this field so her laudatory comments about the importance of this work might be understandable.
Not Satisfactory
No comparison is made with any other method of testing testicular function or reproductive potential in adult men.
Not Applicable
The availability of such a measurement approach is not in question.
Satisfactory
The story describes other research on short anogenital spans, so it’s clear there is other research on this topic.
Satisfactory
It’s clear that the story did not rely solely on a news release.
Total Score: 4 of 8 Satisfactory
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