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. 2011 May 11;6(5):e18973.
doi: 10.1371/journal.pone.0018973.

The relationship between anogenital distance, fatherhood, and fertility in adult men

Michael L Eisenberg  1 , Michael H Hsieh, Rustin Chanc Walters, Ross Krasnow, Larry I Lipshultz
Affiliations

The relationship between anogenital distance, fatherhood, and fertility in adult men

Michael L Eisenberg et al. PLoS One. .

Abstract

Background: Anogenital distance (AGD), a sexually dimorphic measure of genital development, is a marker for endocrine disruption in animal studies and may be shorter in infant males with genital anomalies. Given the correlation between anogenital distance and genital development, we sought to determine if anogenital distance varied in fertile compared to infertile adult men.

Methods: A cross sectional study of consecutive men being evaluated for infertility and men with proven fertility was recruited from an andrology clinic. Anogenital distance (the distance from the posterior aspect of the scrotum to the anal verge) and penile length (PL) were measured using digital calipers. ANOVA and linear regression were used to determine correlations between AGD, fatherhood status, and semen analysis parameters (sperm density, motility, and total motile sperm count).

Findings: A total of 117 infertile men (mean age: 35.3±17.4) and 56 fertile men (mean age: 44.8±9.7) were recruited. The infertile men possessed significantly shorter mean AGD and PL compared to the fertile controls (AGD: 31.8 vs 44.6 mm, PL: 107.1 vs 119.5 mm, p<0.01). The difference in AGD persisted even after accounting for ethnic and anthropomorphic differences. In addition to fatherhood, on both unadjusted and adjusted linear regression, AGD was significantly correlated with sperm density and total motile sperm count. After adjusting for demographic and reproductive variables, for each 1 cm increase in a man's AGD, the sperm density increases by 4.3 million sperm per mL (95% CI 0.53, 8.09, p = 0.03) and the total motile sperm count increases by 6.0 million sperm (95% CI 1.34, 10.58, p = 0.01). On adjusted analyses, no correlation was seen between penile length and semen parameters.

Conclusion: A longer anogenital distance is associated with fatherhood and may predict normal male reproductive potential. Thus, AGD may provide a novel metric to assess reproductive potential in men.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Anogenital distance as measured with men in supine, frog-legged position.
Figure 2
Figure 2. Distribution of anogenital lengths in men that were childless and being evaluated for infertility and men with proven fertility.
Figure 3
Figure 3. Bland-Altman plot showing the difference in anogenital distance (AGD; Plot A) and penile length (PL, Plot B) measurements as recorded by separate investigators.
Figure 4
Figure 4. Boxplot showing the interquartile range (IQR) of the total motile sperm count stratified by anogenital lengths.
Median value is denoted with horizontal bar. Whiskers designate 1.5× IQR.
See this image and copyright information in PMC

Comment in

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