This preliminary study evaluated patients’ satisfaction with an interview with an occupational physician that took place during the first semen analysis of infertile males. We also assessed the general knowledge of these patients about reprotoxic exposures.
Level of reprotoxic knowledge
The mean score for general knowledge of reprotoxicants shows that patients are quite aware of the association of infertility and risk factors. There are very few articles in the literature about this subject. In Hussain T. et al.’s  awareness evaluation of the general population based one-on-one interviews, correct responses were limited (for example, 43 % and 48 % of males considered mumps and smoking, respectively, as culprits). Remes O. et al.’s  semi-structured interviews showed that students had a superficial understanding of the environmental risks associated with environmental contaminants, sexually transmitted diseases and lifestyle and that at times, they relied on media reports and anecdotal information to support their beliefs. The researchers concluded that patients exhibited a general understanding of environmental risks associated with infertility but that young adults are overly optimistic that healthy lifestyle behaviors will safeguard their future fertility. No awareness or knowledge scores were found in the literature.
We observed that excessive heat was underestimated as a reprotoxic risk factor, although it was the most frequently reported reprotoxic exposure in our study and is a recognized reprotoxic factor [2, 9, 10]. Despite the widespread nature of this occupational reprotoxic exposure, patients do not take it as seriously as they should. Several studies have examined the prevention of heat-related illnesses among outdoor workers in warm countries [11, 12], farmers , and bus drivers  and have managed to reduce heat-related morbidity. All of these studies examined all types of heat-related illness (and not specifically fertility impairment), but they indicate a trend toward developing heat-related regulations or guidelines to minimize the risk of occupational heat infertility in affected men. Concentrating efforts on increasing awareness of heat exposure could be an efficient prevention strategy for preserving men’s reproductive health.
Moreover, a comparison of the responses indicating that patients thought they had an occupational reprotoxic exposure before the occupational physician’s interview and having an exposure registered by the occupational physician shows that 1) patients who are aware of the risk of exposure are correct; 2) approximately 2 out of 3 unaware patients underestimate their exposure to both physical and chemical reprotoxic factors; 3) no patient overestimated his exposures.
Patients’ sources of information about reprotoxicants
According to our satisfaction survey, the patients learned about reprotoxic exposure risks through billboard campaigns and from a not dedicated medical consultation. No specific study has assessed the best way for a reprotoxic prevention campaign to be efficient, but several campaigns have successfully increased workers’ awareness of occupational risks: Quach T. et al. trained managers and owners of nail salons to reduce exposure to solvents ; Malchaire J. et al. trained small groups of workers using a 4-step program ; and Riedel JE. et al. described an example of a new “health and productivity dashboard” . Such information sources could be applied to reprotoxic exposure prevention in the future.
The preventive role of occupational medicine
We observed that a minority of patients (1/30) received information through their company’s occupational physician, despite having seen him/her in the past 6 months (19/47). This finding suggests that discussing reprotoxicants with patients is not a priority of such consultations, even when the patients are of reproductive age.
Patients’ rights regarding chemical exposures are clearly addressed in the labor laws, but little is mentioned about physical exposure. Additionally, the European REACH regulations address the effects of chemical toxicants on reproduction and development. Nevertheless, our results demonstrated that physical reprotoxic exposures are very common, and to our knowledge, no regulations are available for physical reprotoxic exposure (except for ionizing radiations). This could also explain the lack of information and preventive efforts provided by occupational physicians.
The patients’ poor self-assessments of their reprotoxic exposures during the occupational consultation could also be related to another important factor that was assessed in previous studies: patients may avoid talking about personal health problems at work even if the occupational physician could improve them, because the patients are 1) ignorant of the role and skills of occupational physicians; 2) doubtful of the occupational physician’s competence; and 3) uncertain about the occupational physician’s independence from their employer and do not want to have their intimate health matters revealed to the company .
In our study, 6 out of 49 patients reported having received information during a medical consultation, likely from a specialist other than their occupational physician. In our population, we can estimate that at least 10 % (5/49) of the patients did not have any link to occupational medicine because they were not salaried workers (1 secondary school teacher, 1 student, 1 dentist and 2 unemployed patients). We suggest that general practitioners should be in a position to inform such patients. Although many studies show that professional collaboration between occupational physicians and general practitioners is difficult [18, 19], other studies also show that there are no significant factors that encourage patients to choose between their general practitioner or their occupational physician regarding health matters at work .
Impact of the reprotoxic exposure analysis on patients
In their responses to the first questionnaire of the survey, a majority of the patients declared being willing to change their individual (92 %) and professional (63 %) behaviors regarding reprotoxic exposures; only 8 % of the patients would not make any changes. In their responses to the second questionnaire (2 months later), 38 % of the patients reported having changed their professional habits, and 46 % reported having changed their personal habits. These results could suggest 1) sufficient pre-existing use of preventive measures (10/49 patients declared in the first questionnaire that they had access to protection devices, and 9/49 reported that they used them all the time or frequently); 2) a pre-existing change in patients’ behaviors in response to their hope to achieve pregnancy without waiting for advice from the occupational physician; and 3) an unconscious resistance to behavior changes .
Indications and perspectives for reproductive health
The routine collaboration between reproductive and occupational medicine could improve the management of infertile men by allowing a better detection, characterization and eviction of reprotoxic exposures by using the specific skills of occupational physician in a separate interview. It could also increase the patient’s perception of the reprotoxic exposures he faces in his domestic and occupational environments, allowing a more active behavior to protect himself from these reprotoxicants. Moreover, occupational physicians are qualified to help employees and employers to insure a safer working environment, which could benefit to infertile patients but also to other young employees willing to conceive. We hypothesize that the setup of this collaboration at the beginning of the patient’s Assisted Reproductive Therapy path could improve the patient’s reproductive and general health, which is an important issue when building a family.
Limitations of our study are: a) the size of our population, which might not confer adequate statistical power; b) the rate of patients who did not want to participate to the second part of the satisfaction survey or were lost of follow-up (47 % of included patients), which may be due to the relatively long delay between the two questionnaires (two months); c) the exclusion of patients without a good command of the French language or who did not want to participate, which could alter the estimation of the general knowledge about reprotoxicants in the population of infertile men.