1. EMF and Reproductive Health Risks Ashok Agarwal Professor, Lerner College of Medicine Director, Center for Reproductive Medicine Director, Andrology Laboratory and Reproductive Tissue Bank Glickman Urological Institute Cleveland Clinic Foundation Cleveland, Ohio, USA EMF and Reproductive Health Risks Teleconference, May 21, 2012

2. Infertility represents one of the most common diseases and affects between 15 and 25% of reproductive-age couples 1 Of these, male factor infertility is responsible for approximately 50% of the infertility cases 2 1.Dunson DB, Baird DD, Colombo B. Increased infertility with age in men and women. Obstet Gynecol 2004;103:51-6. 2.World Health Organization DoRHaR. WHO laboratory manual for the examination and processing of human semen. Fifth Edition ed; 2010.

3. There are many factors that influence male fertility which deal with everyday life-style choices: Cell Phone Use Obesity Tobacco Use Environmental Pollutants Occupational Hazards Sauna and Hot Tubs Choice of Garments Alcohol use Bicycle riding Medications

4. How Cell Phones Work Cell phone is a device emitting radiofrequency electromagnetic waves (RF-EMW). Making a call: Voice  Radio Waves  Base Station Receiving a call: Base Station  Radio Waves  Voice

6. Cell Phone Usage and Male Reproduction There is correlation between cell phone usage and decreased sperm parameters Cell Phone Usage Sperm Motility 1 Normal Morphology 2 Sperm DNA Damage 3 1.Ashok Agarwal, Effect of cell phone usage on semen analysis in men attending infertility clinic: an observational study. Fertility and sterility, 2008 2.Wdowiak A, Wdowiak L, Wiktor h: Evaluation of the effect of using mobile phones on male fertility. Ann Agric Environ Med 2007, 14. 169-172 3.Eric Weterings and David J Chen,, The endless tale of non- homologous end-joining Cell Res 18 (1), 114 (2008)

7. Recent Cell Phone Studies - Supportive Studyn/ speciesage/categoryexposureParametersNotes Kesari '1012/ Wistar rats70 days old,RF-EMR 0.9 w/kgReduction in Protein Significant ~200 g bodySAR @ 2Kinase C, increaseddecrease in weight h/day x 35 daysapoptosis total sperm count as well De Iuliss '0922/ human24.1  1.1y.RF-EMRMotility & vitalityThermal normospermic 1.8 GHz @significant decrease,effect 0.4 W/kg - 27.5mitochondrial ROS minimized W/kg SAR.significant increased,via incubated at 8-OHdG significantincubation 21°C for 16 hincreased for 2h Agarwal '0932/ human28.2  4.1y.RF-EMR 850 MHzMotility & viability Phones were Normospermic@ 1.46 W/kg.significantly decreased,kept in talk (23 men), andExposed atincreased ROS mode, no oliogospermicdistance of level, decreased difference was (9 men) 2.5 cm for 60 min ROS-TAC score found in DNA damage Agarwal '08361/ human31.81  6.12y. [Retrospective]Decreased spermAnalyzed Normospermic (297), 4 groups: count, motility,difference between oligospermic (64) no use, little viability, andnormospermic & use ( 4h/day)effects are same

8. Cleveland Clinic’s Study An Observational study 361 men undergoing infertility evaluation divided in 4 groups by cell phone use. Group A: no use (n = 40); Group B: 4 h a day (n = 114) 8 sperm parameters (volume, liquefaction time, pH, viscosity, sperm count, motility, viability and morphology) evaluated Agarwal et al, Fertil Steril, 2008

10. Sperm parameter profile for cell phone use groups. The x-axis lists eight sperm parameters: 1 = volume; 2 = liquefaction time; 3 = pH; 4 =viscosity; 5 = sperm count; 6 = motility; 7 = viability; and 8 = percent normal morphology 0 20 40 60 80 100 Group mean Sperm parameters 12345678 No use <2 hrs/day 2-4 hrs/day >4 hrs/day Ashok Agarwal, Effect of cell phone usage on semen analysis in men attending infertility clinic: an observational study. Fertility and sterility, 2008

12. Our Conclusions Use of cell phones by men is associated with a decrease in semen quality Decrease in sperm count, motility, viability and normal morphology was related to the duration of cell phone use

13. Cell Phone Usage: Summary There is a correlation between cell phone usage and decreased sperm parametersThere is a correlation between cell phone usage and decreased sperm parameters Cell phones can affect sperm via microwaves, thermal increase, or a combination of bothCell phones can affect sperm via microwaves, thermal increase, or a combination of both Duration of cell phone possession and usage associated with decreased sperm mobility, increased DNA damage, and increased abnormal morphologyDuration of cell phone possession and usage associated with decreased sperm mobility, increased DNA damage, and increased abnormal morphology Substantial controversy surrounding cell phone study results due to lack of proper control group, non-standardized testing protocol, use of animal models with different geometry than humans and contradictory resultsSubstantial controversy surrounding cell phone study results due to lack of proper control group, non-standardized testing protocol, use of animal models with different geometry than humans and contradictory results As the future brings more high tech mobile devices, their SAR and internal temperatures continue to increase, possibly creating a higher risk to the male userAs the future brings more high tech mobile devices, their SAR and internal temperatures continue to increase, possibly creating a higher risk to the male user

14. RecommendationsRecommendations U se your phone as little as possible, and only when you have no alternatives such as sending a text or using a landline insteadU se your phone as little as possible, and only when you have no alternatives such as sending a text or using a landline instead Keep your calls shortKeep your calls short Try to avoid using your phone if the signal strength is lowTry to avoid using your phone if the signal strength is low Hands-free kit can reduce the SAR in the head while the person is on the phone but may increase SAR for the rest of his bodyHands-free kit can reduce the SAR in the head while the person is on the phone but may increase SAR for the rest of his body