Ten terms were then selected based on having the highest total engagements for BuzzSumo interrogation: fertility in men, low sperm treatment, male fertility, male fertility testosterone, male infertility, semen analysis, sperm count, sperm motility, sperm quality, and sperm testosterone.Fig. 1 summarizes the workflow for selecting article links from final search term results. The most popular article links for each search term were identified, fol lowed by analysis of social media engagement. Links were excluded if they were not written in the English language, were not related to male infertility, were audio podcasts, were broken/expired, or had fewer than 100 total engagements, a metric that has been used in prior investigations to exclude low impact content. Two medical student reviewers with curricular training in critical evaluation of the literature independently graded content as accurate, misleading, or inaccurate by assessing references cited, as well as comparing the content to existing peer-reviewed literature . Article links were classified as inaccurate if the content was not supported by scientific literature. Content was classified as misleading if it contained a combination of accurate and inaccurate information, or if it extrapolated animal data to make inappropriate conclusions about human fertility. The senior authors, two urologists with advanced fellowship training in male reproductive medicine, were blinded to the two reviewer decisions and adjudicated all discordances. Cohen’s κ was used to calculate inter-rater reliability between the two independent reviewers. Binary logistic regression was used to compare user engagement with accurate versus inaccurate/misleading article links; a separate regression was run for total engagement,hydroponic table to limit collinearity among variables. Statistical significance was set at p<0.05. Statistical analysis was per formed using IBM SPSS ver. 25 .
After applying exclusion criteria, eight search terms and 52 article links remained. Of the original ten search terms, the two exclusions due to insufficient engagement were “male fertility testosterone” and “low sperm treatment.” The 52 article links were stratified into four categories: scientific peer-reviewed journal, medical center or hospital affiliated website, news organization website, and alternative media . Overall, the majority of links came from websites in the alternative media category , followed by news organizations . Scientific peer-reviewed journal websites and medical center websites comprised the fewest article links, at 8% and 2%, respectively. High-engagement articles hosted on alternative media websites were more accurate compared to misleading/inaccurate . Articles from each remaining category tended to have similar user engagement between accurate and misleading/inaccurate content . Table 2 outlines engagement data stratified by search term and social media platform. “Sperm count” emerged as the most popular search term, capturing 50% of the total engagement across all platforms. Facebook was the most popular platform for sharing male infertility content , followed by Reddit , Twitter , and Pinterest . All search terms experienced highest engagement on Facebook, with the exception of “fertility in men,” which was most popular on Reddit. Overall, 56% of articles were graded as accurate and 44% as misleading or inaccurate . No significant difference was found in engagements between ac curate versus inaccurate/misleading links . Fifteen peer-reviewed research studies comprised the primary citations used by 34 of the 52 total articles links. The remaining 18 links did not cite original peer-reviewed scientific studies, or purported study data were not accessible. Of the 34 links with scientific evidence, 17 referenced the same two original research studies and captured twice as many engagements as the remaining 13 studies combined.
Studies relying upon animal or insect models Though male infertility content proliferates on the internet, little is known about the sources and quality of information encountered by users who may make health care decisions based on what they read online. Prior work has shown that misinformation about urological conditions thrives on social media, but an in-depth analysis of male infertility content has been lacking. To this end, we quantified internet user engagement with male infertility content across a variety of social media platforms, then evaluated the accuracy of information shared on these platforms. We found that social media users encounter misleading or inaccurate information about male infertility at similar rates to accurate content. Nearly a quarter of user engagement focused on article links reporting on experimental results in non-human models, and 90% of these articles were determined to be misleading – the original studies were routinely misinterpreted as having immediate implications for human fertility, then amplified on social media. For example, in a study by Sales et al, male insects exposed to increasing heatwave conditions had significantly lower sperm function and offspring production, and this effect showed transgenerational impact. The study draws no conclusions about human fertility, yet an article in USA Today reported, “…[T]he scientists used beetles to test their theory. But researchers say the insects can be used as a proxy for people,” and concluded that human fertility is directly impacted by climate change. Despite the inappropriate extrapolation, the USA Today link alone received a total of 21,812 social media engagements. We found that over 90% of male infertility content online comes from non-peer-reviewed sources, such as news organizations and alternative media . These data suggest that the scientific and medical establishment have limited traction with an increasingly sensationalized consumer culture. Scientific journal and medical center websites typically target their male infertility content toward scientifically literate health care professionals, rather than the general public. A potential way to mitigate the misinterpretation of scientific research may be for academic institutions to take a greater role in creating press releases or making researchers available for news media comment. The proliferation of misleading conjectures about scientifically sound research becomes subjected to the “illusory truth effect,” the tendency to believe false in formation to be accurate due to repeated exposure.
Sensationalism on social media perpetuates unrealistic expectations of fertility treatments and can have significant economic implications for infertile couples, whose out-of-pocket expenditures related to male factor infertility may reach $15,000 in their quest to conceive a pregnancy. Indeed, a thriving market for male fertility vitamins and nutritional supplements has emerged online despite a paucity of evidence for a positive effect on semen analysis parameters. Although 15 research studies were cited in article links over the one-year study period, just two of these studies drew 50% of citations. The most popular study focused on the effect of marijuana smoking on sperm parameters and reproductive hormones, and the authors of this study cautioned that their data may not be generalizable to men from the general population. The other study that drew the second highest engagements examined the effect of chemical exposures on sperm function using a limited sample size of only nine humans and a comparison group of eleven canines,grow rack yet was featured in an article link that inappropriately generalized the data to imply wide translatability of the results. Our findings suggest that a few studies are tokenized and amplified to guide discussion about male infertility on social media, despite having crucial limitations that are overlooked. We also found that the most popular social media platform to share male infertility content was Face book with 3× more engagements than Reddit and 56× more engagements than Twitter . Facebook’s higher level of engagement may be attributed to its in depth engagement dimensions and primary purpose of connecting with friends and family. For example, Facebook has a larger audience of various age ranges and users have the ability to share videos and engage with posts on a longer-term basis. This is in stark contrast to Twitter, whose primary purpose is to share ideas in 140 characters or less in a fast-paced nature making it difficult for posts to gain traction for very long as posts become quickly buried by new Tweets. Reddit is another platform which allows for longer term engagement with conversations within Reddit subforums, which may account for it being the plat form with the second highest engagements. Our findings suggest that platforms with the ability to keep posts visible to users for longer periods of time plays a role in overall engagements. Overall, our study findings highlight the need to facilitate online health interventions designed to offer users men’s health information that is both accurate, engaging, and tailored to the general public. Discussions about male infertility are no longer occurring in the confines of medical offices and urologists should consider adding social media to their armamentarium to stave off misinformation and engage proactively with patients. The present study is not without limitations. This study focuses only on the accuracy and engagement of male infertility content; little is known on how that engagement directly influences an individual’s behaviors beyond the act of “sharing,” “liking” or “commenting” on social media.
We acknowledge that engagement with the content on social media does not equate to attributing the links content to be accurate by the user. Additionally, our study has the underlying assumption that all social media platforms allow users to engage similarly without accounting for the unique experience and engagement dimensions each platform offers. Fur ther investigation into this topic may allow for better stratification of how users engage with male infertility content.To ensure that chemical transmission in the nervous system occurs with high spatial and temporal resolution, neurotrans mitters released into the synaptic cleft are rapidly disposed of by a variety of mechanisms of inactivation. These fall into two main categories: reuptake into cells mediated by transporter proteins terminates the synaptic effects of biogenic amines, glutamate and y-aminobutyrate, while breakdown by ex tracellular hydrolyzing enzymes terminates the effects of ace tylcholine, and participates in the inactivation of many neuropeptides. Because of these essential regulatory functions, neurotransmitter-inactivating processes have provided targets for drugs of both experimental and clinical significance, ranging from amine reuptake blockers to acetylcho linesterase inhibitors. The abundant expression of cannabinoid receptors in brain and the behavioral consequences of their stimulation by drugs have led to suggest that an endogenous cannabinoid system exists in brain, which may participate in modulating such diverse brain functions as cognition, emotion and movement. Anandamide , a cannabinoid receptor agonist isolated from brain tissue, is thought to be a central component of this modulatory system. Anandamide mimics many of the pharmacological effects of can- nabinoid drugs both in vitro and in vivo, and is produced in and released from neurons in an activity-dependent manner. Two potential mechanisms of anandamide inactivation have been described. An enzyme activity, abundant in brain and liver, catalyses the hydrolysis of anandamide to arachi donic acid and ethanolamine. This amidohydrolase activity is enriched in areas of the rat central nervous system that contain high densities of cannabinoid receptors, suggest ing that it may contribute to anandamide degradation at its sites of action. In addition to enzymatic hydrolysis, evidence for the existence of an anandamide transport system has been provided in primary cultures of rat brain neurons. Do these mechanisms participate in the physiological inactivation of anandamide and, if so, what are their relative roles? These questions have been difficult to address, partly because selective pharmacological blockers of anandamide in activation are not yet available. In the present study we show that the bromoenol lactone, -6- tetrahydro-3–2H pyran-2-one , a mechanism-based inhibitor of Ca2+-independent phospholipase A2, is also potent in preventing anandamide hydrolysis both in vitro and in situ. Its distinctive chemical structure and pharmacological proper ties may make it an interesting lead for the development of more potent and selective inhibitors of anandamide hydroly sis. There is both experimental and therapeutic interest in de veloping potent and selective inhibitors of anandamide hy drolysis. This has recently led to identify a group of polyun saturated fatty acyl trifluoromethylketones which may act astransition-state inhibitors of this enzyme activity. One such compound, AATFMK , prevents anandamide hydrolysis in subcellular fractions of neuroblastoma N18TG2 cells, where it displays an IC5 0 of 0.7-3 uM. Under our exper imental conditions, AATFM K effectively inhibited ananda mide amidohydrolase activity, although 5-fold less potently than BTNP . To obtain evidence that BTNP acts through a direct inter action with the enzyme responsible for anandamide hydroly sis, we examined the inhibitory effects of this drug after frac tionation of the enzyme activity by FPLC. In three experiments, we applied samples of non-solubilized rat brain microsomes to a MonoQ column, eluted the proteins with a NaCl gradient, and measured anandamide amidohydrolase activity in the column eluate.