PONE-D-21-13270

Land use and semen quality: a fertility center cohort study

PLOS ONE

Dear Dr. Kim,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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PLOS ONE

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

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Reviewer #1: Yes

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Reviewer #1: Yes

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5. Review Comments to the Author

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Reviewer #1: The authors report on 5886 men presenting for infertility evaluation in whom various markers of the ‘built-up environment’ were assessed for their impact on semen quality. Specifically, the distance to fresh-water, to the coast and to major roadways, and the neighbourhood ‘greenness index’, described as the Normalized Difference Vegetation Index [NDVI] as assessed from satellite data. A single semen analysis used during infertility evaluation was assessed for various routine parameters.

The great majority of the patient base were white collar workers with an average age of 39 and a normal- overweight BMI. Smoking rates are very high in this population of 51%. These matters were considered in the analyses.

The principle conclusion was that there was no clear association between parameters of the built-up environment and semen quality other than for the NDVI and sperm vitality. There was also some relationship between proximity to fresh water and semen quality, and of sperm vitality and distance from major roadways. All these data point to some association between the relative ‘greenness of the environment’ and semen quailty amongst men with infertility.

The authors rightly acknowledge the limitations of the study and the mechanism by which any effects may occur remains obscure and a matter of speculation. This study is intriguing and in broad terms points toward the need to understand the environment and lifestyle impact on semen quality and to take measures to ensure that the environment and lifestyle factors are optimised to promote fertility. In the Korean population, the attention clearly needs to be paid to the extraordinary smoking rates which would be deleterious to semen quality.

I have a few minor comments:

1. In terms of proximity to water, the question rises to what type of water? They mention rivers and lakes. Can these vary in the quality of the water in those sites, for example, are there any which are heavily polluted and therefore, amongst men proximal to those, might beneficial effects pf water proximity disappear?

2. The data description I think distances can be expressed to the nearest metre, for example, 486.7m can fairly be rounded to 487m for the purposes of this discussion to make the figures easier to read.

3. The effects do not appear to be dose related. Similarly, when they asked about smoking, it was a Yes or No question. Is it possible to consider those who are very heavy smokers as opposed to minimal smokers and see if there might be some interaction which was not taken into account in the existing statistical approach?

4. Line 191 – They talk about motility being highest in the second quartile, distance from roadway and lowest in the fourth quartile. Why could such a relationship be so non-linear, in other words, why is the first quartile lower than the second? Theoretical reasons might underlie that observation.

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Reviewer #1: No

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Land use and semen quality: a fertility center cohort study

PONE-D-21-13270R1

Dear Dr. Kim,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Stefan Schlatt

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The authors have dealt with all questions of the reviewer. They have added additional comments to the manuscript and explained a few critical points.