ARTICLE INFO

Article Type

Original Research

Authors

Saremi   A.T. (*)
Zamanian   M. (1)
Pooladi   A. (2)






(*) ‎“Sarem Fertility & Infertility Research Center (SAFIR)” and “Sarem Cell Research Center (SCRC)” ‎, Sarem Women’s Hospital, Tehran, Iran
(1) Sarem Women’s Hospital, Tehran, Iran
(2) ‎“Sarem Fertility & Infertility Research Center (SAFIR)” and “Sarem Cell Research Center (SCRC)” ‎, Sarem Women’s Hospital, Tehran, Iran

Correspondence

Article History

Received:  September  27, 2016
Accepted:  December 20, 2016
ePublished:  February 15, 2018

BRIEF TEXT


Infertility is defined as inability to be pregnant after one year of unprotected sexual relationship [1] ‎and it includes about 15% of couples [2]. ... [3, 4]. Male infertility is just the cause of infertility in 20% ‎of infertile couples ... [5-9].‎

The diagnosis of male infertility results in lower quality of sexual and personal life [10] and 50% can ‎be cured [11]. ... [12, 13]. The semen analysis is the first step in the study of male infertility [14], and ‎causes classification of patients to normospermia, oligospermia, asthenospermia, ‎ asthenotozoospermia, leukocytospermia, azoospermia, or a combination of these. ... [15-20]. Studies have shown that the quality of semen and fertility has decreased over the past decade [24-21]. ‎Reduced quality of semen is dependent on environmental and occupational pollutants and changes in ‎living conditions and contact with toxins and nutritional habits [25-27]. Lifestyle, excessive alcohol ‎consumption and smoking may be associated with a decrease in the level of semen plasma ‎antioxidants that may expose sperm to higher oxidative damage [28-30]. In recent years, oxidative ‎stress and the role of oxygen-dependent radicals have been identified in the pathophysiology of human ‎sperm and male infertility. Spermatozoa is continuously and persistently in contact with ‎environmental peroxidase the moment it is produced in the testicle until it is injected into the female ‎genitalia and oxidative stress is known to be one of the main causes of male infertility [31]. ... [32].‎

The evaluation of male causes of infertility is essential for the diagnosis and treatment of the ‎inappropriate causes of infertility, which can have a genetic and environmental pathology. The aim of ‎this study was to investigate the factors affecting infertility and determine the type of sperm disorder ‎in Iranian infertile men.‎

This study is a cross-sectional and community-based study.‎

This study was conducted from April 2006 to March 2011 on the infertile men referred to the Infertility ‎Department of Sarem Specialized Hospital.‎

Of the 1953 males with infertility, 1189 cases were excluded from the study due to incompleteness and ‎other entry criteria, including lack of proper collection of semen, lack of male factor, lack of sexual ‎relation avoidance 3 to 5 days before the test, consumption of antibiotic before test and other ‎collection methods except for masturbation and 764 patients with complete records were studied.‎

Population statistics such as age, occupation and duration of infertility, marital status, place of ‎residence in a city or village, smoking, alcohol and drugs, exposure to chemicals, history of disease or ‎surgery, and analysis of semen were extracted from patients' records and their characteristics entered ‎In the form of information. Sampling was done according to the WHO standard protocol [1]. If ‎necessary, hormonal and referral to the anesthetist were also carried out. Data were analyzed by SPSS 16 using mean of data and chi-square test.‎

‎470 (61.5%) had only male infertility without pure male factor and 294 (38.5%) had male infertility ‎with mixed male factor. The mean age of patients was 36.51 ± 6.68 years (Table 1). The mean LH level was 6.51 ± 5.08 international units per liter, FSH was 9.42± 10.57 international ‎units per liter, and testosterone was 5.49 ± 5.48 nmol per liter. Most patients were in their third and ‎fourth decades of life (Table 1). The highest number of cases was in the age range of 30-39 years with ‎‎442 patients (57.9%).‎ Mean duration of infertility was 5.56 ± 4.83 years. The history of infertility was more frequent in the ‎range of 2-5 years (48.7%). 593 patients (77.6%) had primary infertility and 171 (22.4%) had ‎secondary infertility. The incidence of stenotratopermia was observed in 236(30.9%) of patients and ‎stenospermia was observed in 225(29.5%) of the cases.‎ From the point of view of the job, government employees and those with free-trade were the most ‎abundant. The highest male infertility without factors of infertility was related to jobs from the ‎category of employees and free occupation, however, there was no significant relationship between the ‎job status and the male infertility (P>0.05).‎ ‎754 (98.4%) were residents of the city and 10 (1.4%) were residents of the rural areas. The most ‎patients were from Tehran and central provinces of Iran. In terms of marital status, 738 (96.6%) had ‎their first marriage and 26 (3. 4%) had their second marriage (Table 1). In total, 164 (37.2%) had varicocele, and there was no relationship between male and female infertility ‎‎(p <0.05). A total of 10 people (1.3%) had received chemotherapy. Surgery other than testicular biopsy ‎had been performed in 85 (11.1%) patients, with the highest inguinal hernia with an incidence of 28 ‎‎(3.7%) and orchiopexy with a frequency of 16 (2.1%). The relationship between type of surgeries and ‎sperm disorders was not statistically significant (p>0.05). In male patients with infertility, without ‎infertility factor, hydrocele and inguinal hernia, they had the most relationship with asthenospermia ‎and asthenotozoospermia. Among all patients, 5 patients (0.7%) had alcohol abuse and 5 patients (0.7%) had also smoked. In ‎male infertile patients without infertility factors, 3 were alcoholic and 3 were smokers. Few patients ‎‎(0.4%) were exposed to chemicals, hormonal, toxic and narcotic compounds.‎

Possible harmful effects of environmental factors such as heat and chemical agents, lifestyle including ‎diet, number of sexual relationship, cigarettes and alcohol on semen specifications have been reported ‎in Weber et al. Studies in the Netherlands [33] and Korzava et al. In Poland [34]. In the present study, like the study of Chia et al. In Brazil, the prevalence of more abnormal spermatic ‎disorders (asthenospermia and tetratozoospermia) was noticeable in government employees ‎compared to other occupations, but no correlation was found between sperm quality and occupation ‎‎[35]. In the study of Navaz et al., Patients were not exposed with chemical and toxic substances [36]. In the ‎present study, a small percentage of patients were exposed to toxic and chemical substances. This study was similar to study of Ogaga et al. in Nigeria in which the prevalence was more in ‎government servants [37].‎ In this study, varicocele rate and previous history of inguinal surgery were different with study ‎conducted by Navaz et al., in which the most common cause of obstructive azoospermia was attributed ‎to hernia repair [36]. The present study was conducted in accordance with the study of Koblan et al. In ‎Jordan in terms of higher incidence of varicocele [38]. ‎ Ogaga et al. in Nigeria showed a lack of specific pattern of spermatic anomalies in different age groups ‎‎[37], but in this study, asthenospermia and tetrazoospermia were more common than other sperm ‎disorders in most age groups. At the age of 29 years, there was a higher incidence of asthenospermia ‎and oligoasthenospermia, which was not statistically significant. A higher percentage of abnormal ‎semen was observed in the age group of 30-39 years, which was similar to the study of Ogaga et al. In ‎Nigeria [37].‎ In Navaz et al. [36], the number of marriages was similar to that of the present study. In the study of Olivia et al in Argentina, the prevalence of epididymis and orchitis was 28%, and it was ‎‎8.5% and 37% in cryptorchidism and varicocele respectively [39]. The findings of the present study ‎differed from the previous studies in terms of number, movement and sperm shape, and oligo spermia ‎was low in our study, contrary to the study by Koblan et al. In Jordan [38]. The severity of ‎asthenoteratospermia and asthenospermia disorders was higher in the study than other studies. This is ‎while, oligospermia and azoospermia were the most frequent in other studies. In terms of lesser ‎leukocyte in semen, this study was similar to the study of Wang et al. In China [40]. The reason for the ‎lower level of leukocytospermia in this study is perhaps due to better health and higher levels of our ‎patients' cognition than Navaz et al. in Pakistan. .... [41].‎

It is suggested that in addition to conducting clinical examinations and evaluation of seminal fluid, ‎environmental risk factors also be investigated. Infertile couples should be carefully consulted. ‎Investigating their spouses in the first counseling session is also necessary to minimize the negative ‎effects of the environment on male infertility. So far, extensive research has been done in this regard. ‎However, due to the lack of precise knowledge of the factors involved in the quality and quantity of ‎sperm, the diagnosis of the cause and the treatment of its disorders remain controversial. It is hoped ‎that by further research on factors involved in male infertility in the future effective step will be taken ‎in diagnosis and treatment. Since several interfering factors are effective in male infertility, comparing ‎different parameters of seminal fluid simultaneously in male patients with infertility is suggested. ‎



Individual characteristics, occupational factors, history of varicocele disease, and type of surgeries are ‎not related to the rate of infertility. The prevalence of asthenotratospermia and stenospermia among ‎Iranian infertile men is more than other disorders.‎

We are thankful to the doctors at Sarem Hospital and especially to the employees of the Sarem Hospital ‎Infertility Clinic who have contributed to the collection of information and the study.







TABLES and CHARTS

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CITIATION LINKS

[1]Rowe PJ, Comhaire FH. WHO manual for the standardized investigation and diagnosis of the infertile male. Cambridge: Cambridge University Press; 2000.
[2]Guzick DS, Swan S. The decline of infertility: Apparent or real?. Fertil Steril. 2006;86(3):524-6.
[3]Tournaye H. Evidence-based management of male subfertility. Curr Opin Obstet Gynecol. 2006;18(3):253-9.
[4]Das S, Nardo LG, Seif MW. Proximal tubal disease: The place for tubal cannulation. Reprod Biomed Online. 2007;15(4):383-8.
[5]Maheshwari A, Hamilton M, Bhattacharya S. Effect of female age on the diagnostic categories of infertility. Hum Reprod. 2008;23(3):538-42.
[6]Wilkes S, Chinn DJ, Murdoch A, Rubin G. Epidemiology and management of infertility: a population-based study in UK primary care. Fam Pract. 2009;26(4):269-74.
[7]Thonneau P, Marchand S, Tallec A, Ferial ML, Ducot B, Lansac J, et al. Incidence and main causes of infertility in a resident population (1,850,000) of three French regions (1988-1989). Hum Reprod. 1991;6(6):811-6.
[8]Mukhopadhyay D, Varghese AC, Pal M, Banerjee SK, Bhattacharyya AK, Sharma RK, et al. Semen quality and age-specific changes: A study between two decades on 3,729 male partners of couples with normal sperm count and attending an andrology laboratory for infertility-related problems in an Indian city. Fertil Steril. 2010;93(7):2247-54.
[9]Swan SH. Semen quality in fertile US men in relation to geographical area and pesticide exposure. Int J Androl. 2006;29(1):62-8.
[10]Smith J, Walsh T, Shindel A, Turek P, Wing H, Pasch L, et al. Sexual, marital, and social impact of a man's perceived infertility diagnosis. J Sex Med. 2009;6(9):2505-15.
[11]Kolettis PN. Evaluation of the subfertile man. Am Fam Physician. 2003;67(10):2165-72.
[12]Agarwal A, Makker K, Sharma R. Clinical relevance of oxidative stress in male factor infertility: An update. Am J Reprod Immunol. 2008;59(1):2-11.
[13]Everaert K, Mahmoud A, Depuydt C, Maeyaert M, Comhaire F. Chronic prostatitis and male accessory gland infection--is there an impact on male infertility (Diagnosis and therapy)?. Andrologia. 2003;35(5):325-30.
[14]Andrade Rocha FT. Semen analysis in laboratory practice: An overview of routine tests. J Clin Lab Anal. 2003;17(6):247-58.
[15]Buffone MG, Brugo Olmedo S, Calamera JC, Verstraeten SV, Urrutia F, Grippo L, et al. Decreased protein tyrosine phosphorylation and membrane fluidity in spermatozoa from infertile men with varicocele. Mol Reprod Dev. 2006;73(12):1591-9.
[16]Okeke L, Ikuerowo O, Chiekwe I, Etukakpan B, Shittu O, Olapade-Olaopa O. Is varicocelectomy indicated in subfertile men with clinical varicoceles who have asthenospermia or teratospermia and normal sperm density?. Int J Urol. 2007;14(8):729-32.
[17]Schuppe HC, Meinhardt A, Allam JP, Bergmann M, Weidner W, Haidl G. Chronic orchitis: A neglected cause of male infertility?. Andrologia. 2008;40(2):84-91.
[18]Agnew J, McDiarmid MA, Lees PS, Duffy R. Reproductive hazards of fire fighting. I. Non-chemical hazards. Am J Ind Med. 1991;19(4):433-45.
[19]Ochsendorf FR. Sexually transmitted infections: Impact on male fertility. Andrologia. 2008;40(2):72-5.
[20]Verma AK, Basu D, Jayaram G. Testicular cytology in azoospermia. Diagn Cytopathol. 1993;9(1):37-42.
[21]Resko JA. Endocrine correlates of infertility in male primates. Am J Primatol. 1982;3(Suppl 1):37-44.
[22]Kruger TF, Acosta AA, Simmons KF, Swanson RJ, Matta JF, Veeck LL, et al. New method of evaluating sperm morphology with predictive value for human in vitro fertilization. Urology. 1987;30(3):248-51.
[23]Carlsen E, Giwercman A, Keiding N, Skakkebaek NE. Evidence for decreasing quality of semen during past 50 years. BMJ. 1992;305(6854):609-13.
[24]Irvine S, Cawood E, Richardson D, MacDonald E, Aitken J. Evidence of deteriorating semen quality in the United Kingdom: Birth cohort study in 577 men in Scotland over 11 years. BMJ. 1996;312(7029):467-71.
[25]Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. Caffeinated and alcoholic beverage intake in relation to ovulatory disorder infertility. Epidemiology. 2009;20(3):374-81.
[26]Tielemans E, Burdorf A, te Velde ER, Weber RF, van Kooij RJ, Veulemans H, et al. Occupationally related exposures and reduced semen quality: A case-control study. Fertil Steril. 1999;71(4):690-6.
[27]Lopez Teijon M, Garcia F, Serra O, Moragas M, Rabanal A, Olivares R, et al. Semen quality in a population of volunteers from the province of Barcelona. Reprod Biomed Online. 2007;15(4):434-44.
[28]Braga DP, Figueira Rde C, Rodrigues D, Madaschi C, Pasqualotto FF, Iaconelli A Jr, et al. Prognostic value of meiotic spindle imaging on fertilization rate and embryo development in in vitro-matured human oocytes. Fertil Steril. 2008;90(2):429-33.
[29]Mostafa T, Tawadrous G, Roaia MM, Amer MK, Kader RA, Aziz A. Effect of smoking on seminal plasma ascorbic acid in infertile and fertile males. Andrologia. 2006;38(6):221-4.
[30]Zhu Q, Meisinger J, Emanuele NV, Emanuele MA, LaPaglia N, Van Thiel DH. Ethanol exposure enhances apoptosis within the testes. Alcohol Clin Exp Res. 2000;24(10):1550-6.
[31]Lanzafame FM, La Vignera S, Vicari E, Calogero AE. Oxidative stress and medical antioxidant treatment in male infertility. Reprod Biomed Online. 2009;19(5):638-59.
[32]Norman RJ, Noakes M, Wu R, Davies MJ, Moran L, Wang JX. Improving reproductive performance in overweight/obese women with effective weight management. Hum Reprod Update. 2004;10(3):267-80.
[33]Weber RF, Dohle GR, Romijn JC. Clinical laboratory evaluation of male subfertility. Adv Clin Chem. 2005;40:317-64.
[34]Kurzawa R, Kozanecka A, Glabowski W, Malinowska D, Rozewicki S. The analysis of the sperm parameters in view of its concentration and motility in relation to men's age and occupation. Ginekol Pol. 1998;69(6):460-5.
[35]Chia SE, Lim ST, Tay SK. Factors associated with male infertility: Sperm characteristics, strict criteria sperm morphology analysis and hypoosmotic swelling test. Int J Obstet Gynaecol. 2000;107(1):55-61.
[36]Nawaz A, Rafiq M. Male factor infertility: Five years experience. Ann Pak Inst Med Sci. 2010;6(1):7-10.
[37]Ugwuja EI, Ugwu NC, Ejikeme BN. Prevalence of low sperm count and abnormal semen parameters in male partners of women consulting at infertility clinic in Abakaliki, Nigeria. Afr J Reprod Health. 2008;12(1):67-73.
[38]Qublan HS, Al Okoor K, Al Ghoweri AS, Abu Qamar A. Sonographic spectrum of scrotal abnormalities in infertile men. J Clin Ultrasound. 2007;35(8):437-41.
[39]Oliva A, Spira A, Multigner L. Contribution of environmental factors to the risk of male infertility. Hum Reprod. 2001;16(8):1768-76.
[40]Wang AW, Politch J, Anderson D. Leukocytospermia in male infertility patients in China. Andrologia. 1994;26(3):167-72.
[41]Sharpe RM. Lifestyle and environmental contribution to male infertility. Br Med Bull. 2000;56(3):630-42.