|Year : 2019 | Volume
| Issue : 2 | Page : 79-83
Association of demographic and lifestyle factors with semen quality of men with fertility problems attending infertility center in North Karnataka
Makhadumsab M Toragall1, Sanat K Satapathy2, Girish G Kadadevaru3, Murigendra B Hiremath1
1 Department of Biotechnology and Microbiology, Karnatak University, Dharwad, Karnataka, India
2 Department of Hubli Assisted Conception Centre, Hubli, Karnataka, India
3 Department of Zoology, Karnatak University, Dharwad, Karnataka, India
|Date of Submission||10-Jan-2019|
|Date of Decision||11-Mar-2019|
|Date of Acceptance||25-Mar-2019|
|Date of Web Publication||24-May-2019|
Dr. Murigendra B Hiremath
Department of Biotechnology and Microbiology, Karnatak University, Pavate Nagar, Dharwad - 580 003, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Male factor is responsible for 50% of infertility cases. Universal deterioration in human sperm quality occurring in recent times is receiving a greater attention. The impact of numerous lifestyle factors including age, smoking, alcohol consumption, and exposure to occupational and environmental pollutants is unfavorable to male reproductive health. The present study intended to find out the association of demographic, occupational, and several lifestyle factors on semen quality of men diagnosed with infertility. Materials and Methods: The study enlisted 432 men diagnosed with fertility issue. Couples were administrated with a structured questionnaire to provide their demographic attributes and medical and reproductive health information. The collected data were statistically analyzed using SPSS software version 20.0. Results: The mean age of men was 34.44 ± 0.21 years at the time of consultation. Among seven semen abnormalities, asthenozoospermia was recorded the highest (30.09%). Most of the participants were having secondary education (32.26%), working as laborers (26.62%), and were having multiple addictions (27.77%). Decreased sperm count and motility was noticed among advanced age group and those with addictions. Different occupational statuses had substantial correlation with the sperm quality of participants. Conclusion: The incidence of male infertility and the potent lifestyle aspects studied have displayed an association with each other. However, influence of these aspects on impairment of male fertility can be overcome with modification toward healthier lifestyle.
Keywords: Incidence, lifestyle, male infertility, spermatogenesis
|How to cite this article:|
Toragall MM, Satapathy SK, Kadadevaru GG, Hiremath MB. Association of demographic and lifestyle factors with semen quality of men with fertility problems attending infertility center in North Karnataka. Indian J Med Spec 2019;10:79-83
|How to cite this URL:|
Toragall MM, Satapathy SK, Kadadevaru GG, Hiremath MB. Association of demographic and lifestyle factors with semen quality of men with fertility problems attending infertility center in North Karnataka. Indian J Med Spec [serial online] 2019 [cited 2021 Dec 7];10:79-83. Available from: http://www.ijms.in/text.asp?2019/10/2/79/258986
| Introduction|| |
Infertility is the “inability of a sexually active, noncontracepting couple to achieve spontaneous pregnancy in 1 year,” and has become a global health concern. One out of four couples in India are facing infertility, which has increased significantly to a whopping 27.5 million infertile couples. Among couples affected by infertility, 40%–50% is contributed by male factor infertility. Male infertility is an incapability of a male to make a fertile woman pregnant, which is an obscured reproductive health disorder. The factors which cause male infertility are varicocele, testicular failure, endocrine dysfunction, genital tract infection, testicular cancer, retrograde ejaculation, obesity, older age, smoking, alcohol consumption, exposure to heavy metals and pesticides, oxidative stress, and genetic and environmental factors. Men showing semen parameters below World Health Organization's (WHO) normal reference values are considered to have male factor infertility, such as low sperm concentration, poor motility, and abnormal morphology. Though male fertility endures with an advanced age, older parenthood has a negative influence on various reproductive functions. The high concentration of free radicals has been found in the seminal plasma of smokers and tobacco chewers, which causes sperm damage and decline in sperm motility, resulting in a lower fertilization ability. Excessive consumption of alcohol in men leads to shrinkage of testes, ensuing in abnormal production of testosterone, which causes impotency, dwindled libido, and infertility. Occupational and environmental factors, namely excessive heat, mechanical vibrations, and tiring physical activity, pose an impact on impaired spermatogenesis leading to male infertility. Agricultural pollution, more than industrial, affects reproductive health, especially due to the use of pesticides. Hence, the aim of this study is to explore the probable correlation between reproductive health of men, occupational exposures, and contemporary lifestyle factors in the northern parts of Karnataka.
| Materials and Methods|| |
Subjects, design, and data collection
This study was carried out at anin vitro fertilization center, which has been providing infertility-related services to people from different sections of the society. A total of 432 men of couples with fertility issue were enlisted for this study during the period of 2015–2018. All the cases were informed in detail, and written consent to participate in this study was obtained from them. A brief structured questionnaire was designed to obtain information about demographic features and reproductive health history. Demographic attributes such as age, education, occupation, and personal addictions such as smoking, alcohol consumption, chewing tobacco, or a combination of any of these were scrutinized. Along with a semen analysis report, the participants were examined for type of infertility and surgeries, if any.
Semen collection and analysis
Semen samples were collected by masturbation after 2–5 days of ejaculatory abstinence in a sterile plastic container, preferably near the laboratory to limit the time between collection and analysis. Samples were allowed to liquefy at 37°C for 30 min and analyzed within 1 h of collection according to the WHO-2010 criteria. After liquefaction, about 6–10 μL of the semen was put on to a Makler's counting chamber with requisite dilutions and sperm count, motility were performed under bright field microscope at ×400. At least 200 sperms were counted, and the mean value of duplicate measurements was represented.
Demographic and medical attributes including age of the male, education, occupation, smoking, chewing tobacco, alcohol consumption, infertility status, days of abstinence, surgery, past medical illness, and treatment were compared among the participants using Students “t-” test. Statistical inference was based on two-sided tests at a 0.05 significance level. After liquefaction of semen, qualitative variables such as coagulation, liquefaction time, appearance, and odor were expressed as percentage and frequency, whereas the quantitative variables such as semen pH, volume, sperm concentration, and motility were expressed as mean ± standard error of the mean with the level of significance set at <0.05. Analysis of variance was performed to identify significant differences. All statistical analyses were conducted using IBM SPSS Statistics software Inc., version 20.0 (IBM Corp., Armonk, NY, USA).
| Results|| |
The mean age of the study population (n = 432) was 34.44 ± 0.21 years at the time of diagnosis. Based on their semen analysis report, they were grouped into seven abnormal conditions according to the WHO-2010 standards [Table 1]. Among the participants, 92.12% had no previous surgery, 0.69% had varicocelectomy, 0.23% had a surgery which was not mentioned in the questionnaire, and 6.94% did not mention about any surgeries. The education status of the participants showed that 21.52% had completed higher studies, 32.26% secondary education, 30.78% primary education, and 10.41% were illiterate. Considering the occupational status of participants, 26.62% were laborers, 18.28% were farmers, 11.34% were businessmen, 6.48% were drivers, 1.15% were teachers, 18.98% were with other professions, and 17.12% did not mention their profession. Around 18.28% of the participants were active smokers, 25.69% were tobacco chewers, 13.42% were regular consumers of alcohol, 27.77% had multiple habits, and 14.81% were without any addictions. Days of abstinence and liquefaction time were consistent among all the male infertile conditions. Abnormal semen qualitative parameters were higher such as severe oligoasthenoteratozoospermia with anomalous coagulation (58.33%), asthenozoospermia with unusual odor (92.3%), and azoospermia with atypical color (96.8%). Except azoospermia with no spermatozoa, severe oligoasthenoteratozoospermia had the least sperm count (4.75 ± 0.32 mil/ml) and motility (10.17% ± 1.14%) [Table 2]. Decreased sperm count (16.14 ± 2.76 mil/ml) and motility (17.08% ± 2.24%) were found in the advanced age group, i.e., 41–45 years when compared with the mean age group, i.e., 31–35 years [Table 3]. The data on semen parameters such as sperm count and motility with respect to lifestyle addictions revealed statistically significant results (P< 0.05) when compared with participants having no addictions, except sperm count among smokers [Table 4]. Participants with multiple addictions had significantly least sperm count (11.20 ± 1.50 mil/ml) and sperm motility among all (12.99% ± 1.22%). Furthermore, semen parameters with respect to occupation of the participants also presented a significant association. Participants who were working as laborers had sperm count and motility significantly lower to that of the WHO-2010 semen parameters. Normal sperm count and motility were found in participants who were teachers; rest of all the participants with different occupations showed low sperm motility with normal sperm count [Table 5].
|Table 1: Distribution of different infertile male subgroups (n=432) based on sperm count, motility, and morphology|
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|Table 2: Qualitative and quantitative seminal parameters of different infertile male subgroups|
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|Table 3: Comparison of quantitative semen parameters in different age group|
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|Table 4: Sperm count and sperm motility among tobacco smokers, chewers, and alcoholics with respect to individuals having no habit|
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|Table 5: Sperm count and sperm motility among individuals with different occupational status|
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| Discussion|| |
Male infertility is the solitary factor in approximately 50% of infertility cases, which is generally ignored. Asthenozoospermia (30.09%) was found higher and oligozoospermia was recorded the least (3.93%), which is different from that of previous studies. The deterioration of semen quality from the last few years has become the most concerned issue of men's health. In our study, we observed varied semen qualitative parameters among different infertile men such as volume as an indicator of seminal vesicle, liquefaction time as an indication to prostate gland function, and color as a marker of infections and internal bleeding. Significant decline in the mean sperm counts and motility was observed in all infertile men, which was similar to the reports of regional findings in India. At the time of diagnosis, the mean age of participants was 34.44 ± 0.21 years, and 41.89% of these participants were in the age group of 31–35 years, which is attuned with those of the previous studies in India. As men grow older, normal physiology of the reproductive tract and testicular function deteriorate with decreased sperm count and motility, leading to male infertility. Evident to this report in the present study, sperm count and motility were found to be significantly decreased in older age groups (36–45 years).
Lifestyle factors have been associated with infertility in various studies, which have shown diminished semen quality, proving the potential impact of these factors on the impairment of male reproductive function. Earlier reports have presented antagonistic effects of active smoking and chewing tobacco, which are associated with sperm morphological changes and motility. The high concentration of free radicals which are released after smoking causes sperm damage. Whereas excessive consumption of alcohol results in the contraction of testes and abnormal production of testosterone, resulting in impotency and decreased libido. In the present study, compared to participants having no adverse habits, the total sperm count was found nonsignificant (P = 0.179) and sperm motility was found significant (P = 0.003) among smokers. Rest of the other lifestyle habits, namely tobacco chewing and alcohol consumption, were associated with significantly low sperm count and sperm motility.,
At present, occupational menaces are well-known risk factors linked with reduced semen quality or disturbing men's fertility, and these comprise heavy metals, solvents, pesticides, and other agricultural chemicals; physical exposures such as radiation and heat; and the occupations that incorporate a combination of negative factors such as driving. Exposure to hazardous metals causes increase in the levels of these metals in the blood, leading to decrease in the sperm count and sperm motility among laborers and manual workers. Pesticides and other chemicals have shown high impact in the causation of testicular cancer, reduced semen quality, and erectile dysfunction, which may also block the activity of hormones that influence the male reproductive system. In the present study, similar observations were made among laborers and farmers, where low sperm count and motility were found when compared with the rest of the occupations. Testicular hyperthermia can cause genital heat stress leading to the production of low-quality spermatozoa, which is influenced by scrotal position and changes with change in posture. Impairment of spermatogenesis has been reported among drivers and businessmen due to work exposures such as prolonged sitting, unfavorable conditions, and possible development of excessive heat. In the present study, low sperm motility was found in businessmen and drivers, similar to previous reports. Scanning earlier reports, adverse effects of age, lifestyle, and occupational factors affect male fertility.
| Conclusion|| |
To develop a precise summary of occurrence, dispersal and development of male infertility is a significant step toward making evidence-based inferences and policies to diminish the problem of this abandoned infirmity. The present study found an evidence of significant paternal age-related sperm quality reductions along with lifestyle factors and occupational aspects among men. Influence of tobacco smoking/chewing, alcohol consumption, heavy metals, solvents, pesticides, and other agricultural materials, radiation, and heat showed optimistic association with abnormal seminal parameters. Besides many other factors such as anatomical, developmental, immunological, and hormonal factors, a distinct study is needed to elaborate and to describe all the factors including precise molecular and genetic studies of the population. It is very important to calculate the global magnitude of male infertility and to spread an awareness within the society. Prospective efforts are must to reduce the blockades from stigmas linked with male infertility because of religious and cultural beliefs so that necessary medical intervention programs may be considered for the benefit of infertile couples, particularly males.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Rowe PJ, Comhaire FH, Hargreave TB, Mahmoud AM. WHO Manual for the Standardized Investigation and Diagnosis of the Infertile Male. Geneva: Cambridge University Press; 2000.
World Health Organization. WHO Laboratory Manual for the Examination and Processing of Human Semen. Geneva, Switzerland: World Health Organization; 2010.
Shah D. Expanding IVF treatment in India, need of the day! J Hum Reprod Sci 2017;10:69-70.
Naz M, Kamal M. Classification, causes, diagnosis and treatment of male infertility: A review. Orient Pharm Exp Med 2017;17:89-109.
Irvine DS. Epidemiology and aetiology of male infertility. Hum Reprod 1998;13 Suppl 1:33-44.
Plachot M, Belaisch-Allart J, Mayenga JM, Chouraqui A, Tesquier L, Serkine AM. Outcome of conventional IVF and ICSI on sibling oocytes in mild male factor infertility. Hum Reprod 2002;17:362-9.
Kumar N, Singh AK. Trends of male factor infertility, an important cause of infertility: A review of literature. J Hum Reprod Sci 2015;8:191-6.
] [Full text]
Sartorius GA, Nieschlag E. Paternal age and reproduction. Hum Reprod Update 2010;16:65-79.
Zitzmann M. Effects of age on male fertility. Best Pract Res Clin Endocrinol Metab 2013;27:617-28.
Abdullah L, Bondagji N. Histopathological patterns of testicular biopsy in male infertility: A retrospective study from a tertiary care center in the Western part of Saudi Arabia. Urol Ann 2011;3:19-23.
] [Full text]
Onyije FM. Drug: A major cause of infertility in male. Asian J Med Pharm Res 2012;2:30-7.
Figà-Talamanca I, Cini C, Varricchio GC, Dondero F, Gandini L, Lenzi A, et al
. Effects of prolonged autovehicle driving on male reproduction function: A study among taxi drivers. Am J Ind Med 1996;30:750-8.
Hanke W, Jurewicz J. The risk of adverse reproductive and developmental disorders due to occupational pesticide exposure: An overview of current epidemiological evidence. Int J Occup Med Environ Health 2004;17:223-43.
Butt F, Akram N. Semen analysis parameters: Experiences and insight into male infertility at a tertiary care hospital in Punjab. J Pak Med Assoc 2013;63:558-62.
Kumar N, Choudhari AR, Singh AK. Prevalence of male factor infertility in last ten years at a rural tertiary care centre of central India: A retrospective analysis. Indian J Obstet Gynaecol Res 2015;2:132-6.
Samal S, Dhadwe K, Gupta U, Gupta NK. Epidemiological study of male infertility. Indian Med Gaz 2012;5:174-80.
Sengupta P, Dutta S, Tusimin MB, Irez T, Krajewska-Kulak E. Sperm counts in Asian men: Reviewing the trend of past 50 years. Asian Pac J Reprod 2018;7:87. [Full text]
Mahanta P. A clinico-epidemiological study of infertile couples among the suburban/rural population of Bokakhat, Assam. J Evol Med Dent Sci 2016;5:1296-9.
Mittal A, Yadav S, Yadav SS, Bhardwaj A, Kaur R, Singh P. An epidemiological study of infertility among urban population of Ambala, Haryana. Int J Interdiscip Multidiscip Stud 2015;2:124-30.
Gunes S, Hekim GN, Arslan MA, Asci R. Effects of aging on the male reproductive system. J Assist Reprod Genet 2016;33:441-54.
Sunanda P, Panda B, Dash C, Padhy RN, Routray P. Effect of age and abstinence on semen quality: A retrospective study in a teaching hospital. Asian Pac J Reprod 2014;3:134-41.
Durairajanayagam D. Lifestyle causes of male infertility. Arab J Urol 2018;16:10-20.
Ozgur K, Isikoglu M, Seleker M, Donmez L. Semen quality of smoking and non-smoking men in infertile couples in a Turkish population. Arch Gynecol Obstet 2005;271:109-12.
Zhang JP, Meng QY, Zhang LJ, Mao YL, Sun ZX. Study of correlation and effect of smoking on semen quality of men. Zhonghua Nan Ke Xue 2002;8:35-7.
Blanco-Muñoz J, Lacasaña M, Aguilar-Garduño C. Effect of current tobacco consumption on the male reproductive hormone profile. Sci Total Environ 2012;426:100-5.
Sheiner EK, Sheiner E, Hammel RD, Potashnik G, Carel R. Effect of occupational exposures on male fertility: Literature review. Ind Health 2003;41:55-62.
Pizent A, Tariba B, Živković T. Reproductive toxicity of metals in men. Arch Ind Hyg Toxicol 2012;63 Supple 1:35-46.
Kaur RP, Gupta V, Christopher AF, Bansal P. Potential pathways of pesticide action on erectile function – A contributory factor in male infertility. Asian Pac J Reprod 2015;4:322-30.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]