ABSTRACT
Background/Objective/Methods:
Infertility is one of the major global public health issues. In a social setup like India, there is a strong emphasis on childbearing, which leads to economic and psychological stress and trauma. Various studies have shown that worldwide, there is a decline in the quality of semen. Many environmental, nutritional, and lifestyle factors are responsible for the reduced semen quality. The methods of this study are the source of data, the method of collection of data, and statistical analysis.
Results:
Semen analysis is an important diagnostic test in the assessment of infertility in male partners. Ninety-eight semen samples were analyzed from the patients who presented with the complaint of infertility over a period of 2 years (June 2018–May 2020).
Conclusion:
Based on our analysis, it can be inferred that an escalation in the intensity of tobacco consumption is directly associated with a proportional decline in sperm count and motility and a notable increase in liquefaction time.
KEYWORDS: Childbearing, infertility, nicotine absorption, reproductive health, tobacco
INTRODUCTION
Male infertility accounts for 40–50% of the global infertility rate, which affects 8–12% of couples. Every year, anywhere between 12 and 18 million couples in India are told they have infertility issues. Tobacco use has been proven in several studies to reduce sperm count, motility, and morphology. Tobacco consumption is correlated with semen parameters in this investigation. Infertility is one of the many health issues that our research might assist to avoid.
REVIEW OF LITERATURE
Since the early 1930s, testing of sperm has been a required part of any infertility diagnosis process. Male reproductive diseases, such as varicocele and infections, may be better understood by sperm analysis.[1] The relationship between sperm quality and male fertility was initially established by Mantegazza.[2] When James Marion Sims introduced a laboratory technique to examine the more motile sperm in the cervical mucus after coitus, he made a significant contribution.[3] Later on, Alois Lode conducted the first effort at spermatozoa counting. The spermatozoa were counted using a Thoma-Zeiss chamber after the semen was diluted in a 2% potassium hydroxide solution.[4]
Male infertility
Infertility is defined by the International Consortium for the Study of Reproduction and Assisted Technology of the World Health Organization as the inability to establish a clinical pregnancy after trying for at least 12 months with unprotected sexual activity.[5] For a man to be considered infertile, he must be unable to sire a child from a fertile female.[6] “Male factor” infertility is diagnosed when at least one of two sperm analyses taken 1 and 4 weeks apart reveals a change in sperm concentration, motility, or morphology.[7] Around 7% of all males are affected, and it is responsible for 40–50% of infertility.[8] Semen shortages are a major cause of male infertility, and the quality of sperm is often used as a proxy for a man’s reproductive potential.[9]
Tobacco use and semen quality
Cigarette smoke contains polycyclic aromatic hydrocarbons and nicotine, both of which may lead to atrophy of the seminiferous tubules and testis and can inhibit or completely halt the spermatogenic process, as proven by MacKenzie and Angeline.[10]
Smoking and assisted reproductive outcomes
Patients’ egg retrieval rates dropped by 46% if their partners smoked, an impact likely attributable to the woman’s exposure to second-hand smoke.[11]
Smoking and erectile dysfunction
Extensive research shows that smoking reduces erection quality by impairing blood flow (most likely due to a lack of nitric oxide).[12] Cigarette smoke has been linked to erectile dysfunction because of the harm it does to the endothelium and the impairment of eNOS-mediated vasodilation.[13]
MATERIALS AND METHODS
Source of data
This study is a 2-year (June 2018–May 2020) prospective analytical study which was carried out in the department of pathology of our tertiary care hospital.
A written informed consent was taken from all the cases included in the study for utilizing and publishing their data.
Inclusion criteria
Infertile male cases with the history of tobacco consumption in both smokeless and smoking forms were included.
Exclusion criteria
Patients having habit of alcohol consumption, varicocele, and diabetes mellitus were excluded.
DISCUSSION
In the period of 2 years from June 2018 to May 2020, 98 cases were included in the present prospective analytical study. Male spouse of all the infertile couples were included in this study. Out of 98 cases, 14 were smokers, 29 patients were tobacco users and 52 were nontobacco users, and 3 patients were smokers as well as consumed tobacco.
In this study, out of 98 cases, 52 (53%) showed normal semen analysis, while 46 (46.9%) cases had abnormal semen analysis. The commonest abnormality was asthenozoospermia, consisting of 23 (3.4%) cases out of 98 cases followed by oligoasthenospermia in 17.3% of the cases [Table 1].
Table 1.
Distribution of cases according to the diagnosis of semen analysis
| Diagnosis | No. of cases | Percentage (%) |
|---|---|---|
| Normospermia | 52 | 53 |
| Oligospermia | 01 | 1 |
| Oligoasthenozoospermia | 17 | 17.3 |
| Asthenozoospermia | 23 | 23.4 |
| Azoospermia | 03 | 3 |
| Oligonecrozoospermia | 01 | 1 |
| Hematospermia | 01 | 1 |
| Total | 98 | 100 |
The maximum number of cases were seen in normospermia for nontobacco users, with 41 cases out of 52, of which 2 were smokers and the remaining 9 were smokeless tobacco users who showed normal semen analysis. In smokers, the maximum abnormality was oligoasthenospermia, which consists of 7 cases out of 17 smokers and tobacco chewers with 13 cases. Asthenozoospermia consisting of 5 cases out of 17 smokers, tobacco chewers (9 cases), and non-tobacco (9 cases), followed by azoospermia consisting of 2 cases, non-tobacco users (1 case), and oligonecrozoospermia consisting of 1 case, respectively [Table 2].
Table 2.
Comparison of Semen quality between smokers, tobacco chewers, and nontobacco users
| Smokers | Tobacco chewers | Nontobacco users | |
|---|---|---|---|
| Normospermia | 02 | 09 | 41 |
| Oligospermia | 00 | 00 | 01 |
| Oligoasthenozoospermia | 07 | 13 | 00 |
| Asthenozoospermia | 05 | 09 | 09 |
| Azoospermia | 02 | 00 | 01 |
| Oligonecrozoospermia | 01 | 00 | 00 |
| Hematospermia | 00 | 01 | 00 |
| Total | 17 | 32 | 52 |
Chi-square=52.411, P<0.0001
OBSERVATION AND RESULTS
Semen analysis is an important diagnostic test in the assessment of infertility in male partner. Ninety-eight semen samples were analyzed of the patients who presented with the complaint of infertility over a period of 2 years (June 2018–May 2020). Patients were classified into three categories, that is, smokers, tobacco chewers, and nontobacco users. Later, semen samples were assessed according to the WHO criteria 2010 for physical, chemical, and microscopical findings which consisted of pH, volume, liquefaction time, sperm count, sperm motility, and percentage of sperms with abnormal morphology.
SUMMARY
Maximum number of normospermia cases, that is, 41 (41.8%), were seen in nontobacco users, while only 2 out of 17 (2.04%) among smokers and 9 out of 32 (9.1%) among smokeless tobacco users had normal semen analysis.
Mean sperm count in our study was highest in nontobacco users, that is, 83.9 million/ml, and sperm count was reduced in tobacco users (34.7 million/ml) and smokers (32.6 million/ml) with a P-value <0.0001, showing significant difference in sperm count in tobacco consumers and nontobacco users.
In this study, mean semen volume in nontobacco users was 2.41 ml, while it was 2.26 ml in smokers and 2.21 ml in tobacco chewers.
In this study, there was no significant difference in the volume of semen in smokers and tobacco chewers.
CONCLUSION
With the increase in the severity of tobacco usage, there is more decrease in sperm count, motility, and a significantly raised liquefaction time. Semen volume, sperm morphology, viscosity, and pH of semen were not significantly altered with tobacco use. Sperm count and motility were reduced more in smokers as compared to smokeless tobacco users. Liquefaction time was also higher in smokers as compared to smokeless tobacco users. With both habits (smoking and tobacco chewing), these changes were more severe.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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