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Selected Risk Factors and Pattern of Semen Abnormality in Male Partners of Infertile Couples in Eastern Nepal: A Descriptive Cross-sectional Study

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Introduction: Semen analysis is an initial basic step in evaluating and diagnosing male infertility. Multiple risks factors in combination or alone are responsible for abnormal semen parameters. The present study aimed to study certain risk factors and semen parameters of infertile male. Methods: It was a descriptive cross-sectional study. We consecutively enrolled 186 male partners of infertile couple who underwent certain risk factors evaluation and semen analysis according to WHO guideline. Results: Multiple risk factors were present like Gulf country migration, smoking, chemical exposure and heat exposure in infertile male partners. Forty six percent of our patients were gulf workers. Eleven percent patients had azoospermia, 27% had abnormal sperm morphology and 23% had <25% motile spermatozoa. Conclusions: Surprisingly 46% of our patients were Gulf country workers and abnormal semen analysis is very important factor for infertility. Large prospective studies need to be carried out involving Gulf migrant workers only.
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Selected Risk Factors and Pattern of Semen Abnormality in Male
Partners of Infertile Couples in Eastern Nepal: A Descriptive Cross-
sectional Study
Sita Pokhrel,1 Ashima Ghimire,1 Manisha Chhetry,1 Sabina Lamichane,1 Rupesh Kumar Shreewastav2
1Department of Obstetrics and Gynecology, Nobel Medical College Teaching Hospital, Biratnagar, Nepal, 2Department
of Biochemistry, Nobel Medical College Teaching Hospital, Biratnagar, Nepal.
ABSTRACT
Introduction: Semen analysis is an initial basic step in evaluating and diagnosing male infertility.
Multiple risks factors in combination or alone are responsible for abnormal semen parameters. The
present study aimed to study certain risk factors and semen parameters of infertile male.
Methods: It was a descriptive cross-sectional study. We consecutively enrolled 186 male partners
of infertile couple who underwent certain risk factors evaluation and semen analysis according to
WHO guideline.
Results: Multiple risk factors were present like Gulf country migration, smoking, chemical exposure
and heat exposure in infertile male partners. Forty six percent of our patients were gulf workers.
Eleven percent patients had azoospermia, 27% had abnormal sperm morphology and 23% had <25%
motile spermatozoa.
Conclusions: Surprisingly 46% of our patients were Gulf country workers and abnormal semen
analysis is very important factor for infertility. Large prospective studies need to be carried out
involving Gulf migrant workers only.
________________________________________________________________________________________
Keywords: infertility; risk factors; semen abnormality parameters.
________________________________________________________________________________________
______________________________________
Correspondence: Dr. Sita Pokhrel, Department of Obstetrics
and Gynecology, Nobel Medical College Teaching Hospital,
Biratnagar, Nepal, Email: sitap661@gmail.com, Phone: +977-
9842396305.
INTRODUCTION
In our male dominated society, the blame for infertility
goes more to female partners and they suffer from
domestic violence, economic deprivation, social neglect,
separation and mental trauma.1,2 If different parameters
of semen analysis are interpreted with clinical prole
of the male partner it would give more information for
proper future management.3
Functional competence of the spermatozoa may be
associated with certain semen parameters.4 Different
studies showed that causes of infertility is attributed to
female in 1/3rd of cases, male in 1/3rd and unexplained in
1/3rd.5 Factors like diabetes mellitus, chronic medication
and disease, psychological factors, chronic alcohol
consumption of alcohol, smoking, adverse occupation,
nutritional factors and infections play role.6,7
Therefore, we wanted to look into the patterns of
semen parameters and certain risk factors associated
with abnormality in male partners of infertile couple in
our setting. It will help to understand the real pattern
and parameters of investigation.
ORIGINAL ARTICLE J Nepal Med Assoc 2020;58(229):668-71
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doi: 10.31729/jnma.4882
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METHODS
This was a descriptive cross-sectional study of
the certain risk factors and seminal uid indices of
consecutively consenting male partners of infertile
couples seen in the department of Obstetrics and
Gynecology, Nobel Medical College Teaching Hospital,
Biratnagar. The cases were male partner of a couple,
who visited the department for infertility treatment in
the period of 22nd January 2017 to 21st January 2018.
The purpose of the study was explained to the couple,
who agreed to be the part of the study was included.
The study was carried out after getting the approval of
Institutional Review Committee.
We recorded important risk factors and semen
parameters in a structured proforma. Information
related to risk factors and semen parameters were
noted. The male partners were adequately counseled
and given instructions on how to collect the semen
samples. These instructions included abstinence from
coitus for 3-5 days, washing their hands before starting
masturbation, sample collection by masturbation only
accepted and kept close to the body and delivered to
the laboratory within 30 minutes of collection. Spilled
samples were avoided. All samples were collected into
sterile screw capped plastic universal containers. The
semen samples were collected in a dedicated room with
bed and other facilities to make them relax within the
laboratory and analysed within one hour of collection.
The semen analysis was performed according to the
methods and standard outlined by WHO guideline. The
sample analysis was done by same laboratory scientist
to avoid inter-personal variations. Semen analysis was
done within one hour of their collection and was assessed
for volume, appearance, liquefaction, concentration,
motility, morphology, viability and presence of pus
cells. The descriptive statistical analysis was done.
RESULTS
During the year 2017-2018, a total of 196 couple
attended Gynecological OPD for infertility problems and
consecutively entered in our study. Out of them three
couple did not turn up with investigations report and
seven of male partners refused to go for investigation.
So, only 186 cases were analyzed in result. Mean age
of the male was 28.3±5 years. Majority 130 (69.8%)
had duration of infertility ≤5 years followed by 5-10
years 40 (21.2%) and only 17 (9.1%) had ≥10 years.
Majority had secondary infertility. Different risk factors
like (Mumps, diabetes, heat exposure, chemicals, Gulf
country work etc) have been found to affect semen
pattern and parameters adversely in our study. The
numbers of patients suffered with mumps in the past
that involved testis and found to be infertile were 5.
Similarly, the patients exposed to heat exposure,
chemical exposure, involved in smoking, consuming
alcohol, suffering with diabetes mellitus, having
hydrocele, varicocele and working in Gulf countries
with infertility were 9, 14, 14,18,9,6,2,5 and 86 in our
study as shown (Table 1). The most striking fact of this
study is the maximum number of patients with infertility
was from group of patients, who were working abroad
Gulf countries.
Table 1. Distribution of risk factors for Infertility
(n=186).
Main Risk Factors n (%) of Partners
Golf worker 86 (46.2)
No risk Facors 35 (18.8)
Smoking 18 (9.6)
Chemicals Exposure 11 (5.9)
Heat exposure 9 (4.8)
Alcohol 9 (4.8)
Diabetes Mellitus 6 (3.2)
Mumps 5 (2.7)
Varicocele 5 (2.7)
Hydrocele 2 (1.1)
Total 186 (100)
Different parameters of the sperm were analyzed. These
included volume, count, motility, morphology and pus
cells. Culture of the semen of all the 186 patients was
done. In our study, it was found that 101 (54.3%)
patients had less than 2ml of semen volume. Similarly,
the number of patients, who had semen volume 2-4
ml and more than 4 ml were 83 (44.6%) and 2 (1.1%)
respectively as shown (Table 2). While analyzing the
count, it was found that 21(11.2%) patients had
azospermia in our study. Similarly, 60 (32.25%)
patients were having more than 60 million sperm per ml
as shown (Figure 1).
Table 2. Distribution of different characteristics of
semen of male partners (n=186).
Characteristics of semen n (%) of male
partners
Morphology of spermatozoa
Normal 135 (72.5)
Abnormal 51 (27.4)
Number of pus cells/hpf
>5 133 (71.5)
Absent 53 (28.5)
Pokhrel et al. Selected Risk Factors and Pattern of Semen Abnormality in Male partners of Infertile Couples.....
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Volume of semen
<2 ml 101 (54.3)
2-4 ml 83 (44.6)
>4 ml 2 (1.1)
Figure 1. Distribution of Count of Spermatozoa of
male partners.
Our study found that 135 (72.5%) males had normal
spermatozoa morphology and the rest were found to
be abnormal as shown (Table 1). Forty three (23.11%)
patients had less than 25% motile spermatozoa and only
11(5.91%) patients had 75-100% motile spermatozoa
as shown (Figure 2). In 133 (71.5%) semen samples
had more than 5 pus cells per high power eld as shown
(Table 1).
Figure 2. Distribution of motility of spermatozoa of
male partners.
Semen was also looked for the presence of organism by
culture of the all samples. Forty eight (25.8%) semen
samples showed the growth of organism in which E.
Coli was isolated in 32 (17.2%) cases, S. Aureus in
12(6.45%) and Proteus in 4 (2.15%) as shown (Figure
3).
Figure 3. Distribution of growth of organism in semen
sample of male partners.
DISCUSSION
During the analysis of the 186 male partners of infertile
couples, we found the average age is 28±5 years
which are similar with the study done in India.8 Majority
of our patients had secondary infertility and sought
medical help earlier than 5 years this may be because
of the family pressure to have next child earlier, want
to have next child when female is still young a, need
of a friend to previous child and thinking that too much
age gap between children makes couple difcult to care
them properly. We found many risk factors like chronic
smoking, alcohol abuse, diabetes, chemical exposure
and other surgical interventions affecting the sperm
quality and parameters. Above factors may adversely
affect male fertility and surgical interventions may
damage vas deference and vascular supply to the testis.
Chronic smokers have high risk of infertility and toxins
in tobacco smoke may kill sperms.9,10 Nine patients
some from automobile garage who were mechanics
and helpers, others were drivers who were constantly
exposed to the heat coming from machines and vehicle
engine respectively attended our clinic. We presume
that this constant heat exposure to testis in association
with other factors contributed to abnormal semen
parameters in this group of patients. Many studies have
shown that a 1–1.5°C increase in scrotal temperature
leads to either impaired sperm production or abnormal
sperm morphology.11,12 Epidemiological studies have
revealed that more and more infertile men suffer from
acute or chronic inammation like mumps and chronic
chemical exposure of the genitourinary tract, which
often occurs without any symptoms.13 Chronic alcohol
consumption causes sperm parameter abnormalities.14
It is very surprising that majority of the couple who
sought medical help for infertility had their male partner
worked in Gulf countries in the past. There may be
multiple reasons behind this. The risk factors like severe
stress, effect of climate change, sleeplessness, shift
in working hours, exposure to high ambient and work
place temperature, long sexual abstinence, adverse
housing and work place situation and many others.
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JNMA I VOL 58 I ISSUE 229 I SEPTEMBER 2020
These factors, in susceptible person, may induce or
precipitate organic and functional illnesses on top of
the high temperature. The high temperature alone or in
association with other risk factors may induce sperm
parameter abnormalities which in turn lead to infertility.
These issues should be addressed with large prospective
studies involving migrant workers alone.
In analyzing the semen parameters, Eleven percent of
our patients have azoospermia, 55% of the patients
have sperm counts less than 60 million per ml. Absent
and low sperm count is associated with male infertility.15
The sperm counts of male are declined with time.16
Forty ve percent of our patients have sperm motility of
less than 50%. The World Health Organization (WHO).17
Standards of normal sperm indicate that motility value
should be greater than or equal to 50% with forward
progression within 60 minutes of ejaculation. Low
sperm motility is associated with infertility.15 Nearly one
third of the males have abnormal sperm morphology
which may have negative impact on fertility.
CONCLUSIONS
To conclude with, multiple risk factors alone or in
combination act to cause abnormal sperm parameters.
One of our prominent nding is excessive exposure
to heat in Gulf migrant workers that lead to abnormal
sperm parameters. We found that abnormal semen
analysis is the signicant contributor to male infertility.
Conict of Interest: None.
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