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Research Article
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Cigarette Smoking and the Risk of Male Infertility |
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A. Hosseinzadeh Colagar ,
G.A. Jorsaraee
and
E. Tahmasbpour Marzony
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ABSTRACT
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In this research we investigated the effect of cigarette smoking on sperm parameters both before and after swim-up. Semen sample provided from fertile smoker (n = 25), fertile nonsmoker (n = 21), infertile smoker (n = 23) and infertile nonsmoker men (n = 32). Semen analysis was performed manually according to the World Health Organization (WHO) standards guidelines. Present research showed that sperm parameters quality in smoker men was approximately lower than nonsmoker men. As well as present research showed that cigarette smoking has dose dependent effect on sperm parameters, but this effect was not significant. Therefore, it appears that cigarette smoking is associated with reduced sperm quality and the risk of idiopathic male infertility in smoker men.
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INTRODUCTION
Although cigarette smoking is a widely recognized health hazard and a major
cause of mortality (ASRM, 2004 and 2006), people continue to consume cigarettes
on a regular basis. According to the World Health Organization (WHO, 1997-1999),
approximately one third of the worlds population older than 15 years,
are smoker (Saleh et al., 2002; Kunzle et al., 2003). The highest
prevalence of smoking is observed in young adult males during their reproductive
period (46% smokers between 20 and 39 years) (Langgassner, 1999). An additional
portion of nonsmokers, especially children, are also affected as second hand
smokers by inhaling side stream smoke from burning cigarettes and exhaled smoke
from smokers (Zavos, 1999; Saleh et al., 2002). Evidence indicated that
cigarette smoking has become a serious health and societal problem today and
also presents a rather challenging dilemma for the physician or the health care
provider. It can be said today that smoking has been established as the number
one preventable cause of death and disease in the countries worldwide (Zavos
et al., 1999). Most lung cancer and emphysema, as well as a high percentage
of heart attacks are caused by cigarette smoking. About 30-40% of all deaths
from cancer are associated with smoking and chewing tobacco (ASRM, 2006; Wynder
and Hoffman, 1994; Lee et al., 1998). Recent scientific data reveal that
the cancer risk from smoking is not limited to cancer of the lung; it can be
associated with an increased incidence of cancer in the lungs, larynx, cervix,
oral cavity, esophagus, bladder and even leukemia (Lee et al., 1998),
many bladder, cervical, esophageal and pancreatic cancers are also caused by
smoking (Zavos et al., 1999). Cigarette smoke contains a large number
of substances, including nicotine, carbon monoxide and recognized carcinogens
and mutagens such as radioactive polonium, benzopyrene, dimethylbenzanthracene,
dimethylnitrosamine, naphthalene and methnapthalene (Zavos et al., 1998;
Wong et al., 2000; Lee et al., 1998). Many of these constituents,
however, have never been evaluated for toxicity and therefore the complete contents
of cigarettes and cigarette smoke remain unknown. Inhalation of cigarette smoke,
whether through active or passive smoking, leads to absorption of these substances
through the pulmonary vasculature and blood-borne circulation throughout the
body (Zavos et al., 1998). It is also possible that those same substances
could end up in the seminal plasma of smokers via various modes of diffusion
and active transport (Zavos et al., 1998). Therefore, this is not surprising
that cigarette smoking has negative effects on male reproductive system same
as other tissue. But the relationship between cigarette smoking and male fertility
remains controversial. Although the effect of smoking on male fertility remains
inconclusive, the evidence of adverse effects of smoking on semen parameters
suggest that smoking reasonably may be regarded as an infertility risk factor,
smoking should therefore be discouraged for both male and female partners in
couples with a history of infertility or recurrent pregnancy loss, particularly
when marginal or frankly abnormal semen parameters have been documented (ASRM,
2006). Thus, the aim of this study is to evaluate the relationship between cigarette
smoking and sperm quality in male partners of fertile and infertile couples
undergoing infertility evaluation.
MATERIALS AND METHODS Semen population: All samples provided from Fateme Zahra IVF center, then undergoing evaluation for infertility. Study population included fertile nonsmokers (n = 21), fertile smoker (n = 25), infertile nonsmoker (n = 32) and infertile smoker men (n = 23). Fertile and infertile smoker men grouped according to the frequency of their cigarette smoking habit to: group I (fertile smoker with 1-7 cigarettes/day, n = 14), group II (fertile smoker with >7 cigarettes/day, n = 11), group III (infertile smoker men with 1-7 cigarettes/day, n = 11) and group IV (infertile smoker men with >7 cigarettes/day, n = 12). Semen collection and analysis: Semen samples were collected by masturbation into a sterile container after sexual abstinence for 2-3 days. All samples provided according to the WHO criteria and analyzed for appearance, volume, consistency and pH. Before semen analysis, a questionnaire was distributed to obtain information on age and lifestyle male including: smoking habits, alcohol use, use or abuse of other substances and drugs and history of orchitis, testicular trauma, sexually transmitted disease, varicocele, inguinal hernia operation, cryptorchism and etc. All samples provided from smoker and nonsmoker men and had been exception from other case. On microscopic examination, sperm concentrations, percentage of motile sperm and sperm with normal morphology were objectively evaluated. Sperm count and percentage of motile sperm evaluated according to the world health organization (WHO, 1997-1999), whereas percentage of sperm morphology evaluated according to Krugers criteria (Kruger et al., 1986). An aliquot of semen samples washed (swim-up) in Hams F10 medium (include 10% BSA, bovine serum albumin) for half hours in 37°C and then used for sperm count, motility and morphology evaluation.
Statistical analysis: Mean standard (mean±SD) of sperm parameters
quality in the smoker and nonsmoker men analyzed by descriptive statistic. The
relationships of sperm count, motility and morphology between fertile smoker-nonsmoker
and infertile smoker-nonsmoker men were compared with Independent Samples t-test
model. A p-value <0.05 was considered statistically significant.
RESULTS The initial study sample consisted of 101 participants, of whom 20.79% (21/101) were fertile nonsmoker, 31.61% (32/101) were infertile nonsmoker, 24.75% (25/101) were fertile smoker and 22.77% (23/101) were infertile smoker men. Sperm parameters quality between fertile smoker, nonsmoker and infertile smoker, nonsmoker men evaluated both before and after swim-up and showed in Table 1 and 2, respectively. There was no significantly difference between age of fertile smoker, nonsmoker (p-value = 0.351) and infertile smoker, nonsmoker men (p-value = 0.231). Sperm parameters quality before swim-up: Present results showed that sperm parameters in smoker men were approximately lower than nonsmoker men. The statistical analysis between fertile smoker-nonsmoker men showed that sperm counts, motility and morphology of the smoker men are lower than nonsmoker men (Table 1). Sperm count and morphology in fertile smoker men were also strongly affected (p-value = 0.03 and 0.05, respectively), whereas the percentage of sperm motility was slightly but not significantly reduced (p-value = 0.891). Ejaculate volume was not different between fertile smoker-nonsmoker men. In addition statistical analysis in infertile smoker-nonsmoker showed that sperm quality in infertile smoker is lower than infertile nonsmoker. Sperm count and morphology in infertile smoker were significantly lower than nonsmoker men (p-value = 0.05 and 0.03, respectively), whereas sperm motility in infertile smoker men was also slightly lower than infertile nonsmoker men (p-value = 0.935). Semen volume was not significant different in both infertile smoker, nonsmoker men (Table 1).
Sperm parameters quality after swim-up: Table 2 shows
the sperm count and the percentage of sperm morphology, motility in all samples
after swim-up. Statistical analysis in fertile smoker-nonsmoker showed that
sperm morphology in fertile smoker men is significantly lower than fertile nonsmoker
men (p-value<0.01), whereas sperm count and motility in fertile smoker men
were slightly lower than fertile nonsmoker men (p-value = 0.141 and 0.314, respectively).
Sperm morphology in infertile smoker men was significantly lower than infertile
nonsmoker men (p-value = 0.04), whereas sperm count and motility were slightly
lower (p-value = 0.39 and 0.07, respectively).
Table 1: |
Sperm parameters quality in fertile and infertile nonsmoker
and smoker men, before swim-up |
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Results are presented as mean±SD; *p = 0.05, **p<0.05 |
Table 2: |
Sperm count and motility in fertile and infertile nonsmoker
and smoker men, after swim-up |
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Results are presented as mean±SD; * p<0.01, **p<0.05 |
Table 3: |
Sperm parameters quality in group I, II, III and IV |
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Results are presented as mean±SD; *p-value<0.05.
Group I: Fertile smoker men that Smoke 1-7 cigarettes per day, Group II:
Fertile smoker men that smokes >7 cigarettes per day, Group III: Infertile
smoker men that smokes 1-7 cigarettes per day and Group II: Infertile smoker
men that smokes >7 cigarettes per day |
Sperm quality in smoker groups: Fertile-infertile smoker men divided to four groups (groups 1-4) according to cigarettes habitat (Table 3). Present results shows that sperm morphology in group-2 were also strongly affected and were lower than group-1 (p-value<0.05), whereas sperm count and motility slightly affected. In addition statistical between groups III and IV showed that sperm parameters quality in group III was slightly lower than group IV (Table 2), but these difference was not significantly. Therefore, present study showed that (i) cigarette smoking cause to low sperm quality in smoker men and (ii) has a dose-dependent effect on sperm quality. DISCUSSION
We investigated sperm parameters quality both before and after swim-up in smoker
and nonsmoker men. Present study showed that cigarette smoking has negative
affects on sperm count, motility and normal morphology. These results were consistent
with other studies (Kunzle et al., 2003; Saleh et al., 2002;
Stillman et al., 1986; Vine et al., 1996; Close et al.,
1990; Sofikitis et al., 1995). These studies have shown that cigarette
smoking affects on sperm concentration, motility and morphology and related
with poor sperm quality. On the other hand, present results contradict the findings
of other studies that have found no association between smoking and sperm quality
or sperm function (Dikshit et al., 1987; Vogt et al., 1986). Although
these studies showed the negative effects on sperm parameters quality, but the
mechanisms by which smoke affects spermatozoa are poorly understood (Kunzle
et al., 2003; Saleh et al., 2002). Recently, studies show that
cigarette smoking cause to low semen quality with several mechanisms. One of
these mechanisms is seminal oxidative stress induced ROS, which has destructive
effects on sperm quality and function. Saleh et al. (2002) show that
oxidative stress status in semen of smoker men is significantly higher than
nonsmoker men. Studies show that cigarette smoking lead to increase of seminal
oxidative stress with several mechanisms: (i) cigarette smoke itself contains
high levels of ROS such as superoxide anion (O2), hydrogen peroxide
(H2O2) and hydroxyl radicals (OH.) (Saleh et
al., 2002; Lee et al., 1998; Kunzle et al., 2003; Church and
Pryor, 1990; Pryor and Stone, 1993), (ii) Smoking metabolites may induce an
inflammatory reaction in the male genital tract with a subsequent release of
chemical mediators of inflammation that can recruit and activate leukocytes.
Activated leukocytes can generate high levels of ROS in semen, which may overwhelm
the antioxidant strategies, resulting in oxidative stress (Saleh et al.,
2002) and (iii) Toxic metabolites of cigarette smoke may impair spermatogenesis,
resulting in the production of abnormal spermatozoa, that is a important source
of ROS and oxidative stress (Saleh et al., 2002; Karagounis et al.,
1985). ROS produced by cigarette smoke-induced phagocyte cells or abnormal spermatozoa
cause oxidative damage to normal sperm DNA, protein and lipids, which may be
closely related to sperm dysfunction (Aitken and Baker, 2006). Spermatozoa are
particularly susceptible to the damage induced by excessive ROS because their
plasma membranes contain large quantities of polyunsaturated fatty acids (PUFA)
and their cytoplasm contains low concentrations of scavenging enzymes (Agarwal
et al., 2002; Agarwal and Prabakaran, 2005; Aitken and Baker, 2006).
Therefore, production of high levels of ROS in the reproductive tract is detrimental
not only to the fluidity and function of the sperm plasma membrane but also
to the integrity of DNA in the sperm nucleus (Agarwal and Saleh, 2002; Agarwal
and Prabakaran, 2005). DNA damage included by excessive levels of ROS may accelerate
the process of germ cell apoptosis, leading to decline in sperm counts and associated
with male infertility (Agarwal and Allamaneni 2004; Aitken and Krausz, 2001).
Studies found that levels of ROS correlate with motility of spermatozoa (Iwasaki
and Cagnon, 1992; Aitken et al., 1989; Agarwal et al., 1994; Armstrong
et al., 1999). Peroxidative damage to the sperm membrane and axonemal
proteins appears to be the cause of permanent impairment in sperm motility (Agarwal
and Allamaneni, 2004). By accomplished research (Close et al., 1990;
Dikshit et al., 1987; Kunzle et al., 2003; Said et al.,
2005; Saleh et al., 2002; Guzick et al., 2001; Martini et al.,
2004; Pasqualotto et al., 2004; Wang et al., 2001), it appears
that negative effects of cigarette smoking on sperm parameter may have a dose-dependent
effect and high level of cigarette smoking is positive related with decreased
sperm parameter quality. This is may be do to cigarette toxic components that
cause to increase of seminal free radicals and oxidative stress (Karagounis
et al., 1985). Oxidative stress has a destructive effect on sperm membrane
and DNA and associated with low sperm quality in smoker men.
ACKNOWLEDGMENTS This research was supported by Mazandaran University and Babol University of Medical Sciences.
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