Prospective Comparison of Sperm Parameters in SCD Adult Patients Before and after a 6 Months Treatment with hydroxyurea (HU)

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 242-242
Author(s):  
Dora Bachir ◽  
Francois Lionnet ◽  
Justine Gellen Dautremer ◽  
Katia Stankovic ◽  
Anoosha Habibi ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Sperm Concentration ◽  
Real Life ◽  
Adult Patients ◽  
Sperm Parameters ◽  
Semen Parameters ◽  
Accurate Information ◽  
Adult Males ◽  
Life Project ◽  
Prospective Comparison

Abstract Abstract 242 Introduction Hydroxyurea (HU) has proved its efficacy in reducing vaso-occlusive events in patients with SCD and increasing life expectancy. However, effects on fertility in adult males represent a major issue for acceptance and adherence, as HU has been reported to impair spermatogenesis through direct cytotoxic effects and hypogonadism. There are only limited data in the literature in this field and mainly retrospective. Patients and methods 49 adult patients aged 20–52 years with homozygous SCD eligible for first line HU treatment were enrolled after informed consent between June 2010 and April 2012 in this prospective study: HYDREP.The main objective was to compare at Day 0 and 180 of HU treatment the semen parameters according to the WHO (1999) criteria(volume, sperm concentration, viability, forward motility and morphology ). Vaso-occlusive events and other complications, number of transfusions during the 6 months preceding and following HU initiation were recorded. Hematological, biochemical, hormonal parameters, HU dosage were recorded at Day 0, Day 90 and 180. HU was begun at 15mg/Kg dose (Platt *) and modulated following haematological tolerance and renal function. Results and discussion Preliminary results concern the 24/49 patients, who complete the 6 months protocol. A statistically significant impairment in all sperm parameters was observed, after a 6 months HU therapy, with great variations between individuals, which are to be explained by complementary tests. These preliminary deleterious findings must be interpreted with caution as in our experience 1) spermatogenesis may recover after drug withdrawal 2) Repeated vaso-occlusive events are also potentially deleterious on fertility (Berthaut **)and 3)this study must be completed with a survey on effective fertility seen in men treated with HU. Thus, regarding to the great benefit offered by HU on prognosis allowing a real “life project” in young symptomatic adults with SCD, it is worth providing each patient of the most accurate information on fertility as an essential prerequisite for their adhesion to HU treatment. Conclusion Sperm cryopreservation is advised before beginning a treatment with HU. Prospective follow up studies of HU male cohort regarding fertility are warranted. Health education has a major role to play to increase HU compliance especially in view of these results. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Curcumin Along With Fe3O4 Nanoparticles Improved Sperm Parameters In Rats With Testicular Ischemia

2021 ◽  
Vol 10 ◽  
pp. e2034
Author(s):  
Shabnam Zarei Moradi ◽  
Seyed Abdolhamid Angaji ◽  
Mitra Salehi ◽  
Mehrdad Hashemi
Keyword(s):  
Fe3o4 Nanoparticles ◽  
Sperm Concentration ◽  
Concomitant Administration ◽  
Testicular Tissue ◽  
Sperm Parameters ◽  
Male Rats ◽  
Semen Parameters ◽  
Control Group ◽  
Fe3o4 Nps ◽  
Testicular Ischemia

Background: Ischemic/reperfusion (I/R) in testicular tissue is one reason for the worldwide increase in male infertility. In the present study, we assessed the effects of curcumin and Fe3O4 nanoparticles (NPs) on sperm parameters in rats with I/R damage. Materials and Methods: Forty-eight adult male rats were divided into two groups (n=24 per group): control and torsion/detorsion. The control and torsion/detorsion groups were divided into four subgroups include sham, Fe3O4 NPs, curcumin, and Fe3O4 NPs+curcumin. After the rats were sacrificed, semen was collected from their epididymal tissues to assess sperm viability, motility, concentration, and morphology. Results: Curcumin significantly improved viability, motility, and normal sperm morphology in rats with I/R damage compared to the control group; however, it did not have a significant effect on sperm concentration (P<0.001). Fe3O4 NPs alone decreased all sperm parameters in the control and I/R rats (P<0.001). However, concomitant administration of Fe3O4 nanoparticles with curcumin significantly improved sperm parameters in rats with I/R damage (P<0.001). Conclusion: The increase in all semen parameters in the experimental groups with concomitant use of Fe3O4 NPs plus curcumin indicated that green synthesis of NPs could be recommended for future clinical studies.

scholarly journals Managing Fast-Track Construction Project in Qatar: Challenges and Opportunities

Buildings ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 640
Author(s):  
Temitope Egbelakin ◽  
Olabode Emmanuel Ogunmakinde ◽  
Billie Teshich ◽  
Temitope Omotayo
Keyword(s):  
Construction Projects ◽  
Fast Track ◽  
United Arab Emirate ◽  
Real Life ◽  
Project Managers ◽  
Accurate Information ◽  
Change Orders ◽  
Life Project ◽  
Challenges And Opportunities ◽  
Operations And Maintenance

Fast-track construction projects are becoming increasingly prevalent in the construction industry, particularly where completion time is essential. A high adoption rate in some of the United Arab Emirate countries and the lack of a conceptual understanding of the challenges inherent in such may jeopardize the future sustainability of the construction sector. To make an informed decision about adopting a fast-track construction method, it is necessary to first identify the opportunities and challenges associated with it. Therefore, this study examines the critical challenges impeding the performance of Qatar’s fast-track construction projects. The research findings were analysed and triangulated using a real-life project as a case study and several data sources. The results of the research identified four critical categories of barriers: design and coordination-related, scope or change orders-related, material and equipment-related, and contractual-related barriers. In addition, strategies such as accurate information, constructability assessment, early involvement of operations and maintenance personnel, and the use of an effective change control system were identified for addressing the identified challenges. The findings are beneficial to professionals who are currently operating or planning to undertake construction projects in Qatar or other United Arab Emirate countries. This study recommends that project managers be more attentive to key barriers in order to improve the performance of fast-track projects and to meet clients’ objectives.

scholarly journals The Effect of Screening and Treatment of Ureaplasma Urealyticum Infection on Semen Parameters in Asymptomatic Leukocytospermia: A Case Control Study

2020 ◽  
Author(s):  
Qi-Feng Zhang ◽  
Yu-Ji Zhang ◽  
Sheng Wang ◽  
Yu Wei ◽  
Feng Li ◽  
...  
Keyword(s):  
Ureaplasma Urealyticum ◽  
Sperm Quality ◽  
Day Treatment ◽  
Treatment Plan ◽  
Sperm Concentration ◽  
Good Choice ◽  
Semen Parameters ◽  
Adult Males ◽  
Normal Morphology ◽  
Cure Rates

Abstract Background: Ureaplasma urealyticum (UU) infection, as well as asymptomatic leukocytospermia, whether it has effect on semen parameters and whether it needs screening and treatment is still a confusing and controversial topic for clinicians.Methods: Among 1,530 adult males who visited Guilin People's Hospital due to infertility, 295 were diagnosed with asymptomatic leukocytospermia, and 95 were further screened for UU-positive. 81 UU-positive asymptomatic leukocytospermia patients received 7-day or 14-day treatment plan with doxycycline, and 70 cases were cured. The semen parameters of non-leukocytospermia, leukocytospermia, UU-positive leukocytospermia and UU-negative leukocytospermia groups were compared, and the differences between the two treatment plans and the semen parameters before UU treatment and 1 month after UU-cured were compared.Results: Compared with non-leukocytospermia patients, the sperm concentration, progressive motility (PR), and normal morphology of patients with leukocytospermia decreased, while those with UU-positive leukocytospermia performed more significantly. The PR, total motility, and normal morphology of UU-positive leukocytospermia patients were significantly lower than those of UU-negative leukocytospermia patients (all p<0.001). The UU cure rates of the 7-day and 14-day treatment plan with doxcycline was 84.62% and 89.66% (p=0.738), respectively, and the sperm concentration, PR, total motility, and normal morphology of the cured UU-positive leukocytospermia patients were all increased after 1 month (p=0.001, p=0.022, p=0.004 and p=0.008, respectively).Conclusions: It is significant to screen and treat UU infection in asymptomatic leukocytospermia for improving sperm quality. Where appropriate, the 7-day treatment plan with doxycycline may be a good choice.

scholarly journals Analysis of seasonal variability of sperm donors’ semen parameters

2018 ◽  
Vol 8 (3) ◽  
pp. 28-35
Author(s):  
Igor A. Korneyev ◽  
Ruslan D. Zasseev ◽  
Ol'ga B. Pashina ◽  
Ali E. Mamedov ◽  
Al'bert M. Dogov ◽  
...  
Keyword(s):  
Seasonal Variability ◽  
Reproductive Medicine ◽  
Sperm Concentration ◽  
Sperm Parameters ◽  
Semen Parameters ◽  
Motile Sperm ◽  
Sperm Number ◽  
Progressive Motility ◽  
Sperm Donors ◽  
The Mean

Introduction. The concept of seasonal variability of sperm parameters is controversial. However, it should be considered during medical evaluation and solicitation of sperm donors. Aim. To evaluate seasonal variability of sperm parameters from anonymous sperm donors in a reproductive medicine center. Materials and methods. A retrospective study of 1252 semen samples from 39 sperm donors (mean age 27.1 ± 3.9 years) in a reproductive medicine center in Saint Petersburg during the period from October 1, 2015 to October 1, 2017 was performed according to WHO 2010 recommendations. Semen volume, sperm concentration, total sperm number, progressive motility, and number of progressively motile sperm were analyzed. Results. Individual variability in semen parameters was high. The mean ejaculate volume in the summer months was higher than in the autumn, winter, and spring (t = 3.65, p < 0.001; t = 4.18, p < 0.0001; t = 1.92, p = 0.056 respectively). The lowest volume (2.83 ± 1.32 ml) was registered in January. The mean sperm concentration in summer was lower than in autumn, winter, and spring (t = 3.65, p < 0.001; t = 4.18, p < 0.0001; t = 1.92, p = 0.056 respectively). It was higher in winter than in spring and autumn (t = 2.54, p = 0.012; t = 1.72, p = 0.082 respectively). The highest mean sperm concentration was registered in January and the lowest in July (157.2 ± 46.6 and 131.9 ± 44.0 million sperm per ml, respectively). No significant seasonal differences were found in total sperm number, progressive motility, or number of progressively motile sperm (p > 0.1). Conclusions. The study suggests there is both individual and seasonal variability in sperm donors’ semen parameters. As several semen samples are needed to rate semen quality, we recommend that semen analysis for a potential sperm donor be performed in the summer months.

scholarly journals The effect of screening and treatment of Ureaplasma urealyticum infection on semen parameters in asymptomatic leukocytospermia: a case control study

2020 ◽  
Author(s):  
Qi-Feng Zhang ◽  
Yu-Ji Zhang ◽  
Sheng Wang ◽  
Yu Wei ◽  
Feng Li ◽  
...  
Keyword(s):  
Ureaplasma Urealyticum ◽  
Sperm Quality ◽  
Day Treatment ◽  
Treatment Plan ◽  
Sperm Concentration ◽  
Good Choice ◽  
Semen Parameters ◽  
Adult Males ◽  
Normal Morphology ◽  
Cure Rates

Abstract Background: Ureaplasma urealyticum (UU) infection, as well as asymptomatic leukocytospermia, whether it has effect on semen parameters and whether it needs screening and treatment is still a confusing and controversial topic for clinicians.Methods: Among 1,530 adult males who visited Guilin People's Hospital due to infertility, 295 were diagnosed with asymptomatic leukocytospermia, and 95 were further screened for UU-positive. 81 UU-positive asymptomatic leukocytospermia patients received 7-day or 14-day treatment plan with doxycycline, and 70 cases were cured. The semen parameters of non-leukocytospermia, leukocytospermia, UU-positive leukocytospermia and UU-negative leukocytospermia groups were compared, and the differences between the two treatment plans and the semen parameters before UU treatment and 1 month after UU-cured were compared.Results: Compared with non-leukocytospermia patients, the sperm concentration, progressive motility (PR), and normal morphology of patients with leukocytospermia decreased, while those with UU-positive leukocytospermia performed more significantly. The PR, total motility, and normal morphology of UU-positive leukocytospermia patients were significantly lower than those of UU-negative leukocytospermia patients (all p<0.001). The UU cure rates of the 7-day and 14-day treatment plan with doxycycline was 84.62% and 89.66% (p=0.738), respectively, and the sperm concentration, PR, total motility, and normal morphology of the cured UU-positive leukocytospermia patients were all increased after 1 month (p=0.001, p=0.022, p=0.004 and p=0.008, respectively).Conclusions: It is significant to screen and treat UU infection in asymptomatic leukocytospermia for improving sperm quality. Where appropriate, the 7-day treatment plan with doxycycline may be a good choice.

Same Total Normal Forms Sperm Counts of Males From Lhasa and Shanghai, China

2021 ◽  
Author(s):  
Benhong GU ◽  
Shangren WANG ◽  
Feng LIU ◽  
Yuxuan SONG ◽  
Jun LI ◽  
...  
Keyword(s):  
Normal Form ◽  
Sperm Concentration ◽  
Reproductive Function ◽  
Sperm Parameters ◽  
Semen Parameters ◽  
Male Reproductive Function ◽  
Fragmentation Index ◽  
Reproductive Endocrine ◽  
Index Ratio ◽  
The Impact

Abstract Male infertility may be caused by genetic and/or environmental factors that impair spermatogenesis and sperm maturation. High-altitude (HA) hypoxic environments represent one of the most serious challenges faced by humans that reside in these areas. To assess the influence of the plateau environment on semen parameters, 2,798 males, including 1,111 native Tibetans and 1,687 Han Chinese individuals living in the plains(HCILP) who underwent pre-pregnancy checkups, were enrolled in this study. The semen samples of males were evaluated to determine conventional sperm parameters, sperm morphology, and sperm movement. Reproductive endocrine hormones (REHs) were detected in 474 males, including 221 Tibetans and 253 HCILP. Due to recurrent abortions in partners, the DNA fragmentation index (DFI) of 133 native Tibetans and 393 HCILP individuals was further compared. Luteinizing hormone (LH) (4.94 ± 2.12 vs. 3.29 ± 1.43 U/L), prolactin (11.34 ± 3.87 vs. 8.97 ± 3.48 nmol/L), E2/T (0.22 ± 0.11 vs 0.11 ± 0.05), median total sperm motility (61.20% vs. 51.56%), and DFI (23.11% vs. 7.22%) were higher in males from plateau areas while median progressive motility (PR) (35.60% vs. 41.12%), total number of PR sperms (51.61 vs. 59.63 mil/ejaculate), percentage of normal form sperms (3.70% vs. 6.00%), curvilinear velocity (36.10 vs. 48.97 μm/s), straight-line (rectilinear) velocity (14.70 vs. 31.52 μm/s), estradiol (103.82 ± 45.92 vs. 146.01 ± 39.73 pmol/L), progesterone (0.29 ± 0.27 vs. 2.22 ± 0.84 nmol/L), testosterone (4.90 ± 1.96 vs. 14.36 ± 5.24 nmol/L), and testosterone secretion index (ratio of testosterone to LH) (33.45 ± 22.86 vs 145.78 ± 73.41) were lower than those in males from the plains. There was no difference in median total sperm number (157.76 vs. 151.65 mil/mL), sperm concentration (52.40 vs. 51.79 mil/mL), volume (3.10 vs. 3.10 mL), total normal form sperms (5.91 vs. 6.58 mil/ejaculate, p50), and follicle-stimulating hormone (FSH) levels (4.13 ± 2.55 U/L vs 3.82 ± 2.35 U/L) between the two groups of males. The REH and sperm parameters of males from HA hypoxic environments were adaptively altered. Although the total number of PR sperm decreased and DFI increased, the Tibetan population that lives at HAs has been found to grown continuously and rapidly. These results supplement prior findings regarding the impact of HA on male reproductive function.

scholarly journals Best time to wait for the improvement of the sperm parameter after varicocelectomy: 3 or 6 months?

2020 ◽  
Vol 92 (3) ◽  
Author(s):  
Mohammad Ali Ghaed ◽  
Seyed Alireza Makian ◽  
Asaad Moradi ◽  
Robab Maghsoudi ◽  
Alireza Gandomi-Mohammadabadi
Keyword(s):  
Sperm Concentration ◽  
Reproductive Technology ◽  
Sperm Parameters ◽  
Semen Parameters ◽  
Academic Hospital ◽  
Normal Morphology ◽  
Semen Volume ◽  
Significant Difference ◽  
Before And After ◽  
Time Required

Objective: To estimate the duration of time required following varicocelectomy to wait for the improvements of semen parameters. Therefore, we characterized the changes with the time in sperm parameters in men after varicocelectomy. Materials and methods: In this prospective cohort study we included consecutively observed men who underwent varicocelectomy between September 2017 and September 2018 in a referral academic hospital. Clinical data of the patients, as well as their semen parameters, were measured before surgery and at 3 and 6 months afterward. Results: In this study, a total of 100 men with average age of 29.5 ± 6.2 years were included. Mean sperm concentration and sperm motility significantly improved by 3 (p < 0.05), but not by 6 months following varicocelectomy. The semen volume and sperm with normal morphology were the same before and after surgery (p > 0.05). There was no statistically significant difference in the improvement of semen parameters when comparing 6 months to 3 months postoperatively (p > 0.05). Conclusions: Sperm parameters (concentration and motility) improve by 3 months after varicocelectomy without further improvements. Consequently, physicians should decide quickly after 3-month of varicocelectomy if surgery has been not helpful and then plan other therapies, like assisted reproductive technology (ART) for managing infertility in couples.

scholarly journals Treatment With Cholecalciferol Leads to Increase Of Selected Semen Parameters in Young Infertile Males: Results of a 6-month Interventional Study

2021 ◽  
pp. S99-S107
Author(s):  
I. Bartl ◽  
M. Ondrušová ◽  
M. Kužma ◽  
P. Jackuliak ◽  
A. Gažová ◽  
...  
Keyword(s):  
Vitamin D ◽  
Semen Analysis ◽  
Sperm Concentration ◽  
Serum Vitamin ◽  
Vitamin D Supplementation ◽  
Sperm Parameters ◽  
Semen Parameters ◽  
Serum Vitamin D ◽  
Vitamin D Levels

High incidence of infertility along with low vitamin D levels was detected in otherwise healthy young men. The aim is to observe the effect of vitamin D supplementation on semen parameters as assessed by semen analysis in infertile men. In total, 45 men (mean age 36.6 years) in consecutive order were included, of whom 34 finished the study. Subjects were supplemented by vitamin D (cholecalciferol) 2500 IU/day. Vitamin D levels were assessed by HPLC. Semen analysis was performed strictly following 2010 WHO guidelines. Study periods were baseline and month 6. During follow-up, 20 %, 7.4 %, 22 % and 0.7 % increase in serum vitamin D levels, progressive sperm motility, sperm concentration and sperm morphology, respectively, were observed (all p<0.05). At follow-up end, 9 patients (26 %) reached normal sperm parameters of whom 2 fertilized their partner. There was no correlation between vitamin D and semen parameters observed. This study proves that vitamin D supplementation is possibly a modulator of sperm parameters in vitamin D deficient, otherwise healthy men. Although a direct relationship between vitamin D and sperm parameters was not observed obtaining adequate vitamin D levels could likely play a role in the male factor of infertility.

P–108 Which infertile men with normal semen analysis deserve a second semen analysis in the real-life setting?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
L Boeri ◽  
P Capogrosso ◽  
E Pozzi ◽  
L Candela ◽  
F Belladelli ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Semen Analysis ◽  
Sperm Concentration ◽  
Roc Curves ◽  
Testicular Volume ◽  
Sperm Parameters ◽  
Semen Parameters ◽  
Clinical Variables ◽  
Infertile Men ◽  
Abnormal Sperm

Abstract Study question Guidelines suggest that one semen analysis is sufficient during the diagnostic work-up of an infertile man in the case of normality as for WHO criteria. Summary answer We investigated the rate and the clinical features of men with abnormal sperm parameters at a second test, after a normal first semen analysis. What is known already A second test is recommended when the first semen analysis depicted abnormal sperm parameters. Study design, size, duration Complete demographic, clinical and laboratory data from 1358 consecutive primary infertile men (infertility as for WHO definition) were analysed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Serum hormones were measured in every patient. Patients underwent two consecutive semen analyses at the same laboratory, which followed 2010 WHO reference criteria. Participants/materials, setting, methods Descriptive statistics and logistic regression models tested the association between clinical variables and semen parameters. Receiver operative characteristic (ROC) curves were used to assess the relationship between clinical variables and to create a composite risk score for pathological sperm parameters at a second test. Main results and the role of chance At first analysis, 212 (15.6%) infertile men had normal semen parameters. Of 212, 87 (41.0%) had a second normal semen analysis, while 80 (37.7%), 35 (16.5%) and 10 (4.7%) men showed 1, 2 and 3 pathological sperm parameters at second test. Men with a pathological second semen analysis had higher CCI scores (p &lt; 0.001), smaller testicular volume (p &lt; 0.001) and higher FSH values (p &lt; 0.01) than those with normal second samples. Overall, despite being within normal ranges, sperm concentration was lower [34 (23–57) vs. 62 (35–94); p &lt; 0.01] in men with an abnormal second sample compared to those with confirmed normality. At multivariable logistic regression analysis, smaller testicular volume (OR 0.9, p = 0.03), FSH (OR 1.2, p &lt; 0.01), and lower sperm concentration (OR 0.9, p &lt; 0.01) were associated with pathological second semen analyses, after accounting for age and CCI. ROC curves showed that testicular volume &lt;15 ml, FSH values &gt;6 mUI/ml and sperm concentration &lt;40 mil/ml had good predictive ability for pathologic second sperm parameters (all AUC &gt;0.8). Considering 1-point for each of the previous variables, the chances of a pathological second analysis increased from 38.8% to 74.6%, 77.3% and 100% among patients with risk scores of 0, 1, 2 and 3, respectively (p &lt; 0.001). Limitations, reasons for caution It is a retrospective analysis at a single, tertiary-referral academic centre, thus raising the possibility of selection biases. In spite of this, all patients have been consistently analysed over time with a rigorous follow-up, thus limiting potential heterogeneity in terms of data reporting. Wider implications of the findings: Approximately 60% of infertile men with a normal semen analysis depicted a pathological second test. Smaller testicles, higher FSH, lower sperm concentrations were independently associated with a pathologic second test. These features could be useful to identify those infertile men with a normal semen analysis who deserve a second test. Trial registration number Not applicable

scholarly journals Impact of Cigarette Smoking on Sperm Parameters of Infertile Men in Center of Algiers (Capital of Algeria)

2020 ◽  
Vol 10 (4-s) ◽  
pp. 193-196
Author(s):  
Amina Itatahine ◽  
Abbassia Demmouche ◽  
H Maï ◽  
Z.C. Khalloua ◽  
D. Ferrag ◽  
...  
Keyword(s):  
Cigarette Smoking ◽  
Male Infertility ◽  
Sperm Count ◽  
Sperm Concentration ◽  
Sperm Parameters ◽  
Semen Parameters ◽  
Negative Effects ◽  
Negative Effect ◽  
Pass Through ◽  
And Function

Background : Cigarette smoking has negative effects on male fertility. Toxins from tobacco smoking can potentially affect sperm development and function, with a negative effect on semen parameters. In fact, the components of cigarette smoke pass through the blood-testis barrier and thus induce an alteration of sperm parameters and nucleus quality of the spermatozoa. The aim is to determine a diffence between tobbaco and no tobbaco patient and semen parameters. This article aimed to assess the relationship between smoking and male infertility. Subject and Methods : this is retrospective study focused on the effects of smoking on semen analyses.  377 men (165 non-smokers, 212  smokers) with infertility for at least 1 year were evaluated between  Mars  and  November 2018, in center of algiers (capital of Algeria). Sperm characteristics (concentration, motility, morphology, and volume) were detemined. Results: Sperm concentration, percentage motility and morphology were significantly lower in an infertile Smokers group than the infertile Nonsmokers group. We also observed that the infertility duration were significantly increased (p<0.05) in accordance with the age in an infertile Smokers group.  Our study shows that cigarette smoking is associated with reduced sperm count and motility. Conclusions: Our results suggest that cigarette smoking has an overall negative effect on semen parameters. Our study suggests that men should be advised to abstain from smoking in order to improve reproductive outcomes. Keywords: smoking, semen, male infertility, sperm, humans

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