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ORIGINAL ARTICLE
Year : 2022  |  Volume : 15  |  Issue : 5  |  Page : 696-700  

Effect of alcohol and smoking on semen analysis parameters


1 Department of Pathology, Dr D.Y Patil Medical College, Hospital and Research Centre, DYP Vidyapeeth, Pune, Maharashtra, India
2 Armed Forces Medical Services, Punch, Jammu and Kashmir, India

Date of Submission19-Mar-2021
Date of Decision28-Apr-2021
Date of Acceptance10-May-2021
Date of Web Publication04-Oct-2022

Correspondence Address:
Dr. Akshi Raj
Department of Pathology, Dr D.Y Patil Medical College, Hospital and Research Centre, DYP Vidyapeeth, Pimpri, Pune - 411 018, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_209_21

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  Abstract 


Background: Infertility affects close to 10%–15% of all couples in reproductive age group. A myriad of life style variables including consumption of alcohol, smoking along with increased exposure to electromagnetic waves emitting from cell phones and personal computers for prolonged durations, have had a negative impact on the quality of semen in males. Materials and Methods: This cross-sectional study was conducted on 250 male patients under evaluation for infertility. Physical and macroscopic examination was carried out followed by in detail microscopic examination according to the World Health Organization 2010 guidelines. Results: Fertility scoring was done for all 250 subjects and 67.2% of cases were found to be fertile, 14.4% were subfertile, and 18.4% of cases were found to be infertile. Among the 168 fertile subjects, majority 75.6% of cases were young in the age group of 20–30 years, 85.1% of cases did not consume alcohol, and 86.3% of cases did not smoke. Among the 46 infertile subjects, majority 54.3% of cases were in the age group of 20–30 years, 84.8% of cases consumed some amount of alcohol, and 54.3% of cases had a history of tobacco smoking. Majority 64.1% of the subjects having a combination of all three lifestyle factors were found to be infertile, whereas only 2.6% of such subjects were found to be fertile. Conclusion: This study shows that the consumption of alcohol and cigarette smoking has a significant deleterious effect on the process of sperm production and male reproductive potential; therefore, counseling regarding this negative impact needs to be focused upon by all clinicians and infertility specialists while handling such cases.

Keywords: Alcohol consumption, infertility, lifestyle, sperm production, testicular function, tobacco smoking


How to cite this article:
Raj A, Iqbal B, Sharma A, Gore CR, Kumar H, Singh M. Effect of alcohol and smoking on semen analysis parameters. Med J DY Patil Vidyapeeth 2022;15:696-700

How to cite this URL:
Raj A, Iqbal B, Sharma A, Gore CR, Kumar H, Singh M. Effect of alcohol and smoking on semen analysis parameters. Med J DY Patil Vidyapeeth [serial online] 2022 [cited 2022 Dec 10];15:696-700. Available from: https://www.mjdrdypv.org/text.asp?2022/15/5/696/357773




  Introduction Top


According to the International Committee for Monitoring Assisted Reproductive Technology and World Health Organization (WHO), infertility is a disease of the reproductive system defined by a failure to achieve clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.[1] Based on scientific data, it affects close to 8%–12% of all couples in reproductive age group.[2]

There is irrefutable evidence implicating alcohol and tobacco in the deleterious impact on male fertility and reproductive health with a number of studies carried out the world over which elucidated the harmful effects of these modifiable lifestyle factors on not only sperm counts but also on their structure, morphology, vitality, and motility.[3] In addition to consumption of these addictive substances, prolonged exposure of testes to consistently raised temperatures, emotional and psychological stress, snuggly fitted clothes, and prolonged sitting and exposure to certain pesticides have all been shown to have a deleterious impact on sperm concentration as well as function.

Evidence-based research has revealed that chronic abuse of alcohol can lead to impairment in the production of testosterone which, in turn, leads to decreased fertility and secondary sexual characteristics in males. Besides, it also negatively impacts the morphology and motility of spermatozoa which results in reduced levels of semen analysis parameters.

Numerous studies have suggested that cigarette smoking negatively affects the male reproductive organs reducing their functional capabilities which, in turn, results in decreased testicular functioning which affects not just the production of sperm, but also its morphology, structure, and motility.[4],[5],[6]

In the 21st century, lifestyle factors including excessive use of cell phones and personal computers and the harmful trend of keeping the mobile phones in trouser pockets where they remain in close proximity to the male gonads have been shown to cause reduced sperm counts in males, possibly due to hyperthermia and oxidative stress. Also, and often neglected, are the electromagnetic waves emitted from these devices which have been shown to result in a progressive deterioration in morphology and motility of sperm due to their deleterious effects on the structure and function of DNA.[7] Sperm DNA fragmentation has been used to detect high levels of defective spermatozoa in infertile males proving that DNA damage is more common in subfertile/infertile men than fertile men.[8]


  Materials and Methods Top


This study was conducted over a 2-year period at a tertiary care hospital in western Maharashtra. All patients coming to the clinical laboratory for semen evaluation were studied except those who were on long-term medications which can affect sperm parameters, those with previous history of surgery involving male genitourinary tract, those who were suffering from medical conditions affecting testicular function such as trauma, varicocele, hydrocele, undescended testes, orchitis, and mumps, those with a significant previous history of smoking/consumption of alcohol for more than 6 months who were abstinent now, those who chewed tobacco, those who were abstinent for <2 and more than 7 days, those who were over the age of 50 years, and those for whom samples were exposed to adverse temperatures or were not taken in the hospital semen collection room. A total of 250 semen samples reporting to this hospital for infertility evaluation were reviewed. A detailed history was obtained from each patient with increased emphasis on lifestyle factors under consideration, i.e., consumption of alcohol, cigarette smoking, and cell phone usage. As per the WHO 2010 criteria for semen analysis parameters, semen analysis was performed for all the subjects. Based on the results obtained from semen analysis, fertility scoring was done following which, all the cases were classified as fertile, subfertile, or infertile. Individual parameters were assessed according to the guidelines by WHO, 2010.[9] These parameters were categorized under A, B, and C and a score of 2, 1, and 0 were given, respectively.

Caution was undertaken whenever interpreting subfertile sperm measurements as these are not conclusive of infertility. The same goes for men whose sperm counts are above the reference range set by the WHO manual, as these men could have parameters in the indeterminate range where a significant portion of the group is infertile [Table 1].[10]
Table 1: Fertility scoring: According to the World Health Organization 2010

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Subsequently, the lifestyle factors were superimposed on the fertility findings and a causal relationship and association was studied between reproductive potential and lifestyle factors, namely alcohol consumption, tobacco smoking, and cell phone usage. Chi-square test was done to conduct statistical analysis. P < 0.05 was considered statistically significant, whereas P > 0.05 was taken as nonsignificant.


  Results Top


In our study, a majority 79.6% of subjects had normal sperm count, whereas 20.4% of subjects had oligozoospermia and no subject had azoospermia. On evaluation of the progressive motility, a large proportion of cases, i.e., 50.8% of the subjects, were found to have asthenozoospermia, while the remaining 49.2% had normal progressive motility. With respect to volume, 20.8% of cases were found to have hypospermia, while the remaining were normospermic with no cases of hyperspermia. In addition, 11 cases were found to have teratozoospermia [Table 2].
Table 2: Distribution of cases according to sperm count, motility, volume and structure

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With respect to alcohol consumption, 29% out of 87 cases were found to be fertile, 26.4% of cases were subfertile, and 44.8% of cases were found to be infertile. On the other hand, 33.8% out 68 tobacco smokers were found to be fertile, 29.4% were subfertile, and 36.8% were found to be infertile. In our study, the relationship between subfertility/infertility and alcohol consumption and tobacco smoking was found to be statistically significant [Table 3].
Table 3: Association of cases having lifestyle factors with fertility score

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Among the fertile group, a majority, i.e., 85.1%, were nondrinkers, whereas the proportion of mild and moderate alcohol consumers was 11.9% and 2.4%, respectively. Only 0.6% of cases from the fertile group was a severe alcohol consumer. In the subfertile group, the distribution was more even with 36.2% of cases not consuming any alcohol, whereas the proportion of mild, moderate, and severe alcohol consumers was 47.2%, 13.8%, and 2.8%, respectively. In subjects that were found to be infertile, only a small proportion, i.e., 15.2% of cases did not consume any alcohol. Among the remaining infertile cases, 39.2% of cases were mild, 23.9% were moderate, and 21.7% of cases were severe alcohol consumers [Table 3].

Among the fertile group, a majority, i.e., 86.3%, were nonsmokers, whereas the proportion of mild and moderate tobacco smokers was 9.6% and 4.1%, respectively. None of the cases from the fertile group were severe tobacco smokers. In the subfertile group, the distribution was more even with 44.5% of cases not smoking any tobacco, whereas the proportion of mild, moderate, and severe tobacco smokers was 33.3%, 19.5%, and 2.7%, respectively. In subjects that were found to be infertile, a relatively smaller proportion, i.e., 45.7% of cases, did not smoke tobacco. Among the remaining infertile cases, 23.9% of cases were mild, 21.7% were moderate, and 8.7% of cases were severe tobacco smokers [Table 3].

Among the fertile group, the proportion of subjects with mild and moderate cell phone usage was 34% and 42.8%, respectively, whereas 23.2% of cases from the fertile group were subjects with severe cell phone usage. In the subfertile group, the distribution was slightly varied with the proportion of cases with mild, moderate, and severe cell phone usage being 11.1%, 55.6%, and 33.3%, respectively. In subjects that were found to be infertile, only a small proportion, i.e., 13.1% of cases, were subjects with mild cell phone usage, whereas 52.1% of cases were subjects with moderate and 34.8% of cases were subjects with severe cell phone usage [Table 3].

In our study, a majority i.e., 64.1% of cases of infertility, were those subjects who consumed alcohol and smoked tobacco. On the contrary, only 2.6% of subjects from the fertile group had a combination of these two lifestyle factors. This clearly indicates a strong association between presence of one or more deleterious lifestyle factors on male reproductive potential [Table 4] and [Figure 1].
Figure 1: Combined lifestyle factors with fertility score

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Table 4: Association of combined lifestyle factors with fertility score

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  Discussion Top


In this study, out of 250 cases studied, 67.2% of subjects are fertile as per the WHO fertility scoring system. The subfertile group has 14.4% of cases and 18.4% of subjects are found to be infertile. The proportions of these groups are more or less comparable to similar studies conducted all over the world.

This study has 20.4% of cases of oligozoospermia with the majority of subjects, i.e., 79.6%, having normal sperm count. Moreover, we see 50.8% of cases of asthenozoospermia, while the remaining 49.2% of subjects with normal progressive motility of spermatozoa.

The results of this study show a clear correlation between the amount of alcohol consumption and reduction in male reproductive potential corroborating with results of a cross-sectional study on 1221 young males, aged between 18 and 28 years, from Denmark, carried out by Jensen et al.[11] They concluded that total sperm count, sperm concentration, and the percentage of spermatozoa with normal morphology were all negatively associated with an increasing amount of consumption of alcohol. They also found that even mild alcohol consumption of >5 units/week showed a deleterious effect on the quality of semen of unknown fertility.

Kumar et al.[12] conducted a similar study in which it was revealed that in subjects with oligozoospermia, there was a nonsignificant reduction in progressive motility and sperm concentration between nonsmokers and smokers. A similar study conducted by Ramlau-Hansen et al.[13] also showed deleterious effects of tobacco smoking on parameters of semen analysis.

It is evident from the findings of this study that chronic cell phone usage is negatively associated with male reproductive potential. In a similar study conducted by Agarwal et al.,[14] it was shown increasing temperature in and around testes due to continuous carrying of mobile phones in trouser pockets in close proximity to the testes. These devices have been known to emit radiofrequency electromagnetic radiation which has been shown to have a negative impact on the development and function of spermatozoa.

Despite advances in the understanding of male infertility, idiopathic sperm abnormalities still account for about 30% of male infertility.[15]


  Conclusion Top


It is no mystery that lifestyle factors are often implicated in the etiology of infertility. Based on the results obtained in this study, it is clearly evident that semen analysis parameters, especially sperm concentration, viability, and progressive motility, are markedly reduced in subjects who have a positive history of alcohol consumption, tobacco smoking, and excessive cell phone usage. In addition, the degree of exposure to these lifestyle factors is closely associated with the cases of subfertility and infertility. Moreover, it is also observed that the combinations of these factors are implicated in having a magnified negative impact on male reproductive potential. In view of these findings, counseling regarding the deleterious effects and modification of these lifestyle factors needs to be focused upon by all clinicians and specialists while handling couples reporting to their clinics for infertility evaluation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Zegers-Hochschild F, Adamson GD, de Mouzon J, Ishihara O, Mansour R, Nygren K, et al. The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary on ART terminology, 2009. Hum Reprod 2009;24:2683-7.  Back to cited text no. 1
    
2.
Practice Committee of American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss. Fertil Steril 2008;90:S60.  Back to cited text no. 2
    
3.
Brugo-Olmedo S, Chillik C, Kopelman S. Definition and causes of infertility. Reprod Biomed Online 2001;2:41-53.  Back to cited text no. 3
    
4.
Holzki G, Gall H, Hermann J. Cigarette smoking and sperm quality. Andrologia 1991;23:141-4.  Back to cited text no. 4
    
5.
Künzle R, Mueller MD, Hänggi W, Birkhäuser MH, Drescher H, Bersinger NA. Semen quality of male smokers and nonsmokers in infertile couples. Fertil Steril 2003;79:287-91.  Back to cited text no. 5
    
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Goverde HJ, Dekker HS, Janssen HJ, Bastiaans BA, Rolland R, Zielhuis GA. Semen quality and frequency of smoking and alcohol consumption--an explorative study. Int J Fertil Menopausal Stud 1995;40:135-8.  Back to cited text no. 6
    
7.
Dada R, Gupta NP, Kucheria K. Spermatogenic arrest in men with testicular hyperthermia. Teratog Carcinog Mutagen 2003;Suppl 1:235-43.  Back to cited text no. 7
    
8.
Dissanayake DM, Keerthirathna WL, Peiris LD. Male infertility problem: A contemporary review on present status and future perspective. Gender and the Genome. 2019;3:1-7.  Back to cited text no. 8
    
9.
World Health Organization Standard Procedures. In: Cooper TG, editor. WHO Laboratory Manual for the Examination and Processing of Human Semen. 5th ed. Geneva: World Health Organization; 2010. p. 1-141.  Back to cited text no. 9
    
10.
Patel AS, Leong JY, Ramasamy R. Prediction of male infertility by the World Health Organization laboratory manual for assessment of semen analysis: A systematic review. Arab J Urol 2018;16:96-102.  Back to cited text no. 10
    
11.
Jensen TK, Gottschau M, Madsen JO, Andersson AM, Lassen TH, Skakkebæk NE, et al. Habitual alcohol consumption associated with reduced semen quality and changes in reproductive hormones; a cross-sectional study among 1221 young Danish men. BMJ Open 2014;4:e005462.  Back to cited text no. 11
    
12.
Kumar S, Murarka S, Mishra VV, Gautam AK. Environmental and lifestyle factors in deterioration of male reproductive health. Indian J Med Res 2014;140 Suppl:S29-35.  Back to cited text no. 12
    
13.
Ramlau-Hansen CH, Thulstrup AM, Aggerholm AS, Jensen MS, Toft G, Bonde JP. Is smoking a risk factor for decreased semen quality? A cross-sectional analysis. Hum Reprod 2007;22:188-96.  Back to cited text no. 13
    
14.
Agarwal A, Deepinder F, Sharma RK, Ranga G, Li J. Effect of cell phone usage on semen analysis in men attending infertility clinic: An observational study. Fertil Steril 2008;89:124-8.  Back to cited text no. 14
    
15.
Fainberg J, Kashanian JA. Recent advances in understanding and managing male infertility. F1000Res. 2019;8:F1000 Faculty Rev-670. Published 2019.  Back to cited text no. 15
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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