Zakarea A.Yaseen AL-KHAYAT
MB. Ch.B, M.Sc, Ph.D. Clinical microbiology, Dept. of Microbiology, College of medicine, Hawler Medical University, Erbil, Kurdestan Region, IRAQ
E mail: dr_zakarea@yahoo.co.uk

INTRODUCTION

Infertility affects up to 15% of the sexually active population and in 50% of cases a male factor is involved, either as a primary problem or in combination with a problem in the female⁽¹⁾.
In recent years the quality of human sperm and its fertility potential have decreased dramatically. This may suggest the quality of semen has deteriorated partly due to the effects of increasing toxic factors in the environment. Many environmental agents such as tobacco smoke and nicotine have been implicated in the poor semen function and resultant infertility⁽²⁾.
Approximately 30% of reproductive age women and 35% of reproductive age men in the United States smoke cigarettes. Substantial harmful effects of cigarette smoke on fecundity and reproduction have become apparent but are not generally appreciated⁽³⁾.
Numerous investigations have been conducted on the relationship between cigarette smoking and male infertility, however the exact molecular mechanisms are not well understood in most of the cases⁽⁴⁾.

1- Study group:
This study group was conducted at the IVF center in Erbil city, between March 2005 and Sept 2008. Strict patient selection criteria were taken into consideration in order to exclude as many co-existing factors as possible, as they may otherwise influence or modify the effect of cigarette smoke on semen parameters.
For the same reasons, comparison of the infertile smokers with healthy fertile controls was not done to exclude any undiscovered factors present in infertile men. Only patients with primary infertility who were either smokers or strict non-smokers were selected. These patients were married at least for the past one year. Strict non-smokers were those men who had never smoked before.

The followings were excluded from the study :
1- Patients with history of injury to the testes, varicocele, hydrocele, undescended testis or its corrective surgery.
2- Patients with certain occupations: bakers, prolonged drivers.
3- Patients with a history of diabetes mellitus, hypertension, chronic urinary tract infection.
4- Patients with history of medications or tonics.
5- Azoospermic patients.
6- Patients above 45 years of age, to avoid effects of ageing on sperm variables.
Thus , the selected study group of 110 smokers and 110 strict non-smokers, had only one known factor which differentiated between them, i.e: cigarette smoking.

2-Semen collection and analysis:
All patients had sexual abstinence of 3 days. Samples were collected in a wide mouthed sterile container by masturbation. All samples were kept at 37 C°, and processed immediately after complete liquefaction.
All semen samples were analyzed for liquefaction time, volume, and Ph. In addition, semen samples were microscopically examined for sperm density, sperm motility and morphology.
Sperm morphology was studied on haematoxylin and eosin stained smears, counting a minimum of 200 spermatozoa using 100 x magnification oil-immersion lens.

3- The data was analyzed by t-test. A p-value of < 0.05 was taken as being statistically significant.

Table (1) and Table (2) delineate the different parameters regarding semen and sperm in both groups studied.
Table (1) shows that semen volume, PH, and sperm count were lower in the smoker group although statistically there was no significant difference between both groups.
Table (2) clarifies that there was a highly significant difference between both groups regarding the grade (a) of the sperm motility. In addition to that, there was a significant difference between both groups regarding grades b and c of sperm motility.

a- rapid motility
b- slow motility
c- non-progressive motility
d- immortality

The results of the present study support the view that smoking does affect the sperm quality in infertile men.
Smoking is a lifestyle hazard for both active and passive smokers.
Although much is known now about the carcinogens in tobacco cigarette smoke and their resultant effects on organs like lung and urinary bladder, their effects on fertility have been less documented⁽⁵⁾.
New figures show that smoking is having a far more serious effect on sexual health than previously thought and is responsible for many thousands of cases of impotence, cervical cancers, miscarriages and infertility in the United Kingdom each year⁽⁶⁾.
Many studies have examined the effects of cigarette smoking on fertility and cumulative evidence suggests that smoking has a significant negative impact on sperm production, motility and morphology⁽¹⁾.
Merino G, et al⁽⁷⁾ in his 1998 study corroborates reports of detrimental effects of cigarette smoking on sperm characteristics, i.e lower percentage of viability, normal morphology and motility.
Hass H et al⁽⁸⁾ in a 2006 study in Turkey, demonstrated that smoking has an adverse effect on the progressive sperm motility irrespective of the total number of cigarettes smoked per day.
Ramlau-Hansen (2007)⁽⁹⁾ had observed an inverse dose response relationship between smoking and semen volume, total sperm count and motile sperm percentage.
Reina Bouvet et al in 2007⁽¹⁰⁾ demonstrated that tobacco consumption alters the spermatogenesis process.
Rantal ML⁽¹¹⁾ in a 1987 study in Finland, where a comparison of semen quality was undertaken between 60 smokers and 50 non-smoking men attending infertility investigations in which other factors influencing semen quality were eliminated. It was found that heavy smoking may have a detrimental effect on the motility of the sperm.
Saaranen M in 1987⁽¹²⁾ delineated that the only clear difference between men with different smoking habits was in the percentual change in the sperm motility.
Ochedalski T⁽¹³⁾ 0 in a 1994 study from Poland, clarified that the sperm count and motility were lower in smokers. In addition, smokers also have higher incidence of oligospermia compared to non-smokers.
Berthiller J in 2005⁽¹⁴⁾ concluded in a study from France, that among men, active smoking reduces the quality and mobility of the spermatozoa which could result in loss of fertility.
Several studies have noticed the noxious effects of tobacco before and after conception. For men, standard sperm parameters are modified and spermatozoa nuclear quality is compromised. One of the mechanisms involved in those anomalies could be the oxidative stress produced by some cigarette smoking components⁽¹⁵⁾.
Nicotine is able to alter the fertility potential of man by inducing sperm membrane impairment, changing the sperm morphology and motility and also inducing the DNA fragmentation⁽²⁾.
Direct exposure of spermatozoa to the toxins in cigarettes smoke probably tilts the delicate balance of reactive oxygen species (ROS) that are produced by spermatozoa for their special functions like decapitation. Increased quantities of ROS have been shown to be detrimental to the DNA of the spermatozoa thus producing negative effects on the viability and morphology of the spermatozoa⁽¹⁶⁾.
Arabi M in 2005⁽²⁾ stated that antioxidant supplementation could partially reverse the negative effects on sperm function.
Further studies are needed to explain the mechanisms by which smoking affects spermatogenesis and it would be sensible to advise men to abstain from smoking to avoid decreased fertility.

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