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Provide a detailed account of the factors that may cause a male patient to present with suboptimal semen characteristics in comparison to a fertile man with an IVF quality ejaculate.

In Advanced Reproductive Technologies (ART), it is necessary to consider random semen analysis while considering infertility cases. Abnormalities in sperm production or quantity and quality account for almost 40% of infertility cases. There have always been contradictions about standardising the basics of semen analysis. However, a cursory evaluation of the male semen analysis is always considered through the recommendations and guidelines of the World Health Organisation(WHO), which is widely followed by almost all practitioners across the world.


In human male reproduction, the sperm in the ejaculation of male semen is retrieved by a process of about 74-100 days. The process by which stem cells develop into matured spermatozoa is called spermatogenesis, further, the development of these mature spermatozoa into sperm cells is called spermiogenesis. The complete process of developing sperm cells is marked by a number of events that lead to the retrieval of millions of sperm in each semen ejaculate. According to WHO, different parameters for evaluation have been set, which have more or less changed with time. It also recommends abstinence of about 2to7days.

Standard parameters for semen sample analysis are :

• Volume 1.4-1.7ml.
• Liquefaction time of less than 60 minutes at room temperature.
• Appearance grey and opalescent. • Consistency as a discrete droplet.
• Leukocytes <1million/mL.
• Sperm Concentration 12-16*106. • Total Sperm Count 33-46*106.
• Total Motility 38-42%. • pH 7.2.
• Morphology 3-4%.

It is considered for any male with infertility issues should be evaluated on at least 2 semen samples
for accurate analysis of the parameters.


The complete process of spermatogenesis is temperature specific and occurs at a temperature lower than the body temperature. It is adequate to maintain thermoregulation else disturbance in temperature causes effects on spermatogenesis resulting in altered spermatozoa(sperm cells).
The molecular response to the germ cells being exposed to heat causing possible heat-induced germ cell damage leads to apoptosis, and autophagy DNA damage.


Smoke contains over 7000 chemical substances like carcinogenic elements , Volatile Organic Compounds (VOC’s) and relatively increased exposure to hazardous substances. Smoking is considered to damage DNA causing mutation and even fragmentation. This affects on sperm count ,
motility, morphology.


Intake of alcohol adversely effects the functioning of the male reproductive system. The consumption of alcohol interferes with the actions of Hypothalamus-Pituitary-Gonadal (HPG) which alters the production of GnRH , FSH , LH and Testosterone. The altered production of these hormones impairs functioning of Leydig and Sertoli cells. Alcohol consumption does not only cause impaired functioning , but also deteriorates sperm production, morphology , development, and maturation.

Recreational Drugs

Illicit yet addictive drugs includes marijuana , Anabolic Androgenic Steroids (AAS) , narcotics , cocaine which eventually have adversely negative effect on male fertility. These drugs effect overall sperm functioning , testicular architecture and also the HPG axis. Deregulation of the Endogenous Cannabinoid System (ECS) shows significant impaired spermatogenesis which leads to eventual lower total sperm count and motility. The phytocannabinoids in marijuana , and endocannabinoids for binding to the cannabinoid and vanilloid receptors disrupts the homeostasis of the ECS that causing impairing of parameters related to male fertility. Cocaine is a strong stimulating drug which directly disrupts testicular structure and spermatogenesis , this is due to cocaine induced apoptosis. The range of AAS and its derivatives is often used by males for athletic performance. Increased and prolonged dosage of these drugs sends a negative feedback to the HPG axis, that causes reversible and even sometimes irreversible suppression of complete mechanism of spermatogenesis, testicular atrophy, and further more also effects libido loss , erectile dysfunction.

Psychological Stress

Although the cause of stress has no specific parameter to be measured or considered to be affecting specific functioning , but it creates a huge impact on the reproduction and how mechanism behind it works. Even though , Stress has now significant effect on GnRH ,but with high levels of FSH , LH while low levels of Testosterone. Stress eventually happens to affect abnormally on the semen parameters causing , less volume , low motility.

Advanced Paternal Age(APA)

The APA is considered for a male above 35 years of age till is able to ejacuate. The natural ageing of the male decline the overall health but necessarily decline in semen volume, sperm total, and progressive motility, normal sperm morphology along with an increase in DNA fragmentation. The testicular function and metabolism of the men’s body deteriorates as the testis undergoes morphological changes. This decline leads to decrease Germ cells, Leydig and Sertoli cells, further also affects the structural changes, narrowing of seminiferous tubules.

Diet and Caffeine

Diet and nutrition holds essential role in overall health of humans , further to the semen quality. Regular healthy meals with processed meat, full fat meals, dairy products, alcohol, coffee, and sugar-sweetened beverages and even unsweetened non flavoured carbonated drinks are associated
with bad semen quality and overall lesser ability to ejacuate.

Other Factors Related to Lifestyle

Often, men with prolonged hours of sitting for work, excessive exposure to radiant heat, leads to testicular heat stress. These increased levels of temperature in the scrotal lead to spermatogenic arrest , germ cell apoptosis, and sperm DNA damage.


Although, the hallmark protocol to evaluate the underlying cause of male infertility is semen analysis. It is essential to have standard protocol to determine the factors affecting the semen for men who lie under the suboptimal semen characteristics. All the potential factors for men fertility are regulated by Hypothalmus-Pituitary-Gonadal (HPG) regulation. Even though , there are a lot of factors that leads to problems with the sperm but most commonly hindering issues are smoking , alcohol , drugs , anabolic steroids , obesity , stress and major lifestyle changes over a period of time.





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