Male infertility is known to contribute to about half of all infertility cases. In Ghana, the prevalence of male infertility is higher (15.8%) than in females (11.8%). We evaluated descriptive parameters of semen analysis obtained from males in the workup of infertility in some men undergoing sub-fertility/invitro fertilization (IVF) treatment. We conducted a prospective cohort study in a specialized IVF center in Ghana involving 558 men who reported with their female partners for sub-fertility treatment (clinically diagnosed). Patient selection criteria were based on sub-fertility partners participating in an IVF/ Intracytoplasmic Sperm Injection (ICSI) program. The clients were considered eligible for inclusion in the study if the male partner had motile ejaculated spermatozoa during preliminary semen analysis and before controlled ovarian stimulation (COS). The age group of the men was 27 to 65 years. Exclusion criteria were: previous disease(s) or surgery associated with reproductive function (including varicocele, cryptorchidism, epididymitis, mumps, azoospermia); vasectomy and vasectomy reversal. Clients were questioned regarding their careers, smoking habits, alcohol consumption, medical and family histories. All cases of severe alteration in spermatogenesis, including frozen and surgically retrieved sperm, prostatitis, and or patients who had prior cancer therapy were excluded from this study. Semen samples were then collected by masturbation into sterile containers and analyzed following WHO guidance for semen analysis within 60 minutes after ejaculation and collection. The total number of spermatozoa, and percentages of progressively motile (PR) and morphologically normal spermatozoa, equal to or above the lower reference limits (Normozoospermia) were observed in men less than 40 years (13.38%) and compared to men between 40 - 50 years (13.71%) and those above 50years. The highest percentage of progressively motile (PR) spermatozoa below the lower reference limit (Asthenozoospermia) was observed in men older than 50 years (35.00%) as compared to men less than 40 years (5.43%) and those between 40 and 50 years (4.68%). The highest total number of spermatozoa below the lower reference limit (Oligozoospermia) was observed in men older than 50 years (30.00%) as compared to men less than 40 years (27.20%) and those between 40 and 50 years of age (22.41%). Semen analysis from a small population of some Ghanaian men undergoing IVF treatment showed that morphologically normal spermatozoa below the lower reference limit
References
[1]
Esteves, S., Prudencio, C., Seol, B., Verza, S., Knoedler, C. and Agarwal, A. (2014) Comparison of Sperm Retrieval and Reproductive Outcome in Azoospermic Men with Testicular Failure and Obstructive Azoospermia Treated for Infertility. Asian Journal of Andrology, 16, 602-606. https://doi.org/10.4103/1008-682x.126015
[2]
Esteves, S.C., Miyaoka, R. and Agarwal, A. (2011) Sperm Retrieval Techniques for Assisted Reproduction. International Brazilian Journal of Urology, 37, 570-583. https://doi.org/10.1590/s1677-55382011000500002
[3]
Roque, M., Bedoschi, G. and Esteves, S.C. (2020) Sperm Physiology and Assessment of Spermatogenesis Kinetics in Vivo. In: Parekattil, S.J., Esteves, S.C. and Agarwal, A., Eds., Male Infertility: Contemporary Clinical Approaches, Andrology, ART and Antioxidants, Springer International Publishing, 347-360. https://doi.org/10.1007/978-3-030-32300-4_28
[4]
Carlson, B.M. (2018) Human Embryology and Developmental Biology-Inkling Enhanced E-Book. Elsevier Health Sciences.
[5]
Desai, N., Ludgin, J., Sharma, R., Anirudh, R.K. and Agarwal, A. (2017) Female and Male Gametogenesis. In: Falcone, T. and Hurd, W.W., Eds., Clinical Reproductive Medicine and Surgery: A Practical Guide, Springer International Publishing, 19-45. https://doi.org/10.1007/978-3-319-52210-4_2
[6]
Riparbelli, M.G. and Callaini, G. (2011) Male Gametogenesis without Centrioles. Developmental Biology, 349, 427-439. https://doi.org/10.1016/j.ydbio.2010.10.021
[7]
Sharma, R. and Agarwal, A. (2011) Spermatogenesis: An Overview. In: Zini, A. and Agarwal, A., Eds., Sperm Chromatin: Biological and Clinical Applications in Male Infertility and Assisted Reproduction, Springer, 19-44. https://doi.org/10.1007/978-1-4419-6857-9_2
[8]
Baker, M.D., Ezzati, M., Aloisio, G.M., Tarnawa, E.D., Cuevas, I., Nakada, Y., et al. (2014) The Small GTPase Rheb Is Required for Spermatogenesis but Not Oogenesis. Reproduction, 147, 615-625. https://doi.org/10.1530/rep-13-0304
[9]
Ebata, K.T., Yeh, J.R., Zhang, X. and Nagano, M.C. (2011) Soluble Growth Factors Stimulate Spermatogonial Stem Cell Divisions That Maintain a Stem Cell Pool and Produce Progenitors in Vitro. Experimental Cell Research, 317, 1319-1329. https://doi.org/10.1016/j.yexcr.2011.03.013
[10]
Suárez, J.P., Du Plessis, S.S. and Maya, W.D.C. (2018) Spermatozoa: A Historical Perspective. International Journal of Fertility & Sterility, 12, 182.
Curia, C.A., Ernesto, J.I., Stein, P., Busso, D., Schultz, R.M., Cuasnicu, P.S., et al. (2013) Fertilization Induces a Transient Exposure of Phosphatidylserine in Mouse Eggs. PLOS ONE, 8, e71995. https://doi.org/10.1371/journal.pone.0071995
[13]
Wang, J., Hayes, F., Chadwick, D.R., Hill, P.W., Mills, G. and Jones, D.L. (2019) Short-Term Responses of Greenhouse Gas Emissions and Ecosystem Carbon Fluxes to Elevated Ozone and N Fertilization in a Temperate Grassland. Atmospheric Environment, 211, 204-213. https://doi.org/10.1016/j.atmosenv.2019.05.027
[14]
De Felici, M. and Dolci, S. (2013) From Testis to Teratomas: A Brief History of Male Germ Cells in Mammals. The International Journal of Developmental Biology, 57, 115-121. https://doi.org/10.1387/ijdb.130069md
[15]
Jones, R., James, P.S., Oxley, D., Coadwell, J., Suzuki-Toyota, F. and Howes, E.A. (2008) The Equatorial Subsegment in Mammalian Spermatozoa Is Enriched in Tyrosine Phosphorylated Proteins. Biology of Reproduction, 79, 421-431. https://doi.org/10.1095/biolreprod.107.067314
[16]
Vasudevan, S.R., Lewis, A.M., Chan, J.W., Machin, C.L., Sinha, D., Galione, A., et al. (2010) The Calcium-Mobilizing Messenger Nicotinic Acid Adenine Dinucleotide Phosphate Participates in Sperm Activation by Mediating the Acrosome Reaction. Journal of Biological Chemistry, 285, 18262-18269. https://doi.org/10.1074/jbc.m109.087858
[17]
Richardson, S.S. (2012) Sexing the X: How the X Became the “Female Chromosome”. Signs: Journal of Women in Culture and Society, 37, 909-933. https://doi.org/10.1086/664477
[18]
Wall, R.J., Ferguson, D.J.P., Freville, A., Franke-Fayard, B., Brady, D., Zeeshan, M., et al. (2018) Plasmodium APC3 Mediates Chromosome Condensation and Cytokinesis during Atypical Mitosis in Male Gametogenesis. Scientific Reports, 8, Article No. 5610. https://doi.org/10.1038/s41598-018-23871-9
[19]
Martín, A.C., Borrill, P., Higgins, J., Alabdullah, A., Ramírez-González, R.H., Swarbreck, D., et al. (2018) Genome-Wide Transcription during Early Wheat Meiosis Is Independent of Synapsis, Ploidy Level, and the Ph1 Locus. Frontiers in Plant Science, 9, Article No. 1791. https://doi.org/10.3389/fpls.2018.01791
[20]
Warshauer, D.H., Churchill, J.D., Novroski, N., King, J.L. and Budowle, B. (2015) Novel Y-Chromosome Short Tandem Repeat Variants Detected through the Use of Massively Parallel Sequencing. Genomics, Proteomics & Bioinformatics, 13, 250-257. https://doi.org/10.1016/j.gpb.2015.08.001
[21]
Rey, M., Moore, G. and Martín, A.C. (2018) Identification and Comparison of Individual Chromosomes of Three Accessions of Hordeum chilense, Hordeum vulgare, and Triticum aestivum by FISH. Genome, 61, 387-396. https://doi.org/10.1139/gen-2018-0016
[22]
Knoblaugh, S.E., Adissu, H.A., McKerlie, C. and Cardiff, R.D. (2021) Male Reproductive System. In: Sundberg, J.P., et al, Eds., Pathology of Genetically Engineered and Other Mutant Mice, John Wiley & Sons, Inc., 431-461. https://doi.org/10.1002/9781119624608.ch20
[23]
Mohanty, S.K. and Singh, R. (2017) Overview of the Male Reproductive System. In: Singh, R. and Singh, K., Eds., Male Infertility: Understanding, Causes and Treatment, Springer, 3-12. https://doi.org/10.1007/978-981-10-4017-7_1
[24]
Mawhinney, M. and Mariotti, A. (2012) Physiology, Pathology and Pharmacology of the Male Reproductive System. Periodontology 2000, 61, 232-251. https://doi.org/10.1111/j.1600-0757.2011.00408.x
[25]
Bella, A.J. and Shamloul, R. (2011) Functional Anatomy of the Male Sex Organs. In: Mulhall, J.P., et al., Eds., Cancer and Sexual Health, Humana Press, 3-12. https://doi.org/10.1007/978-1-60761-916-1_1
[26]
Kalthur, S.G. and Kalthur, G. (2016) Anatomy and Development of the Male Reproductive System. In: Gunasekaran, K. and Pandiyan, N., Eds., Male Infertility: A Clinical Approach, Springer, 1-15. https://doi.org/10.1007/978-81-322-3604-7_1
[27]
Puppo, V. and Puppo, G. (2015) Comprehensive Review of the Anatomy and Physiology of Male Ejaculation: Premature Ejaculation Is Not a Disease. Clinical Anatomy, 29, 111-119. https://doi.org/10.1002/ca.22655
[28]
Holmes, E., Björndahl, L. and Kvist, U. (2019) Post-Ejaculatory Increase in Human Semen Osmolality in Vitro. Andrologia, 51, e13311. https://doi.org/10.1111/and.13311
[29]
Barrett, B.J., Garg, A.X., Goeree, R., Levin, A., Molzahn, A., Rigatto, C., et al. (2011) A Nurse-Coordinated Model of Care versus Usual Care for Stage 3/4 Chronic Kidney Disease in the Community: A Randomized Controlled Trial. Clinical Journal of the American Society of Nephrology, 6, 1241-1247. https://doi.org/10.2215/cjn.07160810
[30]
Bjørndal, L., Fransson, H., Bruun, G., Markvart, M., Kjældgaard, M., Näsman, P., et al. (2017) Randomized Clinical Trials on Deep Carious Lesions: 5-Year Follow-Up. Journal of Dental Research, 96, 747-753. https://doi.org/10.1177/0022034517702620
[31]
Group, R.C., Horby, P.W., Mafham, M., Peto, L., Campbell, M., Pessoa-Amorim, G., et al. (2021) Casirivimab and Imdevimab in Patients Admitted to Hospital with Covid-19 (Recovery): A Randomised, Controlled, Open-Label, Platform Trial. https://doi.org/10.1101/2021.06.15.21258542
[32]
Menkveld, R. (2010) Clinical Significance of the Low Normal Sperm Morphology Value as Proposed in the Fifth Edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen. Asian Journal of Andrology, 12, 47-58. https://doi.org/10.1038/aja.2009.14
[33]
Menkveld, R., Holleboom, C.A. and Rhemrev, J.P. (2010) Measurement and Significance of Sperm Morphology. Asian Journal of Andrology, 13, 59-68. https://doi.org/10.1038/aja.2010.67
[34]
Sepil, I., Hopkins, B.R., Dean, R., Thézénas, M., Charles, P.D., Konietzny, R., et al. (2019) Quantitative Proteomics Identification of Seminal Fluid Proteins in Male Drosophila Melanogaster. Molecular & Cellular Proteomics, 18, S46-S58. https://doi.org/10.1074/mcp.ra118.000831
[35]
Kliesch, S. (2020) Cryopreservation of Sperm and Testicular Tissue. In: von Wolff, M. and Nawroth, F., Eds., Fertility Preservation in Oncological and Non-Oncological Diseases: A Practical Guide, Springer International Publishing, 229-239. https://doi.org/10.1007/978-3-030-47568-0_26
[36]
Rao, T., Mohanty, T., Chauhan, I. and Patel, N. (2014) Critical Control Points for Quality Semen Production and Utilization: An Overview.
[37]
Cooper, T.G., Noonan, E., von Eckardstein, S., Auger, J., Baker, H.W.G., Behre, H.M., et al. (2009) World Health Organization Reference Values for Human Semen Characteristics. Human Reproduction Update, 16, 231-245. https://doi.org/10.1093/humupd/dmp048
[38]
Cooper, T.G. (2007) Sperm Maturation in the Epididymis: A New Look at an Old Problem. Asian Journal of Andrology, 9, 533-539. https://doi.org/10.1111/j.1745-7262.2007.00285.x
[39]
Smith, J.F., Walsh, T.J. and Turek, P.J. (2008) Ejaculatory Duct Obstruction. Urologic Clinics of North America, 35, 221-227. https://doi.org/10.1016/j.ucl.2008.01.011
[40]
Henkel, R., Schreiber, G., Sturmhoefel, A., Hipler, U., Zermann, D.H. and Menkveld, R. (2008) Comparison of Three Staining Methods for the Morphological Evaluation of Human Spermatozoa. Fertility and Sterility, 89, 449-455. https://doi.org/10.1016/j.fertnstert.2007.03.027
[41]
Cooper, T.G. (2010) Semen Analysis. In: Nieschlag, E., Behre, H.M. and Nieschlag, S., Eds., Andrology: Male Reproductive Health and Dysfunction, Springer, 125-138. https://doi.org/10.1007/978-3-540-78355-8_9
[42]
Blay, R.M., Pinamang, A.D., Sagoe, A.E., Owusu, E.D.A., Koney, N.K. and Arko-Boham, B. (2020) Influence of Lifestyle and Environmental Factors on Semen Quality in Ghanaian Men. International Journal of Reproductive Medicine, 2020, Article ID: 6908458. https://doi.org/10.1155/2020/6908458
[43]
Tang, Z., Zhang, R., Lian, Z., Deng, S. and Yu, K. (2019) Estrogen-Receptor Expression and Function in Female Reproductive Disease. Cells, 8, Article No. 1123. https://doi.org/10.3390/cells8101123
[44]
Ramaswamy, S. and Weinbauer, G.F. (2014) Endocrine Control of Spermatogenesis: Role of FSH and LH/Testosterone. Spermatogenesis, 4, e996025. https://doi.org/10.1080/21565562.2014.996025
[45]
Schooling, C.M. and Zhao, J.V. (2021) Investigating the Association of Testosterone with Survival in Men and Women Using a Mendelian Randomization Study in the UK Biobank. Scientific Reports, 11, Article No. 14039. https://doi.org/10.1038/s41598-021-93360-z
[46]
Schlatt, S. and Ehmcke, J. (2014) Regulation of Spermatogenesis: An Evolutionary Biologist’s Perspective. Seminars in Cell & Developmental Biology, 29, 2-16. https://doi.org/10.1016/j.semcdb.2014.03.007
[47]
Corona, G., Filippi, S., Comelio, P., Bianchi, N., Frizza, F., Dicuio, M., et al. (2021) Sexual Function in Men Undergoing Androgen Deprivation Therapy. International Journal of Impotence Research, 33, 439-447. https://doi.org/10.1038/s41443-021-00418-7
[48]
Rey, R.A. (2020) The Role of Androgen Signaling in Male Sexual Development at Puberty. Endocrinology, 162, bqaa215. https://doi.org/10.1210/endocr/bqaa215
[49]
Turcu, A., Smith, J.M., Auchus, R. and Rainey, W.E. (2014) Adrenal Androgens and Androgen Precursors—Definition, Synthesis, Regulation and Physiologic Actions. Comprehensive Physiology, 4, 1369-1381. https://doi.org/10.1002/j.2040-4603.2014.tb00590.x
[50]
Jungwirth, A., Giwercman, A., Tournaye, H., Diemer, T., Kopa, Z., Dohle, G., et al. (2012) European Association of Urology Guidelines on Male Infertility: The 2012 Update. European Urology, 62, 324-332. https://doi.org/10.1016/j.eururo.2012.04.048
[51]
Bonetti, A., Tirelli, F., Catapano, A., Dazzi, D., Dei Cas, A., Solito, F., et al. (2008) Side Effects of Anabolic Androgenic Steroids Abuse. International Journal of Sports Medicine, 29, 679-687. https://doi.org/10.1055/s-2007-965808
[52]
Sharma, M. and Leslie, S. (2023) Azoospermia. StatPearls Publishing.
[53]
Sunder, M. and Leslie, S.W. (2022) Semen Analysis. StatPearls Publishing.
[54]
Sharma, A., Minhas, S., Dhillo, W.S. and Jayasena, C.N. (2020) Male Infertility Due to Testicular Disorders. The Journal of Clinical Endocrinology & Metabolism, 106, e442-e459. https://doi.org/10.1210/clinem/dgaa781
[55]
Benkhalifa, M., Montjean, D., Belloc, S., Dalleac, A., Ducasse, M., Boyer, P., et al. (2013) Emerging Molecular Methods for Male Infertility Investigation. Expert Review of Molecular Diagnostics, 14, 37-45. https://doi.org/10.1586/14737159.2014.864558
[56]
Alshahrani, S., Aldossari, K., Al-Zahrani, J., Gabr, A.H., Henkel, R. and Ahmad, G. (2017) Interpretation of Semen Analysis Using WHO 1999 and WHO 2010 Reference Values: Abnormal Becoming Normal. Andrologia, 50, e12838. https://doi.org/10.1111/and.12838
[57]
van den Hoven, L., Hendriks, J.C.M., Verbeet, J.G.M., Westphal, J.R. and Wetzels, A.M.M. (2015) Status of Sperm Morphology Assessment: An Evaluation of Methodology and Clinical Value. Fertility and Sterility, 103, 53-58. https://doi.org/10.1016/j.fertnstert.2014.09.036
[58]
Barbăroșie, C., Agarwal, A. and Henkel, R. (2020) Diagnostic Value of Advanced Semen Analysis in Evaluation of Male Infertility. Andrologia, 53, e13625. https://doi.org/10.1111/and.13625
[59]
Amidu, N., Owiredu, W.K.B.A., Gyasi-Sarpong, C.K., Alidu, H., Antuamwine, B.B. and Sarpong, C. (2017) The Inter-Relational Effect of Metabolic Syndrome and Sexual Dysfunction on Hypogonadism in Type II Diabetic Men. International Journal of Impotence Research, 29, 120-125. https://doi.org/10.1038/ijir.2017.6
[60]
Turner, K.A., Rambhatla, A., Schon, S., Agarwal, A., Krawetz, S.A., Dupree, J.M., et al. (2020) Male Infertility Is a Women’s Health Issue—Research and Clinical Evaluation of Male Infertility Is Needed. Cells, 9, Article No. 990. https://doi.org/10.3390/cells9040990
[61]
Asare-Anane, H., Bannison, S.B., Ofori, E.K., Ateko, R.O., Bawah, A.T., Amanquah, S.D., et al. (2016) Tobacco Smoking Is Associated with Decreased Semen Quality. Reproductive Health, 13, 1-6. https://doi.org/10.1186/s12978-016-0207-z
[62]
Madkour, A., Bouamoud, N., Kaarouch, I., Louanjli, N., Saadani, B., Assou, S., et al. (2018) Follicular Fluid and Supernatant from Cultured Cumulus-Granulosa Cells Improve in Vitro Maturation in Patients with Polycystic Ovarian Syndrome. Fertility and Sterility, 110, 710-719. https://doi.org/10.1016/j.fertnstert.2018.04.038
[63]
Ramgir, S.S. and Abilash, V.G. (2019) Impact of Smoking and Alcohol Consumption on Oxidative Status in Male Infertility and Sperm Quality. Indian Journal of Pharmaceutical Sciences, 81, 933-945. https://doi.org/10.36468/pharmaceutical-sciences.588
[64]
O’Flynn O’Brien, K.L., Varghese, A.C. and Agarwal, A. (2010) The Genetic Causes of Male Factor Infertility: A Review. Fertility and Sterility, 93, 1-12. https://doi.org/10.1016/j.fertnstert.2009.10.045
[65]
Olsen, J.F. (2023) Studies of Sex-Sorted Bull Sperm Cells: Establishment of a New Potential Sperm Quality Test: Inland Norway University.
[66]
Browne, R.K., Silla, A.J., Upton, R., Della-Togna, G., Marcec-Greaves, R., Shishova, N.V., et al. (2019) Sperm Collection and Storage for the Sustainable Management of Amphibian Biodiversity. Theriogenology, 133, 187-200. https://doi.org/10.1016/j.theriogenology.2019.03.035
[67]
Agyepong, E. and Bedu-Addo, K. (2018) Semen Parameters and the Incidence and Effects of Bacteriospermia in Male Partners of Infertile Couples Attending a Fertility Clinic in the Kumasi Metropolis, Ghana. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 8, 99-107. https://doi.org/10.18203/2320-1770.ijrcog20185403
[68]
Amoah, B.Y., Yao Bayamina, S., Gborsong, C., Owusu, H., Asare, G.A., Yeboah, E.K., et al. (2025) Modifiable Life Style Factors and Male Reproductive Health: A Cross-Sectional Study in IVF Clinic Attendees in Ghana. Frontiers in Reproductive Health, 7, Article ID: 1520938. https://doi.org/10.3389/frph.2025.1520938
[69]
World Health Organization (2021) WHO Laboratory Manual for the Examination and Processing of Human Semen. https://doi.org/10.1016/j.fertnstert.2021.12.012
[70]
Ugwu, A.O., Igbodike, E.P., Funtua Anas, R., Kusamotu, O.A., Adefemi, A., Anyobode, O., et al. (2023) A Multicenter Retrospective Cohort Study of the Profile of Seminal Fluid Analyses of Men Seeking Fertility Care at Different Hospitals. West Africa Journal of Medicine, 40, 863-868.
[71]
Ibitoye, B.O., Fasasi, A.O., Imosemi, I.O., Alabi, O., Olaniyan, O.T., Ibitoye, F.O., et al. (2023) The Spermiogram and Correlation of Seminal Fluid Parameters in Patient Attending Fertility Centre in Lagos, South West Nigeria. Morphologie, 107, Article ID: 100606. https://doi.org/10.1016/j.morpho.2023.05.004
[72]
Igibah, C.O., Okoeguale, J., Amadi, S.C., Ilenbodiaye, T.N., Erah, F., Okocha, A.N., et al. (2023) Abnormalities of Semen Parameters among Male Partners of Infertile Couples in a Sub-Urban Tertiary Hospital in Nigeria. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 12, 2900-2905. https://doi.org/10.18203/2320-1770.ijrcog20232923
[73]
Ajayi, A.B., Ajayi, V., Osuolale, K.A., Obi, N., Obasa-Gbadebo, R., Balogun, T., et al. (2025) Understanding the Impact of Lifestyle and Demographic Factors on DNA Fragmentation Index (DFI) among Infertile Men. BMC Urology, 25, Article No. 198. https://doi.org/10.1186/s12894-025-01883-8
[74]
Tilahun, T., Oljira, R. and Getahun, A. (2022) Pattern of Semen Analysis in Male Partners of Infertile Couples in Western Ethiopia: Retrospective Cross-Sectional Study. SAGE Open Medicine, 10, 2-6. https://doi.org/10.1177/20503121221088100
