Article Data

  • Views 696
  • Dowloads 115

Original Research

Open Access


  • Saad Alshahrani1
  • Gulfam Ahmad2
  • Haroon Latif Khan3
  • Ahmet Ayaz4
  • Ali Hassan A. Ali1,5

1Department of Surgery, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia

2Discipline of Pathology, School of Medical Sciences, Sydney Medical School, University of Sydney, Sydney, Australia

3Lahore Institute of Fertility and Endocrinology (LIFE), Lahore, Pakistan

4Department of Environmental Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA

5Faculty of Medicine, Department of Anatomy, Al-Azhar University, Cairo, Egypt

DOI: 10.22374/jomh.v15i2.144 Vol.15,Issue 2,April 2019 pp.58-65

Published: 01 April 2019

*Corresponding Author(s): Saad Alshahrani E-mail:

PDF (458.27 kB)


Background and objective

The aim of the present study was to identify the impact of defective standard sperm parameters indi-vidually and in combination on DNA damage in a large cohort of infertile men.

Material and methods

Retrospective analysis of semen characteristics was conducted on 436 patients. DNA fragmentation analysis was performed by using the terminal deoxynucleotidyl transferase (TdT)-mediated fluoresce-in-dUTP nick end labeling (TUNEL) assay. Sperm parameters were arranged into different categories such as normospermia asthenospermic, teratospermic, asthenoteratospermic, and oligoasthenoter-atospermic. GraphPad Prism version 7 software was used for data analysis.


Our results suggest that the mean percentage of DNA damage was proportionally higher than the semen abnormalities. Sperm with 3 abnormal parameters showed significantly higher DNA damage, suggesting that sperm having more than 2 abnormalities are more likely to have higher DNA damage.


Sperm motility had significant correlation and is supposed to be a predictor for these tests, while mor-phology was the second standard sperm parameter inversely correlated with sperm DNA damage. Patients demonstrating low levels of leukocytospermia should be advised sperm DNA testing before assisted reproductive technology treatment. However, there is a clear need for more research studies to further address these issues.


semen analysis, DNA fragmentation, male infertility, sperm abnormalities

Cite and Share

Saad Alshahrani,Gulfam Ahmad,Haroon Latif Khan,Ahmet Ayaz,Ali Hassan A. Ali. IMPACT OF SINGLE AND MULTIPLE SPERM ABNORMALITIES AND LOW-LEVEL LEUKOCYTOSPERMIA ON SPERM DNA. Journal of Men's Health. 2019. 15(2);58-65.


1. Alshahrani S, Aldossari K, Al-Zahrani J, Gabr AH, Henkel R, Ahmad G. Interpretation of semen analysis using WHO 1999 and WHO 2010 reference values: abnormal becoming normal. Andrologia 2018 Mar;50(2):e12838. Available at: 785

2. Agarwal A, Majzoub A, Esteves SC, Ko E, Ramasamy R, Zini A. Clinical utility of sperm DNA fragmentation testing: practice recommen-dations based on clinical scenarios. Transl Androl Urol 2016 Dec;5(6):935.

3. Cooper TG, Noonan E, Von Eckardstein S, et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update 2010 Jan 1;16(3):231–45. Available at: https://www.

4. Al Omrani B, Al Eisa N, Javed M, Al Ghedan M, Al Matrafi H, Al Sufyan H. Associations of sperm DNA fragmentation with lifestyle factors and semen parameters of Saudi men and its impact on ICSI outcome. Reprod Biol Endocrinol 2018 Dec;16(1):49. 10.1186/s129 58-018-0369-3

5. Oehninger S. Clinical and laboratory management of male infertility: an opinion on its current status. J Androl 2000 Nov 12;21(6):814–21. https://doi. org/10.1002/j.1939-4640.2000.tb03411.x

6. Agarwal A, Said TM. Role of sperm chromatin abnormalities and DNA damage in male infertil-ity. Hum Reprod Update. 2003 Jul 1;9(4):331–45. Available at:

7. Lewis SE, Aitken RJ, Conner SJ, et al. The impact of sperm DNA damage in assisted con-ception and beyond: recent advances in diagnosis and treatment. Reprod Biomed Online 2013 Oct 1;27(4):325–37. 2013.06.014

8. Hammoud AO, Gibson M, Peterson CM, Meikle AW, Carrell DT. Impact of male obesity on infer-tility: a critical review of the current literature. Fertil Steril 2008 Oct 1;90(4):897–904.

9. Saleh RA, Agarwal A, Nada EA, et al. Negative effects of increased sperm DNA damage in rela-tion to seminal oxidative stress in men with idio-pathic and male factor infertility. Fertil Steril 2003 Jun 1;79:1597–605.

 10. Evenson DP, Larson KL, Jost LK. Sperm chro-matin structure assay: its clinical use for detect-ing sperm DNA fragmentation in male infertility and comparisons with other techniques. J Androl 2002 Jan 2;23(1):25–43.

j. 1939-4640.2002.tb02599.x

 11. Spanò M, Bonde JP, Hjøllund HI, et al. Sperm chromatin damage impairs human fertility. Fertil Steril 2000 Jan 1;73(1):43–50. 1016/S0015-0282(99)00462-8

 12. Evenson D, Wixon R. Meta-analysis of sperm DNA fragmentation using the sperm chromatin structure assay. Reprod Biomed Online 2006 Jan 1;12(4):466–72.

 13. Esteves SC, Sharma RK, Gosálvez J, Agarwal A. A translational medicine appraisal of specialized andrology testing in unexplained male infertility. Int Urol Nephrol 2014 Jun 1;46(6):1037–52.

 14. Ahmad G, Moinard N, Esquerré-Lamare C, Mieusset R, Bujan L. Mild induced testicular and epididymal hyperthermia alters sperm chromatin integrity in men. Fertil Steril 2012 Mar 1;97(3):546–53. 025

 15. Ilacqua A, Izzo G, Emerenziani GP, Baldari C, Aversa A. Lifestyle and fertility: the influence of stress and quality of life on male fertility. Reprod Biol Endocrinol 2018 Dec;16(1):115. https://doi. org/10.1186/s12958-018-0436-9

 16. Rehman S, Usman Z, Rehman S, et al. Endocrine disrupting chemicals and impact on male reproduc-tive health. Transl Androl Urol 2018 Jun;7(3):490–

503. 05.17

 17. Simon L, Emery BR, Carrell DT. Diagnosis and impact of sperm DNA alterations in assisted reproduction. Best Pract Res Clin Obstet Gynaecol 2017 Oct 1;44:38–56. https://doi. org/10.1016/j.bpobgyn.2017.07.003

 18. Simon L, Zini A, Dyachenko A, Ciampi A, Carrell DT. A systematic review and meta-analysis to determine the effect of sperm DNA damage on in vitro fertilization and intracytoplasmic sperm injec-tion outcome. Asian J Androl 2017 Jan;19(1):80. 182822

 19. Giwercman A, Richthoff J, Hjøllund H, et al. Correlation between sperm motility and sperm chromatin structure assay parameters. Fertil Steril 2003 Dec 1;80(6):1404–12

 20. Das M, Al-Hathal N, San-Gabriel M, et al. High prevalence of isolated sperm DNA damage in infertile men with advanced paternal age. J Assist Reprod Genet 2013 Jun 1;30(6):843–8. https://doi. org/10.1007/s10815-013-0015-0

 21. Erenpreiss J, Elzanaty S, Giwercman A. Sperm DNA damage in men from infertile couples. Asian J Androl 2008 Sep;10(5):786–90. https://doi. org/10.1111/j.1745-7262.2008.00417.x

 22. Moskovtsev SI, Willis J, White J, Mullen JB. Sperm DNA damage: correlation to severity of semen abnormalities. Urology 2009. Oct 1;74(4):789–93. 2009.05.043

 23. Agarwal A, Mulgund A, Alshahrani S, et al. Reactive oxygen species and sperm DNA damage in infertile men presenting with low level leukocytospermia. Reprod Biol Endocrinol 2014 Dec;12(1):126. -7827-12-126

 24. Ahmad G, Agarwal A, Esteves SC, et al. Ascorbic acid reduces redox potential in human spermato-zoa subjected to heat-induced oxidative stress. Andrologia 2017 Dec;49(10):e12773. https://doi. org/10.1111/and.12773

Abstracted / indexed in

Science Citation Index Expanded Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Social Sciences Citation Index Social Sciences Citation Index contains over 3,400 journals across 58 social sciences disciplines, as well as selected items from 3,500 of the world’s leading scientific and technical journals. More than 9.37 million records and 122 million cited references date back from 1900 to present.

Current Contents - Social & Behavioral Sciences Current Contents - Social & Behavioral Sciences provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in the social and behavioral sciences.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

SCOPUS Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

DOAJ DOAJ is a community-curated online directory that indexes and provides access to high quality, open access, peer-reviewed journals.

CrossRef Crossref makes research outputs easy to find, cite, link, assess, and reuse. Crossref committed to open scholarly infrastructure and collaboration, this is now announcing a very deliberate path.

Portico Portico is a community-supported preservation archive that safeguards access to e-journals, e-books, and digital collections. Our unique, trusted process ensures that the content we preserve will remain accessible and usable for researchers, scholars, and students in the future.

Submission Turnaround Time