Semin Reprod Med 2020; 38(01): 003-020
DOI: 10.1055/s-0040-1718941
Review Article

The Male Is Significantly Implicated as the Cause of Unexplained Infertility

1   Priority Research Centre in Reproductive Science, Faculty of Science and Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
2   Hunter Medical Research Institute, Newcastle, New South Wales, Australia
› Author Affiliations

Abstract

Male infertility is recognized as a relatively common, complex condition, generated by a broad array of environmental and genetic factors. Historical reliance on the conventional semen profile has tended to underestimate the true contribution of “the male factor” to human infertility. This review highlights the importance of genetic and epigenetic factors in the etiology of male infertility, identifying a range of mutations responsible for primary testicular failure and impaired fertilizing potential. More than three quarters of all de novo mutations arise in the male germline via mechanisms that involve the inefficient or defective repair of DNA damage. Understanding the range of factors capable of creating genetic turmoil in the paternal germline is essential, if we are to gain a deep understanding of the causes of male infertility, rather than just the symptoms that characterize its presence. High levels of DNA fragmentation induced by oxidative stress are part of this equation. Oxidative stress is, in turn, driven by biological (age, ejaculation frequency, varicocele, infection), lifestyle (smoking, obesity), and environmental factors (heat, other forms of electromagnetic radiation, and toxins) that can impair the fertilizing potential of the spermatozoa and influence the incidence of spontaneous mutations that may cause infertility in the offspring.

Note

Dr. Aitken has a patent PCT/AU2004/001367 licensed.




Publication History

Article published online:
21 October 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Thonneau P, Marchand S, Tallec A. et al. Incidence and main causes of infertility in a resident population (1,850,000) of three French regions (1988-1989). Hum Reprod 1991; 6 (06) 811-816
  • 2 WHO Laboratory Manual for the Examination and Processing of Human Semen. 5th ed. World Health Organization. 2010
  • 3 Zinaman MJ, Brown CC, Selevan SG, Clegg ED. Semen quality and human fertility: a prospective study with healthy couples. J Androl 2000; 21 (01) 145-153
  • 4 Aitken RJ, Irvine DS, Wu FC. Prospective analysis of sperm-oocyte fusion and reactive oxygen species generation as criteria for the diagnosis of infertility. Am J Obstet Gynecol 1991; 164 (02) 542-551
  • 5 Wallace EM, Aitken RJ, Wu FC. Residual sperm function in oligozoospermia induced by testosterone enanthate administered as a potential steroid male contraceptive. Int J Androl 1992; 15 (05) 416-424
  • 6 Burris AS, Clark RV, Vantman DJ, Sherins RJ. A low sperm concentration does not preclude fertility in men with isolated hypogonadotropic hypogonadism after gonadotropin therapy. Fertil Steril 1988; 50 (02) 343-347
  • 7 Moreau J, Gatimel N, Parinaud J, Leandri R. Results of intrauterine inseminations with two pooled sequential ejaculates in cases of oligozoospermia. Asian J Androl 2018; 20 (05) 523-524
  • 8 Krausz C, Hoefsloot L, Simoni M, Tüttelmann F. European Academy of Andrology, European Molecular Genetics Quality Network. EAA/EMQN best practice guidelines for molecular diagnosis of Y-chromosomal microdeletions: state-of-the-art 2013. Andrology 2014; 2 (01) 5-19
  • 9 Kjellman C, Sjögren HO, Widegren B. The Y chromosome: a graveyard for endogenous retroviruses. Gene 1995; 161 (02) 163-170
  • 10 Hughes JF, Skaletsky H, Pyntikova T. et al. Conservation of Y-linked genes during human evolution revealed by comparative sequencing in chimpanzee. Nature 2005; 437 (7055): 100-103
  • 11 Bachtrog D. Y-chromosome evolution: emerging insights into processes of Y-chromosome degeneration. Nat Rev Genet 2013; 14 (02) 113-124
  • 12 Trombetta B, Cruciani F. Y chromosome palindromes and gene conversion. Hum Genet 2017; 136 (05) 605-619
  • 13 Colaco S, Modi D. Genetics of the human Y chromosome and its association with male infertility. Reprod Biol Endocrinol 2018; 16 (01) 14
  • 14 Li Z, Haines CJ, Han Y. “Micro-deletions” of the human Y chromosome and their relationship with male infertility. J Genet Genomics 2008; 35 (04) 193-199
  • 15 Kuroda-Kawaguchi T, Skaletsky H, Brown LG. et al. The AZFc region of the Y chromosome features massive palindromes and uniform recurrent deletions in infertile men. Nat Genet 2001; 29 (03) 279-286
  • 16 Fischer M, Kosyakova N, Liehr T, Dobrowolski P. Large deletion on the Y-chromosome long arm (Yq) of C57BL/6JBomTac inbred mice. Mamm Genome 2017; 28 (1-2): 31-37
  • 17 Simon L, Emery B, Carrell DT. Sperm DNA fragmentation: consequences for reproduction. Adv Exp Med Biol 2019; 1166: 87-105
  • 18 De Iuliis GN, Thomson LK, Mitchell LA. et al. DNA damage in human spermatozoa is highly correlated with the efficiency of chromatin remodeling and the formation of 8-hydroxy-2′-deoxyguanosine, a marker of oxidative stress. Biol Reprod 2009; 81 (03) 517-524
  • 19 Bennetts LE, Aitken RJ. A comparative study of oxidative DNA damage in mammalian spermatozoa. Mol Reprod Dev 2005; 71 (01) 77-87
  • 20 Koppers AJ, Mitchell LA, Wang P, Lin M, Aitken RJ. Phosphoinositide 3-kinase signalling pathway involvement in a truncated apoptotic cascade associated with motility loss and oxidative DNA damage in human spermatozoa. Biochem J 2011; 436 (03) 687-698
  • 21 Vorilhon S, Brugnon F, Kocer A. et al. Accuracy of human sperm DNA oxidation quantification and threshold determination using an 8-OHdG immuno-detection assay. Hum Reprod 2018; 33 (04) 553-562
  • 22 Aitken RJ, De Iuliis GN, Finnie JM, Hedges A, McLachlan RI. Analysis of the relationships between oxidative stress, DNA damage and sperm vitality in a patient population: development of diagnostic criteria. Hum Reprod 2010; 25 (10) 2415-2426
  • 23 Smith TB, Dun MD, Smith ND, Curry BJ, Connaughton HS, Aitken RJ. The presence of a truncated base excision repair pathway in human spermatozoa that is mediated by OGG1. J Cell Sci 2013; 126 (Pt 6): 1488-1497
  • 24 Gawecka JE, Ribas-Maynou J, Benet J, Ward WS. A model for the control of DNA integrity by the sperm nuclear matrix. Asian J Androl 2015; 17 (04) 610-615
  • 25 Maione B, Pittoggi C, Achene L, Lorenzini R, Spadafora C. Activation of endogenous nucleases in mature sperm cells upon interaction with exogenous DNA. DNA Cell Biol 1997; 16 (09) 1087-1097
  • 26 Aitken RJ. Not every sperm is sacred; a perspective on male infertility. Mol Hum Reprod 2018; 24 (06) 287-298
  • 27 Feijó CM, Esteves SC. Diagnostic accuracy of sperm chromatin dispersion test to evaluate sperm deoxyribonucleic acid damage in men with unexplained infertility. Fertil Steril 2014; 101 (01) 58-63.e3
  • 28 Osman A, Alsomait H, Seshadri S, El-Toukhy T, Khalaf Y. The effect of sperm DNA fragmentation on live birth rate after IVF or ICSI: a systematic review and meta-analysis. Reprod Biomed Online 2015; 30 (02) 120-127
  • 29 Larson-Cook KL, Brannian JD, Hansen KA, Kasperson KM, Aamold ET, Evenson DP. Relationship between the outcomes of assisted reproductive techniques and sperm DNA fragmentation as measured by the sperm chromatin structure assay. Fertil Steril 2003; 80 (04) 895-902
  • 30 McQueen DB, Zhang J, Robins JC. Sperm DNA fragmentation and recurrent pregnancy loss: a systematic review and meta-analysis. Fertil Steril 2019; 112 (01) 54-60.e3
  • 31 Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile male: a committee opinion. Fertil Steril 2015; 103 (03) e18-e25
  • 32 Ohno M. Spontaneous de novo germline mutations in humans and mice: rates, spectra, causes and consequences. Genes Genet Syst 2019; 94 (01) 13-22
  • 33 Fernández-Gonzalez R, Moreira PN, Pérez-Crespo M. et al. Long-term effects of mouse intracytoplasmic sperm injection with DNA-fragmented sperm on health and behavior of adult offspring. Biol Reprod 2008; 78 (04) 761-772
  • 34 Beal MA, Yauk CL, Marchetti F. From sperm to offspring: assessing the heritable genetic consequences of paternal smoking and potential public health impacts. Mutat Res 2017; 773: 26-50
  • 35 Lee KM, Ward MH, Han S. et al. Paternal smoking, genetic polymorphisms in CYP1A1 and childhood leukemia risk. Leuk Res 2009; 33 (02) 250-258
  • 36 Gharagozloo P, Gutiérrez-Adán A, Champroux A. et al. A novel antioxidant formulation designed to treat male infertility associated with oxidative stress: promising preclinical evidence from animal models. Hum Reprod 2016; 31 (02) 252-262
  • 37 Bisht S, Dada R. Oxidative stress: major executioner in disease pathology, role in sperm DNA damage and preventive strategies. Front Biosci (Schol Ed) 2017; 9: 420-447
  • 38 Singh V, Kumar Mohanty S, Verma P. et al. XRCC1 deficiency correlates with increased DNA damage and male infertility. Mutat Res Genet Toxicol Environ Mutagen 2019; 839: 1-8
  • 39 Aitken RJ, Clarkson JS, Fishel S. Generation of reactive oxygen species, lipid peroxidation, and human sperm function. Biol Reprod 1989; 41 (01) 183-197
  • 40 Baker MA, Weinberg A, Hetherington L. et al. Defining the mechanisms by which the reactive oxygen species by-product, 4-hydroxynonenal, affects human sperm cell function. Biol Reprod 2015; 92 (04) 108
  • 41 Nixon B, Bernstein IR, Cafe SL. et al. A kinase anchor protein 4 is vulnerable to oxidative adduction in male germ cells. Front Cell Dev Biol 2019; 7: 319
  • 42 Bromfield EG, Aitken RJ, Anderson AL, McLaughlin EA, Nixon B. The impact of oxidative stress on chaperone-mediated human sperm-egg interaction. Hum Reprod 2015; 30 (11) 2597-2613
  • 43 Aitken RJ, Whiting S, De Iuliis GN, McClymont S, Mitchell LA, Baker MA. Electrophilic aldehydes generated by sperm metabolism activate mitochondrial reactive oxygen species generation and apoptosis by targeting succinate dehydrogenase. J Biol Chem 2012; 287 (39) 33048-33060
  • 44 Moazamian R, Polhemus A, Connaughton H. et al. Oxidative stress and human spermatozoa: diagnostic and functional significance of aldehydes generated as a result of lipid peroxidation. Mol Hum Reprod 2015; 21 (06) 502-515
  • 45 Aitken RJ, Clarkson JS. Cellular basis of defective sperm function and its association with the genesis of reactive oxygen species by human spermatozoa. J Reprod Fertil 1987; 81 (02) 459-469
  • 46 Alvarez JG, Touchstone JC, Blasco L, Storey BT. Spontaneous lipid peroxidation and production of hydrogen peroxide and superoxide in human spermatozoa. Superoxide dismutase as major enzyme protectant against oxygen toxicity. J Androl 1987; 8 (05) 338-348
  • 47 Bisht S, Faiq M, Tolahunase M, Dada R. Oxidative stress and male infertility. Nat Rev Urol 2017; 14 (08) 470-485
  • 48 Agarwal A, Rana M, Qiu E, AlBunni H, Bui AD, Henkel R. Role of oxidative stress, infection and inflammation in male infertility. Andrologia 2018; 50 (11) e13126
  • 49 De Iuliis GN, Wingate JK, Koppers AJ, McLaughlin EA, Aitken RJ. Definitive evidence for the nonmitochondrial production of superoxide anion by human spermatozoa. J Clin Endocrinol Metab 2006; 91 (05) 1968-1975
  • 50 Koppers AJ, De Iuliis GN, Finnie JM, McLaughlin EA, Aitken RJ. Significance of mitochondrial reactive oxygen species in the generation of oxidative stress in spermatozoa. J Clin Endocrinol Metab 2008; 93 (08) 3199-3207
  • 51 Aitken RJ, Wingate JK, De Iuliis GN, McLaughlin EA. Analysis of lipid peroxidation in human spermatozoa using BODIPY C11. Mol Hum Reprod 2007; 13 (04) 203-211
  • 52 Aitken RJ, Smith TB, Lord T. et al. On methods for the detection of reactive oxygen species generation by human spermatozoa: analysis of the cellular responses to catechol oestrogen, lipid aldehyde, menadione and arachidonic acid. Andrology 2013; 1 (02) 192-205
  • 53 Aitken RJ, Buckingham DW, West K, Brindle J. On the use of paramagnetic beads and ferrofluids to assess and eliminate the leukocytic contribution to oxygen radical generation by human sperm suspensions. Am J Reprod Immunol 1996; 35 (06) 541-551
  • 54 Aitken RJ. Nitroblue tetrazolium (NBT) assay. Reprod Biomed Online 2018; 36 (01) 90-91
  • 55 Prasad A, Kikuchi H, Inoue KY. et al. Simultaneous real-time monitoring of oxygen consumption and hydrogen peroxide production in cells using our newly developed chip-type biosensor device. Front Physiol 2016; 7: 109
  • 56 Jannatifar R, Parivar K, Roodbari NH, Nasr-Esfahani MH. Effects of N-acetyl-cysteine supplementation on sperm quality, chromatin integrity and level of oxidative stress in infertile men. Reprod Biol Endocrinol 2019; 17 (01) 24
  • 57 Showell MG, Mackenzie-Proctor R, Brown J, Yazdani A, Stankiewicz MT, Hart RJ. Antioxidants for male subfertility. Cochrane Database Syst Rev 2014; 12 (12) CD007411
  • 58 Smits RM, Mackenzie-Proctor R, Yazdani A, Stankiewicz MT, Jordan V, Showell MG. Antioxidants for male subfertility. Cochrane Database Syst Rev 2019; 3: CD007411
  • 59 Steiner AZ, Hansen KR, Barnhart KT. et al; Reproductive Medicine Network. The effect of antioxidants on male factor infertility: the Males, Antioxidants, and Infertility (MOXI) randomized clinical trial. Fertil Steril 2020; 113 (03) 552-560.e3
  • 60 Yu Y, Xi Q, Jing J. et al. Intracytoplasmic sperm injection outcome of ejaculated spermatozoa from a man with mosaic Klinefelter's syndrome: case report and literature review. J Int Med Res 2018; 46 (10) 4323-4331
  • 61 Tan YQ, Tu C, Meng L. et al. Loss-of-function mutations in TDRD7 lead to a rare novel syndrome combining congenital cataract and nonobstructive azoospermia in humans. Genet Med 2019; 21 (05) 1209-1217
  • 62 Krausz C, Escamilla AR, Chianese C. Genetics of male infertility: from research to clinic. Reproduction 2015; 150 (05) R159-R174
  • 63 Tu C, Nie H, Meng L. et al. Novel mutations in SPEF2 causing different defects between flagella and cilia bridge: the phenotypic link between MMAF and PCD. Hum Genet 2020; 139 (02) 257-271
  • 64 Wang X, Sha YW, Wang WT. et al. Novel IFT140 variants cause spermatogenic dysfunction in humans. Mol Genet Genomic Med 2019; 7 (09) e920
  • 65 Liu W, He X, Yang S. et al. Bi-allelic mutations in TTC21A induce asthenoteratospermia in humans and mice. Am J Hum Genet 2019; 104 (04) 738-748
  • 66 Aitken RJ, Kerr L, Bolton V, Hargreave T. Analysis of sperm function in globozoospermia: implications for the mechanism of sperm-zona interaction. Fertil Steril 1990; 54 (04) 701-707
  • 67 Eskandari N, Tavalaee M, Zohrabi D, Nasr-Esfahani MH. Association between total globozoospermia and sperm chromatin defects. Andrologia 2018; 50 (02) DOI: 10.1111/and.12843.
  • 68 De Braekeleer M, Nguyen MH, Morel F, Perrin A. Genetic aspects of monomorphic teratozoospermia: a review. J Assist Reprod Genet 2015; 32 (04) 615-623
  • 69 Ounis L, Zoghmar A, Coutton C. et al. Mutations of the aurora kinase C gene causing macrozoospermia are the most frequent genetic cause of male infertility in Algerian men. Asian J Androl 2015; 17 (01) 68-73
  • 70 Aitken RJ, Ross A, Lees MM. Analysis of sperm function in Kartagener's syndrome. Fertil Steril 1983; 40 (05) 696-698
  • 71 Zariwala MA, Gee HY, Kurkowiak M. et al. ZMYND10 is mutated in primary ciliary dyskinesia and interacts with LRRC6. Am J Hum Genet 2013; 93 (02) 336-345
  • 72 Onoufriadis A, Shoemark A, Munye MM. et al; UK10K. Combined exome and whole-genome sequencing identifies mutations in ARMC4 as a cause of primary ciliary dyskinesia with defects in the outer dynein arm. J Med Genet 2014; 51 (01) 61-67
  • 73 Thomas L, Bouhouche K, Whitfield M. et al. TTC12 loss-of-function mutations cause primary ciliary dyskinesia and unveil distinct dynein assembly mechanisms in motile cilia versus flagella. Am J Hum Genet 2020; 106 (02) 153-169
  • 74 Sironen A, Shoemark A, Patel M, Loebinger MR, Mitchison HM. Sperm defects in primary ciliary dyskinesia and related causes of male infertility. Cell Mol Life Sci 2020; 77 (11) 2029-2048
  • 75 Paff T, Loges NT, Aprea I. et al. Mutations in PIH1D3 cause X-linked primary ciliary dyskinesia with outer and inner dynein arm defects. Am J Hum Genet 2017; 100 (01) 160-168
  • 76 Fassad MR, Shoemark A, Legendre M. et al. Mutations in outer dynein arm heavy chain DNAH9 cause motile cilia defects and situs inversus. Am J Hum Genet 2018; 103 (06) 984-994
  • 77 Whitfield M, Thomas L, Bequignon E. et al. Mutations in DNAH17, encoding a sperm-specific axonemal outer dynein arm heavy chain, cause isolated male infertility due to asthenozoospermia. Am J Hum Genet 2019; 105 (01) 198-212
  • 78 Ben Khelifa M, Coutton C, Zouari R. et al. Mutations in DNAH1, which encodes an inner arm heavy chain dynein, lead to male infertility from multiple morphological abnormalities of the sperm flagella. Am J Hum Genet 2014; 94 (01) 95-104
  • 79 Zuccarello D, Ferlin A, Cazzadore C. et al. Mutations in dynein genes in patients affected by isolated non-syndromic asthenozoospermia. Hum Reprod 2008; 23 (08) 1957-1962
  • 80 Lorès P, Coutton C, El Khouri E. et al. Homozygous missense mutation L673P in adenylate kinase 7 (AK7) leads to primary male infertility and multiple morphological anomalies of the flagella but not to primary ciliary dyskinesia. Hum Mol Genet 2018; 27 (07) 1196-1211
  • 81 Pereira R, Oliveira J, Ferraz L, Barros A, Santos R, Sousa M. Mutation analysis in patients with total sperm immotility. J Assist Reprod Genet 2015; 32 (06) 893-902
  • 82 El Khouri E, Thomas L, Jeanson L. et al. Mutations in DNAJB13, encoding an HSP40 family member, cause primary ciliary dyskinesia and male infertility. Am J Hum Genet 2016; 99 (02) 489-500
  • 83 Shen Y, Zhang F, Li F. et al. Loss-of-function mutations in QRICH2 cause male infertility with multiple morphological abnormalities of the sperm flagella. Nat Commun 2019; 10 (01) 433
  • 84 Tang S, Wang X, Li W. et al. Biallelic mutations in CFAP43 and CFAP44 cause male infertility with multiple morphological abnormalities of the sperm flagella. Am J Hum Genet 2017; 100 (06) 854-864
  • 85 Li W, Wu H, Li F. et al. Biallelic mutations in CFAP65 cause male infertility with multiple morphological abnormalities of the sperm flagella in humans and mice. J Med Genet 2020; 57 (02) 89-95
  • 86 Wang W, Tu C, Nie H. et al. Biallelic mutations in CFAP65 lead to severe asthenoteratospermia due to acrosome hypoplasia and flagellum malformations. J Med Genet 2019; 56 (11) 750-757
  • 87 Sha YW, Xu X, Mei LB. et al. A homozygous CEP135 mutation is associated with multiple morphological abnormalities of the sperm flagella (MMAF). Gene 2017; 633: 48-53
  • 88 Martinez G, Kherraf ZE, Zouari R. et al. Whole-exome sequencing identifies mutations in FSIP2 as a recurrent cause of multiple morphological abnormalities of the sperm flagella. Hum Reprod 2018; 33 (10) 1973-1984
  • 89 Lv M, Liu W, Chi W. et al. Homozygous mutations in DZIP1 can induce asthenoteratospermia with severe MMAF. J Med Genet 2020; 57 (07) 445-453
  • 90 Ambulkar PS, Chuadhari AR, Pal AK. Association of large scale 4977-bp “common” deletions in sperm mitochondrial DNA with asthenozoospermia and oligoasthenoteratozoospermia. J Hum Reprod Sci 2016; 9 (01) 35-40
  • 91 Moye AR, Bedoni N, Cunningham JG. et al. Mutations in ARL2BP, a protein required for ciliary microtubule structure, cause syndromic male infertility in humans and mice. PLoS Genet 2019; 15 (08) e1008315
  • 92 Askari M, Kordi-Tamandani DM, Almadani N, McElreavey K, Totonchi M. Identification of a homozygous GFPT2 variant in a family with asthenozoospermia. Gene 2019; 699: 16-23
  • 93 Touré A, Martinez G, Kherraf ZE. et al. The genetic architecture of morphological abnormalities of the sperm tail. Hum Genet 2020; ; (epub ahead of print) DOI: 10.1007/s00439-020-02113-x.
  • 94 Perez-Cerezales S, Boryshpolets S, Eisenbach M. Behavioral mechanisms of mammalian sperm guidance. Asian J Androl 2015; 17 (04) 628-632
  • 95 Yuan P, Yang C, Ren Y. et al. A novel homozygous mutation of phospholipase C zeta leading to defective human oocyte activation and fertilization failure. Hum Reprod 2020; 35 (04) 977-985
  • 96 Sha YW, Xu X, Ji ZY. et al. Genetic contribution of SUN5 mutations to acephalic spermatozoa in Fujian China. Gene 2018; 647: 221-225
  • 97 Sha Y, Wang X, Yuan J. et al. Loss-of-function mutations in centrosomal protein 112 is associated with human acephalic spermatozoa phenotype. Clin Genet 2020; 97 (02) 321-328
  • 98 Brown SG, Miller MR, Lishko PV. et al. Homozygous in-frame deletion in CATSPERE in a man producing spermatozoa with loss of CatSper function and compromised fertilizing capacity. Hum Reprod 2018; 33 (10) 1812-1816
  • 99 Mao GH, Wang YN, Xu M, Wang WL, Tan L, Tao SB. Polymorphisms in the MT-ATP6 and MT-CYB genes in in vitro fertilization failure. Mitochondrial DNA 2015; 26 (01) 20-24
  • 100 Wu H, Whitcomb BW, Huffman A. et al. Associations of sperm mitochondrial DNA copy number and deletion rate with fertilization and embryo development in a clinical setting. Hum Reprod 2019; 34 (01) 163-170
  • 101 Gunes S, Arslan MA, Hekim GNT, Asci R. The role of epigenetics in idiopathic male infertility. J Assist Reprod Genet 2016; 33 (05) 553-569
  • 102 Kelly TL, Neaga OR, Schwahn BC, Rozen R, Trasler JM. Infertility in 5,10-methylenetetrahydrofolate reductase (MTHFR)-deficient male mice is partially alleviated by lifetime dietary betaine supplementation. Biol Reprod 2005; 72 (03) 667-677
  • 103 Xie C, Ping P, Ma Y, Wu Z, Chen X. Correlation between methylenetetrahydrofolate reductase gene polymorphism and oligoasthenospermia and the effects of folic acid supplementation on semen quality. Transl Androl Urol 2019; 8 (06) 678-685
  • 104 Aitken RJ, Flanagan HM, Connaughton H, Whiting S, Hedges A, Baker MA. Involvement of homocysteine, homocysteine thiolactone, and paraoxonase type 1 (PON-1) in the etiology of defective human sperm function. Andrology 2016; 4 (02) 345-360
  • 105 Tavilani H, Fattahi A, Esfahani M. et al. Genotype and phenotype frequencies of paraoxonase 1 in fertile and infertile men. Syst Biol Reprod Med 2014; 60 (06) 361-366
  • 106 Menezo YJ, Silvestris E, Dale B, Elder K. Oxidative stress and alterations in DNA methylation: two sides of the same coin in reproduction. Reprod Biomed Online 2016; 33 (06) 668-683
  • 107 Novakovic B, Lewis S, Halliday J. et al. Assisted reproductive technologies are associated with limited epigenetic variation at birth that largely resolves by adulthood. Nat Commun 2019; 10 (01) 3922
  • 108 Rumke P. The presence of sperm antibodies in the serum of two patients with oligospermia. Vox Sang 1954; 4: 135-140
  • 109 Wilson L. Sperm agglutinins in human semen and blood. Proc Soc Exp Biol Med 1954; 85 (04) 652-655
  • 110 Baskin M. Temporary sterilization by the injection of human spermatozoa. A preliminary report. Am J Obstet Gynecol 1932; 24: 892-897
  • 111 Aitken RJ, Rudak EA, Richardson DW, Dor J, Djahanbahkch O, Templeton AA. The influence of anti-zona and anti-sperm antibodies on sperm--egg interactions. J Reprod Fertil 1981; 62 (02) 597-606
  • 112 Kremer J, Jager S. Characteristics of anti-spermatozoal antibodies responsible for the shaking phenomenon with special regard to immunoglobulin class and antigen-reactive sites. Int J Androl 1980; 3 (02) 143-152
  • 113 Domagała A, Pulido S, Kurpisz M, Herr JC. Application of proteomic methods for identification of sperm immunogenic antigens. Mol Hum Reprod 2007; 13 (07) 437-444
  • 114 Lähteenmäki A, Veilahti J, Hovatta O. Intra-uterine insemination versus cyclic, low-dose prednisolone in couples with male antisperm antibodies. Hum Reprod 1995; 10 (01) 142-147
  • 115 Kutteh WH, Byrd W, Blankenship L, Kutteh CC, Carr BR. Cervical mucus anti-sperm antibodies: treatment with intrauterine insemination. Am J Reprod Immunol 1996; 35 (04) 429-433
  • 116 Xu F, Ye L, Hu Y. et al. A novel protein biochip screening serum anti-sperm antibody expression and natural pregnancy rate in a follow-up study in Chinese infertility. Biosci Rep 2020; 40 (02) BSR20191769
  • 117 Wakimoto Y, Fukui A, Kojima T, Hasegawa A, Shigeta M, Shibahara H. Application of computer-aided sperm analysis (CASA) for detecting sperm-immobilizing antibody. Am J Reprod Immunol 2018; 79 (03) DOI: 10.1111/aji.12814.
  • 118 Fu J, Yao R, Luo Y. et al. Anti-GAPDHS antibodies: a biomarker of immune infertility. Cell Tissue Res 2016; 364 (01) 199-207
  • 119 Fu J, Yao R, Luo Y. et al. Immune infertility should be positively diagnosed using an accurate method by monitoring the level of anti-ACTL7a antibody. Sci Rep 2016; 6: 22844
  • 120 Jiang Y, Cui D, Du Y. et al. Association of anti-sperm antibodies with chronic prostatitis: a systematic review and meta-analysis. J Reprod Immunol 2016; 118: 85-91
  • 121 Aitken RJ, Baker MA. Oxidative stress, spermatozoa and leukocytic infiltration: relationships forged by the opposing forces of microbial invasion and the search for perfection. J Reprod Immunol 2013; 100 (01) 11-19
  • 122 Martínez-Prado E, Camejo Bermúdez MI. Expression of IL-6, IL-8, TNF-alpha, IL-10, HSP-60, anti-HSP-60 antibodies, and anti-sperm antibodies, in semen of men with leukocytes and/or bacteria. Am J Reprod Immunol 2010; 63 (03) 233-243
  • 123 Aitken RJ, Buckingham DW, Brindle J, Gomez E, Baker HW, Irvine DS. Analysis of sperm movement in relation to the oxidative stress created by leukocytes in washed sperm preparations and seminal plasma. Hum Reprod 1995; 10 (08) 2061-2071
  • 124 Krausz C, Mills C, Rogers S, Tan SL, Aitken RJ. Stimulation of oxidant generation by human sperm suspensions using phorbol esters and formyl peptides: relationships with motility and fertilization in vitro. Fertil Steril 1994; 62 (03) 599-605
  • 125 Coutton C, Abada F, Karaouzene T. et al. Fine characterisation of a recombination hotspot at the DPY19L2 locus and resolution of the paradoxical excess of duplications over deletions in the general population. PLoS Genet 2013; 9 (03) e1003363
  • 126 Gao Z, Moorjani P, Sasani TA. et al. Overlooked roles of DNA damage and maternal age in generating human germline mutations. Proc Natl Acad Sci U S A 2019; 116 (19) 9491-9500
  • 127 Aitken RJ, Koopman P, Lewis SE. Seeds of concern. Nature 2004; 432 (7013): 48-52
  • 128 Xavier MJ, Nixon B, Roman SD, Scott RJ, Drevet JR, Aitken RJ. Paternal impacts on development: identification of genomic regions vulnerable to oxidative DNA damage in human spermatozoa. Hum Reprod 2019; 34 (10) 1876-1890
  • 129 Kazemijaliseh H, Ramezani Tehrani F, Behboudi-Gandevani S, Hosseinpanah F, Khalili D, Azizi F. The prevalence and causes of primary infertility in Iran: a population-based study. Glob J Health Sci 2015; 7 (06) 226-232
  • 130 Deshpande PS, Gupta AS. Causes and prevalence of factors causing infertility in a public health facility. J Hum Reprod Sci 2019; 12 (04) 287-293
  • 131 Philippov OS, Radionchenko AA, Bolotova VP, Voronovskaya NI, Potemkina TV. Estimation of the prevalence and causes of infertility in western Siberia. Bull World Health Organ 1998; 76 (02) 183-187
  • 132 Farhi J, Ben-Haroush A. Distribution of causes of infertility in patients attending primary fertility clinics in Israel. Isr Med Assoc J 2011; 13 (01) 51-54
  • 133 Bayasgalan G, Naranbat D, Tsedmaa B. et al. Clinical patterns and major causes of infertility in Mongolia. J Obstet Gynaecol Res 2004; 30 (05) 386-393
  • 134 Elussein EA, Magid YM, Omer MM, Adam I. Clinical patterns and major causes of infertility among Sudanese couples. Trop Doct 2008; 38 (04) 243-244
  • 135 Chiamchanya C, Su-angkawatin W. Study of the causes and the results of treatment in infertile couples at Thammasat Hospital between 1999-2004. J Med Assoc Thai 2008; 91 (06) 805-812
  • 136 Dhont N, van de Wijgert J, Vyankandondera J, Busasa R, Gasarabwe A, Temmerman M. Results of infertility investigations and follow-up among 312 infertile women and their partners in Kigali, Rwanda. Trop Doct 2011; 41 (02) 96-101
  • 137 Collins JA, Crosignani PG. Unexplained infertility: a review of diagnosis, prognosis, treatment efficacy and management. Int J Gynaecol Obstet 1992; 39 (04) 267-275
  • 138 Larsen U, Masenga G, Mlay J. Infertility in a community and clinic-based sample of couples in Moshi, Northern Tanzania. East Afr Med J 2006; 83 (01) 10-17
  • 139 Razzak AH, Wais SA. The infertile couple: a cohort study in Duhok, Iraq. East Mediterr Health J 2002; 8 (2-3): 234-238
  • 140 Benbella A, Aboulmakarim S, Hardizi H, Zaidouni A, Bezad R. Infertility in the Moroccan population: an etiological study in the reproductive health centre in Rabat. Pan Afr Med J 2018; 30: 204
  • 141 Adegbola O, Akindele MO. The pattern and challenges of infertility management in Lagos, Nigeria. Afr Health Sci 2013; 13 (04) 1126-1129