Dermatoglyphic Study in Azoospermic and Oligozoospermic Males

Infertility resulting in men has evoked considerable medical and social interest. The dermatoglyphic study has been proven to be a useful diagnostic tool for different diseases. It is easy due to its cost-effectiveness and non-invasive procedure. Multiple aetiological factors are responsible for azoospermia and oligozoospermia. This study was done to know thedermatoglyphic patterns among male patients suffering from azoospermia and oligozoospermia and compare the findings with the general population. Total seventy-six cases suffering from azoospermia and oligozoospermia were taken with an equal number of individuals in the control group. The fingerprint patterns and ridge counts were compared with healthy age-matched control subjects. The fingerprint patterns were collected by standard ink method. The data was collected and subjected to Chi-square and analysis of variance at a 95 % confidence interval. The overall frequency was loop was higher, followed by whorls and arches in men with azoospermia and oligozoospermia. It was observed that comparing the fingertip ridge patterns and their frequencies were significant (p<.05) inazoospermia and oligozoospermia as compared to controls.The increase in the total number of arches wasobserved in men with oligozoospermia as compared with respect to the control group. Thedifferencesin cases and control groups with respect to parameters such as Total finger ridge count (TFRC)as well as Absolute finger ridge count (AFRC) were found statistically insignificant. There is a substantial correlation between fingerprint patterns of men withazoospermia and oligozoospermiamales attending the In Vitro fertilisation Centre. These correlations may have an essential role in the early diagnosis of reproductive dysfunction in the future.

Infertility resulting in men has evoked considerable medical and social interest. According to WHO, the infertility isa disease of the reproductive system, defined as the inability to achieve clinical pregnancyover one year or more of regular unprotected sexual intercourse. Male infertility refers to a males inability to result in pregnancy in a fertile female.Male infertility affects approximately 10% of couples worldwide. 1 Sperm abnormalities have been significantly associated with male infertility. The normal sperm concentration plays a substantial role in fertilisation and pregnancy outcomes. 2 The dermatoglyphic study has been proven to be a useful diagnostic tool as a marker for genetic origin diseases. During a few decades, the magnitude of male infertility has increased globally. Early detection of infertility is still a problematic medical task in such cases. The dermatoglyphic study may play an important role to identify suspected infertile males from a vast population.
An objective of the present study was to investigatedermatoglyphic patterns in azoospermia and oligozoospermia male patients and compare the findings of patients with the general population.

Material and Methods
This study was done on seventy-six infertile males (35 individuals having azoospermia and 41 individuals having oligozoospermia) visiting the Indira IVF Centre, Patna, Bihar.The male individuals who have infertility with not less than three years periodwere included in the infertile group.The average age of included malesin the infertile group was 39.84years. Thecontrol group included normal healthy individuals representing the general population havingthe same reproductive age group and socioeconomic status. The infertile and control subjects without any particulargenetic disease were taken.The verbal and informed consent from individuals of each group were taken. All of them were explained about the procedure of taking dermatoglyphics before havingfingerprints and palmar prints.
Clinical information of subjects werecollectedincludingage, the period of the marriage, history of infertility and parity. Semen was collected for estimation of sperm count as per theWorld Health Organization guidelines. 3 The individuals ofthe infertile groupwere classified based on sperm concentration, as azoospermia (no spermatozoa) and oligozoospermia (<20million sperm/ml). In the fertile control group, the sperm count was ranged from 35-200 million sperm/ ml. The ethical clearance wasobtained from the Institutional Ethics Committee, AIIMS, Patna (IEC/AIIMS/PAT/158/2017) beforedoing this study.Confidentiality and anonymity of subjects were ensured.
Necessary equipment required includes good quality printer ink, a flat glass, rubber roller,glazed surface paper (A3), cotton,turpentine oil, spirit,measuringprotractor, sharpener, pointedpencil, and a hand lens (Magnavision). The standard ink method was used to take prints. 4 The hand was impregnated with a thin layer of ink and gently pressed on the paper from proximal to a distal end. The patterns were classified into loops, whorls, arches and unknown (Galton system). 5 We considered "unknown" to any prints other than these three main classes and their subgroups. The ridges counting of each fingerprint pattern was analysed using a hand lens. The palmar angles such as 'atd', 'dat' and 'adt' were measured after drawing lines connecting the 'a', 'd' and 't' triradii. The findings of both hands of cases and controls were compared. All data were collected and statistically analysedusing the student's t-test and chi-square test. After the sampling data was compiled and analysed in the Department of Anatomy, All India Institute of Medical Sciences, Patna.

results and discussion
The mean age (in years) of cases and control was 39.84±6.02 and 36.30±5.32,respectively. Most ofthe infertile males were in the age ranging from 41-50 years, comprising approximately 49% of the total cases. Examination on fingerprint patterns revealed that the loop was the most common type of fingerprint, followed by whorls and arches in men with azoospermia and oligozoospermia (53.14% and 57.32% respectively). Astatistically significant difference (p<.05) was noticed on comparing the fingertip ridge patterns of both hands of azoospermia males and control group. In men with azoospermia demonstrated a higher prevalence of whorl and arch patterns with a low prevalence of loop patterns as compared to the males of the control group(Table1).  Similarly, on observing the frequencies of different types of fingertip patternsin men with oligozoospermia and control males, we also found the statistically significant differences in these groups (p<.05). The total number of arches was increased in men with oligozoospermia (35; 8.54%) as compared to control males (20; 4.88%) ( Table 2). The mean of 'dat' angle (left hand) of cases (azoospermia and oligozoospermia) was statistically significant on comparing with the control group. In contrast, the other angles, such as 'atd' and 'adt'palmar angles were found insignificant in both hands of infertile and control groups ( Table 3).
The observed mean TFRC (Total finger ridge count) seen between azoospermia and oligozoospermia infertile males was 128.45 and 134.10, respectively, whereas mean AFRC in those two groups was 177.77 and 134.10, respectively. There were insignificant differences between both types of infertile males concerning AFRC and TFRC (Table 4).
In the present study,most of the infertile males were between the age group of 41-50 (37; 48.68%). Some studies suggested that the advanced age may be associated with impaired sexual function, sperm count profilewhich may be responsiblefor increased time to conception, and increased miscarriage rates. [6][7][8] The main concern of this work was to compare the dermatoglyphic patterns in infertile men with azoospermia and oligozoospermia. Based on the result, the most common type of fingerprints in these cases was a loop pattern. Statistically significant differenceswere found in fingerprint patterns of cases and controls.Asignificant decrease in the frequency of loops in men with azoospermia (186, 55.14%) and oligozoospermia (255, 57.32%). Whereasin controls the frequency of loops(217, 57.32% and 259, 63.17% respectively). Similar results were also reflected in a dermatoglyphics study conducted on 24 infertile males by Sontakke et al. 9 While Makol et al. 10 in New Delhi and Jafari etal. 11 in Iran found significantly increased frequencies of loops in infertile males as compared to that of controls.The increased whorl pattern in the infertile men with azoospermia (104, 29.71%) as compared to that of controls (96, 27.43%). A similar finding wasreached by Sontakke et al. 9 and Jafari et al. 11 ,but this outcome is contrary to that of Singh et al. (2017)who found that in infertile males,there was a significant decrease in the frequency of whorls as compared to the general population. 13 We found a significantly increased frequency of arches in men with azoospermia (53, 15.14%) and oligozoospermia (35, 8.54%) as compared to controls (34, 9.71% and 20, 4.88% respectively). The arches increased frequency was consistent with the findings of Sontakke et al. 9 and Prasad etal. 12 In another study done on infertile malesand compared to controls by Singh et al. reported significantly decreased frequencies in the arches. 13 The present study has shown that the significant differences in 'atd' angle (left hand) among infertile males and control group, whereas the findings of the right hand were insignificant regarding differences in'atd' angle among infertile males and control group. Partial similar findings were reported by Sontakke et al. 9 and Prasad et al. 12 The finger ridge count determines the size of the pattern. In this study, we found that differences in men with azoospermia and oligozoospermiaconcerningTFRC and as well as AFRC were insignificant. Similarly,on comparing with the control,non-significant differences in TFRC and AFRC of infertile patients were reported by Sontakke and colleagues as well as also by Jafari et al.Singh et al also reported similar factsin oligozoospermia affected males. 9,11,13 conclusions The dermatoglyphic study is easy due to its cost-effectiveness and non-invasive procedure and would serve as a prediction tool, for early screening of infertile male subjects. This study revealed a significant dermatoglyphic difference between controls and men with azoospermia and oligozoospermia. This study showed an increased number of whorl and arch patterns along with decrease number of loop patterns with an increase in the 'dat' angle value of the left hand. Thedetection of such patterns by a physician could aid them toanticipate infertility problems in the susceptible patient.It can be used as a ready costeffective screener to identify infertile subjects from a larger population for further investigations and to confirm or rule out infertility in such patients. So, physicians may advise for necessary preventive and encouraging health measures for individuals at risk.

acKnoWledGeMents
Authors are very thankful to Dr Dayanidhi Kumar, who gave us the chance to get the fingerprints of infertile males in Indira IVF, Patna, Bihar. We are also grateful to the persons who have extended their cooperation in this study.

Conflict of Interest
None.

Financial support and sponsorship
It was a non-funds project-based work. No financial support or any sponsorship was taken by any of the authors for the same.