EFFECT OF TOBACCO CHEWING ON SEMINAL PARAMETERS IN MALE PARTNERS OF INFERTILE COUPLES

Background: Male factors contribute to almost 50% of infertile couples. Deleterious effects of tobacco smoking on male reproductive system are well known. Research studies report contradictory ﬁndings about the effect of tobacco chewing on male fertility. Aim and objectives: To study effect of tobacco chewing on seminal parameters in male partners of infertile couples. Material and Methods: Present study was conducted on 100 male partners of infertile couples (50 tobacco chewers and 50 non-chewers) in age group of 21-40 years in the semen analysis laboratory in department of Physiology of Government Medical College, Nagpur from October 2014 to March 2016. Seminal parameters like volume of ejaculate, sperm count, sperm motility and motile sperm count were measured and compared in both groups. Result: Tobacco chewers had signiﬁcantly lower values of all the seminal parameters as compared to non-chewers. Signiﬁcantly low values of all parameters were observed in severe tobacco chewers as compared to mild and moderate tobacco chewers. Conclusion: Tobacco chewing has adverse effect on seminal parameters of male partners of infertile couples thus proving its pronounced role in male infertility. Severity of this effect increases as duration of tobacco chewing is prolonged. Findings of our study suggests adverse effects of tobacco chewing habit on male fertility. Tobacco chewers had signiﬁcantly less values of all the studied parameters as compared to non-users. Mean Volume of ejaculate (ml) of controls was found to be 3.60 + 0.81 ml while that of mild, moderate and heavy chewers was found to be 3.35 +0.63, 2.71 +0.88 and 2.48 + 0.98 ml respectively. ANOVA test p value was 0.03 which is statistically signiﬁcant (p < 0.05). Similar ﬁndings were Phatale S. et . Mean Sperm count/ml(millions) of controls + million mild, and chewers + + + ANOVA test p is statistically signiﬁcant (p Our study thus indicates that heavy signiﬁcant in sperm count. Many our results; Phatale


INTRODUCTION
Reproduction is the necessity of life for the propagation of species. In spite of vast advances, there are many challenges of infertility. Male factors contribute to almost 50% of infertile couples while remaining other causes may be either due to a female factors or a combination of [1] male and female factors . Tobacco chewing constitutes one of the forms of smokeless tobacco. The habit of tobacco chewing is common among young age groups in India, China, and the south-east Asia [2] region . In India, chewing tobacco is systematically associated with socioeconomic markers at the individual and household level. Several carcinogens have been identified in smokeless tobacco; the tobaccospecific N-nitrosamine (TSNA), N-nitrosonornicotine (NNN), and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) are the most important. NNN and NNK are formed from nicotine during curing, [3] aging, and especially during fermentation . Other compounds, such as 3 methylnitrosaminopropionaldehyde (MNPA), negatively affect [4] DNA by causing single-strand breaks and protein crosslinks . Detrimental effects of cigarette smoking on male fertility are well [5] known . Studies done in India report contradictory findings about effect of smokeless tobacco on male fertility. While some studies [6,7] report adversity of smokeless tobacco on semen quality , other [8] report non-significant effects . Hence this study was taken to evaluate the relationship between tobacco chewing and sperm quality in male partners of infertile couples undergoing infertility evaluation.

MATERIAL AND METHODS
Present study was conducted on 100 male partners of infertile couples (50 cases and 50 controls) in age group of 21-40 years in the semen analysis laboratory in department of Physiology of Government Medical College, Nagpur from October 2014 to March 2016. The subjects were the patients referred by various departments of the hospital for infertility. Male partners of couples having history of primary infertility, after an unprotected sexual intercourse of more [9] than one year were included as subjects in the study . Those who never chewed tobacco were included as controls. Cases and controls were matched for age and anthropometric parameters. Tobacco chewers were again divided into mild (< 5 yrs), moderate (5 to 10 yrs) and severe (> 10 yrs) categories depending on duration of tobacco chewing. The protocol of project was submitted to institutional ethics committee and the project was started after approval. Informed written consent was taken from the subjects after explaining the study design. Semen samples were collected from subjects and seminal parameters like volume of ejaculate, sperm count, sperm motility and motile sperm count were measured and compared between cases and controls. [10] Semen analysis was done as per WHO standard guidelines .

STATISTICAL ANALYSIS
Statistical data was recorded on Microsoft Excel programme. Data was analysed using graph pad prism 6.0 software. The values were quoted in the form of mean ± standard deviation wherever required. Data was compared using repeated measures one way ANOVA, unpaired Student's t test. The p value (p< 0.05) was considered as significant.

RESULT
Incidence of Oligozoospermia (36%) was more in tobacco chewers as compared to non-chewers (12%). Azoospermia was also more common in tobacco chewers (20%) as compared to non-chewers (4%). Similarly incidence of decreased motility was more in tobacco chewers (50%) as compared to non-chewers (10.41%). Semen volume of less than 1.5 ml was only observed in tobacco chewers (14%). These findings are presented in table 1.
Tobacco chewers had comparatively lower values of all the seminal parameters (p< 0.05) as compared to controls who didn't chew tobacco.
Significantly low values of all parameters (volume of ejaculate, sperm count, sperm motility and motile sperm count) were observed in severe tobacco chewers as compared moderate and in moderate as compared to mild (p<0.05). These findings are presented in table 2. S. et al , Parmar N. et al . Nicotine the main alkaloid of tobacco is known to elevate the plasma epinephrine and this elevation stimulates [12] the secretion of ACTH . The adrenal cortical hyperactivity, resulting in induced stress, causes high level of catecholamines in the body, which is a known vasoconstrictor. Because of vasoconstriction as well as due to action of nicotine there occurs impairment of Leydig cell function. These alterations in steroidogenesis ultimately lead to decreased testosterone levels, which in turn causes disturbances in [13] spermatogenesis leading to decrease in sperm count . consistent with researchers like Patel K. et al and Mankar S. et al , who showed the percentage of motile sperm and total sperm count were significantly lower (p <0.05). Nicotine and other chemicals in tobacco probably cause either damage to mitochondrial genome or/and mitochondrial enzymatic activities or an impairment of [15] function of the seminal vesicle affecting sperm motility .

LIMITATIONS OF STUDY
Only hospital cases were selected, hence representativeness of the sample may be questionable to some extent. Sample size of our study is small, so need to evaluate relationship of addiction (tobacco chewing) with infertility in larger sample size.

CONCLUSION
To summarize, it can be concluded that severity of infertility is more in tobacco chewers as compared to non-chewers. So there is definite relationship between tobacco chewing and infertility in males. As exposure period of tobacco chewing is prolonged, severity of its adverse effect also increases. Male partners of infertile couples should be counselled about the ill effects of tobacco chewing on sperm quality and advised to quit tobacco chewing for better reproductive health.