• Mohammad Shoaib Khan
  • Fariyal Deepa
  • Zahoor Ahmed
  • Fahim Tahir
  • Mudassir Ahmad Khan


Background: Data available over the past twenty years reveal that in approximately 30% of cases ofinfertility, pathology is found in man alone, and in another 20% both man and woman are abnormal.Therefore, the male factor is at least partly responsible in about 50% of infertile couples. The longer acouple remains sub fertile, the worse is their chance for an effective cure. This study was planned toanalyse the complete semen picture of infertile men for assigning the specific cause to male infertilityrelated to concentration, motility and morphology and to know the distribution and pattern of maleinfertility in the various subclasses in Pakistani population. Methods: It was a prospective descriptiveanalytical study conducted at Department of Reproductive Physiology/ Health, Public Health Divisions,National Institute of Health (NIH), Islamabad. One thousand five hundred twenty-one (1,521) infertilemale patients, and 97 proven fathers, taken as a control. Conventional semen analysis was performed onall samples. Results: Out of 1,521 infertile men, 13.3% were azoospermic, 23.2% oligozoospermic,0.9% polyzoospermic, 14.5% normozoospermic, 35.2% asthenozoospermic 10.5% oligoasthenozoospermic and 2.4% teratozoospermic. Sperm concentration and active motility of proven fathers, wassignificantly higher (p<0.05) than the normal concentration group. Least liquefaction time was recordedin case of polyzoospermic subjects, and highest for azoospermic cases. Although, the liquefaction timeof azoospermic and oligozoospermic subjects varied non-significantly (p>0.05) with the proven fathers.Normal forms were significantly higher (p<0.05) among the proven fathers and polyzoospermic cases, incomparison with the other groups. Head defects were more in teratozoospermic group, followed byoligoasthenozoospermic and oligozoospermic patients. Neck defects were more profound inoligoasthenozoospermic and oligozoospermic patients, while, tail defect showed significant increase interatozoospermic and asthenozoospermic cases only. Head and neck defect varied significantly (p<0.05)with proven fathers in all groups, while tail defect varied significantly (p<0.05) in oligozoospermic,asthenozoospermic and teratozoospermic groups only when compared with proven fathers.Conclusions: Complete semen analysis which provides important information about the quality andquantity of the sperm, should be performed before reaching a final conclusion.Keywords: Semen analysis, male infertility, Pakistani population


Khan T, Qureshi MS. Prevalence of infertility. In: Pakistan

lactation and fertility survey. National Research Institute of

Fertility Control, Ministry of Population Welfare, Government of

Pakistan, Karachi, Pakistan, 1983. p. 21–30.

Aitken RJ, Baker HWG, Irvine, DS. The diagnosis of male

infertility by semen quality: On the nature of semen quality and

infertility. Hum Reprod 1995;10:248–50.

Wong WY, Thomas CM, Merkus JM, Zielhuis GA, SteegersTheunissen RP. Male factor sub-fertility: Possible causes and the

impact of nutritional factors. Fertil Steril 2000;73:435–42.

WHO laboratory manual for the examination of human semen

and sperm-cervical mucus interaction. Cambridge: Cambridge

University Press; 1992. p.1–107.

Siegel MS. The male infertility investigation and the role of the

andrology laboratory. J Reprod Med 1993;38:317–34.

Seibel MM. Workup of the infertile couple. In: Seibel MM. (ed.)

Infertility A Comprehensive Text Book,. Appleton and Lange,

Connecticut. USA: Norwalk; 1990. p. 1–21.

Shakkeback VE, Giwercman A, de-krester D, Pathogenesis and

management of male infertility. Lancet 1994;343(11):1473–9.

J Ayub Med Coll Abbottabad 2011;23(1)

Bornman MS, Schulenburg GW, Boomker D, Chauke TR, Reif

S. Observations in infertile African males at an Andrology clinic

in South Africa. Arch. Androl 1994;33:101–4.

Khan AA, Khan FA, Sattar A, Naveed AK, Ahmed M.

Azoospermia in clinical practice at Rawalpindi. Pak Armed Force

Med J 1992;42(2):93–5.

Rikhasor RM, Rathi SL, Jalbani MH, Pirzada ZA. Semen

analysis of infertile men and plasma levels of LH, FSH, and

Testosterone in oligospermia. Medical Channel 2001;7(2):30–2.

Jarow JP, Espeland MA, Lipshultz G. Evaluation of the

azoospermic patients. J Urol 1989;142(1):62–5.

Mathews T, Mati JKG, Formula JM. A study of infertility in

Kenya. Result of investigation of the infertile couple in Nairobi.

East Afr Med J 1981;58:258–67.

Mbizvo MT, Chinibira THK, Gwavava, NJT, Luyombya JSM.

Azoospermic infertile men. Br J Urol 1989;63:423–7.

Liu DY, Baker HW. High frequency of defective sperm Zona

Pellucida interaction in oligozoospermic infertile men. Hum

Repro 2004;19(2):228–33.

Merino G, Carranza Lira S. Semen characteristics, endocrine

profiles, and testicular biopsies of infertile men of different ages.

Arch Androl 1995;35:219–24.

Merino Ruiz MC, De León Cervantes MG, García Flores RF.

Male sterility and its association with genital disease and

environmental factors. Ginecol Obstet Mex 1995;63:427–31.

Krause W. The significance of computer assisted semen analysis

(CASA) for diagnosis in andrology and fertility prognosis. Int J

Androl 1995;18(2):32–5.

Morton B, Harrigan-Lum J, Albagli L, Joss T. The activation of

motility in quiescent hamster sperm from the epididymis by

calcium and cyclic nucleotides. Biochem Biophys Res Commum


McConnell JD. Abnormalities in sperm motility: Techniques of

evaluation and treatment. In: Lipschulz LI, Howard SS, (editors).

Infertlity in the male. 3rd ed. St. Louis, Missouri: Mosby;1997. p.


Henkel R, Muller C, Miska W, Schill WB, Kleinstein J, Gips H.

Acrosin activity of human spermatozoa by means of a simple

gelatinolytic technique: a method useful for IVF. J Androl


Glezerman M, Bernstein D, Zakut C, Misgav N, Insler V.

Polyzoospermia: a definite pathologic entity. Fertil Steril


Krieg K, Gerlach R, Rost D. [Impulse cytophotometric studies of

spermatozoa for the demonstration of fertility disorders].

Zentralbl. Gynakol 1977;99:1217–24.

Amelar RD, Dubin L, Quigley MM, Schoenfeld C. Successful

management of infertility due to polyzoospermia. Fertil Steril


Rabbani KJ. Infertility: the male factor. First national symposium

on current trends in developmental and reproductive biology,

held at the Pakistan Academy of Sciences, Islamabad, Pakistan.

–23 November 1997.

Kholkute SD, Meherji P, Puri CP. Capacitation and the acrosome

reaction in sperm from men with various semen profiles

monitored by a chlortetracycline fluorescence assay. Int J Androl


Schill WB. Determination of active, non zymogen acrosin, proacrosin and total acrosin in different andrological patients. Arch

Dermatol Res 1990;282:335–42.

Calamera JC, Giovenco P, Brugo S, Dondero F, Nicholson RF.

Adenosine 5 triphosphate (ATP) content and acrosin activity in

polyzoospermic subjects. Andrologia 1987;19:460–3.

Schill WB, Topfer Petersen E, Heissler E. The sperm acrosome:

functional and clinical aspects. Hum Reprod 1988;3:139–45.

Topfer-Petersen E, Volcker C, Heissler E, Schill WB. Absence of

acrosome reaction in polyzoospermia. Andrologia 1987;19:225–

Schill WB, Feifel M. Low acrosin activity in polyzoospermia.

Andrologia 1984;16:589–91.

Lalonde L, Langlais J, Antaki P, Chapdelaine A, Roberts KD,

Bleau G. Male infertility associated with round headed

acrsomeless spermatozoa. Fertil Steril 1988;49:316–21.

Stainislavov R, Ganev V. A clinco-genetic study of male

infertility with globozoospermia. Akush Ginekol 1998;37:20–2.

Nistal M, Herruzo A, Sanchez-Corral F. Absolute

teratozoospermia in a family, irrugalr microcephalic

spermatozoon without acrosome. Andrologia 1978;10:234–40.

Nistal M, Paniiagua R, Herruzo A. Multi tailed spermatozoa in a

case with asthenospermia and teratospermia. Virchows Arch B

Cell Pathol 1977;26:111–8.

Pieters MH, Speed RM, deBoer P, Vreeburg JT, Cohle G, Int

Veld PA. Evidence of disturbed meiosis in a man referred for

intracytoplasmic sperm injection. Lancet 1998;351:957.

Coeetzee K, Kruger TF, Lombard CJ. Predictive value of normal

sperm morphology: a structured literature review. Hum Reprod

Update 1998;4:73–82.

Menkveld R, Wong WY, Lombard CJ, Wetzels AM, Thomas

CM, Merkus HM, et al. Semen parameters, including WHO and

strict criteria morphology, in a fertile and subfertile population: an

effort towards standardization of in-vivo thresholds. Hum Reprod


Meistrich ML, Kasai K, Olds Clarke P, MacGregor GR,

Berkowitz AD, Tung KS. Deficiency in fertilization by

morphologically abnormal sperm produced by azh mutant mice.

Mol Reprod Dev 1994;37:69–77.

Tesarik J, Thebault A. Fertilization failure after subzonal sperm

insertion associated with defective functional capacity of

acrosome-reacted spermatozoa. Fertil Steril 1993;60:369–71.

Damjanov I. Clinical evaluation of the infertile couple. In:

Pathology of infertility. Mosby-Year Book, Inc. St. Louis,

Missouri, USA. 1993. p. 7–42.