Articles In Press
Back to the articles list |
Back to browse issues page
1- Department of Clinical Laboratory Sciences, College of Pharmacy, University of Misan, Misan, Iraq
2- Department of Pharmacology and Toxicology, College of Pharmacy, University of Misan, Misan, Iraq
3- Department of Clinical Laboratory Sciences, College of Pharmacy, University of Misan, Misan, Iraq ,dr.mohammed_talib@uomisan.edu.iq
2- Department of Pharmacology and Toxicology, College of Pharmacy, University of Misan, Misan, Iraq
3- Department of Clinical Laboratory Sciences, College of Pharmacy, University of Misan, Misan, Iraq ,
Abstract: (4 Views)
Background and Objectives: Male factors account for approximately 50% of global infertility cases. This study aimed to compare the relationship between key serum reproductive hormones—Luteinizing Hormone (LH), Follicle-Stimulating Hormone (FSH), and testosterone-and semen parameters in infertile men versus healthy, fertile controls across various clinically defined infertility causes.
Materials and Methods: A comprehensive descriptive cross-sectional study was conducted in Maysan Province, Iraq. A total of 477 participants were enrolled, including 393 infertile men and 84 age-matched healthy controls. The infertile group was divided into six categories: Obstructive Azoospermia, Non-obstructive Azoospermia, Primary Hypogonadism, Secondary Hypogonadism, Asthenozoospermia, and Teratozoospermia. All participants underwent serum hormone analysis using validated ELISA techniques and detailed semen analysis. Female-factor infertility was carefully excluded to focus solely on male-specific causes.
Results: Significant differences in hormonal profiles were observed among the groups. FSH levels were markedly elevated in Non-obstructive Azoospermia and Primary Hypogonadism compared to healthy controls and the Obstructive Azoospermia group. LH concentrations were highest in Primary Hypogonadism and Non-obstructive Azoospermia, while suppressed in Secondary Hypogonadism. Testosterone levels were significantly lower in both Primary and Secondary Hypogonadism compared to healthy controls. Semen analysis showed distinct impairments across the infertile groups consistent with their underlying causes, while healthy controls exhibited optimal values.
Conclusion: This study characterizes the distinct hormonal and semen parameter profiles associated with various male infertility etiologies in an Iraqi population. The findings highlight that FSH is a beneficial biomarker for differentiating between testicular failure and post-testicular causes, and confirm that integrating multiple parameters is a more effective approach than relying on a single marker for improved diagnosis and prognostic assessment in male infertility management.
Type of Study: Original Research Article |
Subject:
Clinical Medicine
Received: 2025/09/2 | Accepted: 2025/11/1 | Published: 2025/11/11
Received: 2025/09/2 | Accepted: 2025/11/1 | Published: 2025/11/11
References
1. Vander Borght M, Wyns C. Fertility and infertility: Definition and epidemiology. Clin Biochem. 2018;62:2-10. [DOI:10.1016/j.clinbiochem.2018.03.012] [PMID]
2. Calogero AE, Cannarella R, Agarwal A, Hamoda TA-AA-M, Rambhatla A, Saleh R, et al. The renaissance of male infertility management in the golden age of andrology. World J Mens Health. 2023;41(2):237. [DOI:10.5534/wjmh.220213] [PMID] [PMCID]
3. Odetayo AF, Akhigbe RE, Bassey GE, Hamed MA, Olayaki LA. Impact of stress on male fertility: role of gonadotropin inhibitory hormone. Front Endocrinol. 2024;14:1329564. [DOI:10.3389/fendo.2023.1329564] [PMID] [PMCID]
4. Ramaswamy S, Weinbauer GF. Endocrine control of spermatogenesis: Role of FSH and LH/testosterone. Spermatogenesis. 2014;4(2):e996025. [DOI:10.1080/21565562.2014.996025] [PMID] [PMCID]
5. Bhattacharya I, Dey S, Banerjee A. Revisiting the gonadotropic regulation of mammalian spermatogenesis: evolving lessons during the past decade. Front Endocrinol. 2023;14:1110572. [DOI:10.3389/fendo.2023.1110572] [PMID] [PMCID]
6. De Jonge CJ, Barratt CL, Aitken RJ, Anderson RA, Baker P, Chan DY, et al. Current global status of male reproductive health. Hum Reprod Open. 2024;2024(2):hoae017. [DOI:10.1093/hropen/hoae017] [PMID] [PMCID]
7. Gül M, Russo GI, Kandil H, Boitrelle F, Saleh R, Chung E, et al. Male infertility: new developments, current challenges, and future directions. World J Mens Health. 2024;42(3):502. [DOI:10.5534/wjmh.230232] [PMID] [PMCID]
8. Barratt CL, Björndahl L, De Jonge CJ, Lamb DJ, Osorio Martini F, McLachlan R, et al. The diagnosis of male infertility: an analysis of the evidence to support the development of global WHO guidance-challenges and future research opportunities. Hum Reprod Update. 2017;23(6):660-80. [DOI:10.1093/humupd/dmx021] [PMID] [PMCID]
9. Wahid B, Bashir H, Bilal M, Wahid K, Sumrin A. Developing a deeper insight into reproductive biomarkers. Clin Exp Reprod Med. 2017;44(4):159. [DOI:10.5653/cerm.2017.44.4.159] [PMID] [PMCID]
10. Chung E, Atmoko W, Saleh R, Shah R, Agarwal A. of the World Health Organization laboratory manual of semen analysis: updates and essential take away for busy clinicians. Arab J Urol. 2024;22(2):71-4. [DOI:10.1080/20905998.2023.2298048] [PMID] [PMCID]
11. Pozzi E, Belladelli F, Corsini C, Boeri L, Capogrosso P, Fallara G, et al. Contemporary diagnostic work-up for male infertility: emphasizing comprehensive baseline assessment. World J Mens Health. 2024;43(2):265. [DOI:10.5534/wjmh.240069] [PMID] [PMCID]
12. Palmer SS, Barnhart KT. Biomarkers in reproductive medicine: the promise, and can it be fulfilled?. Fertil Steril. 2013;99(4):954-62. [DOI:10.1016/j.fertnstert.2012.11.019] [PMID] [PMCID]
13. Qaderi K, Sharifipour F, Dabir M, Shams R, Behmanesh A. Artificial intelligence (AI) approaches to male infertility in IVF: a mapping review. Eur J Med Res. 2025;30(1):246. [DOI:10.1186/s40001-025-02479-6] [PMID] [PMCID]
14. Tang LC, Chan SY. Seminal plasma levels of luteinizing hormone, prolactin and testosterone in the evaluation of male infertility. Asia-Oceania J Obstet Gynaecol. 1986;12(2):275-83. [DOI:10.1111/j.1447-0756.1986.tb00191.x] [PMID]
15. Khan MS, Ali I, Khattak AM, Tahir F, Subhan F, Kazi BM, et al. Role of estimating serum luteinizing hormone and testosterone in infertile males. Gomal J Med Sci. 2005;3(2):61-5.
16. Mahmud AA, Anu UH, Foysal KA, Hasan M, Sazib SM, Ragib AA, et al. Elevated serum malondialdehyde (MDA), insulin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and thyroid-stimulating hormone (TSH), and reduced antioxidant vitamins in polycystic ovarian syndrome patients. Narra J. 2022;2(1):e56. [DOI:10.52225/narra.v2i1.56]
17. Kobayashi H, Uetani M, Yamabe F, Mitsui Y, Nakajima K, Nagao K. A new model for determining risk of male infertility from serum hormone levels, without semen analysis. Sci Rep. 2024;14(1):17079. [DOI:10.1038/s41598-024-67910-0] [PMID] [PMCID]
18. Agarwal A, Sharma R, Gupta S, Finelli R, Parekh N, Selvam MKP, et al. Standardized laboratory procedures, quality control and quality assurance are key requirements for accurate semen analysis in the evaluation of infertile male. World J Mens Health. 2021;40(1):52. [DOI:10.5534/wjmh.210022] [PMID] [PMCID]
19. Greene DN, Ahmed SB, Daccarett S, Kling JM, Lorey TS, Rytz CL, et al. A Comprehensive Review of Estradiol, Progesterone, Luteinizing Hormone, and Follicle-Stimulating Hormone in the Context of Laboratory Medicine to Support Women's Health. Clin Chem. 2025:hvaf039. [DOI:10.1093/clinchem/hvaf039] [PMID]
20. Kavoussi PK, Hudson K, Machen GL, Barsky M, Lebovic DI, Kavoussi SK. FSH levels and testicular volumes are associated with the severity of testicular histopathology in men with non-obstructive azoospermia. J Assist Reprod Genet. 2021;38(11):3015-8. [DOI:10.1007/s10815-021-02313-y] [PMID] [PMCID]
21. Bergmann M, Behre HM, Nieschlag E. Serum FSH and testicular morphology in male infertility. Clin Endocrinol. 1994;40(1):133-6. [DOI:10.1111/j.1365-2265.1994.tb02455.x] [PMID]
22. Dandona P, Rosenberg MT. A practical guide to male hypogonadism in the primary care setting. Int J Clin Pract. 2010;64(6):682-96. [DOI:10.1111/j.1742-1241.2010.02355.x] [PMID] [PMCID]
23. Jamalirad H, Jajroudi M, Khajehpour B, Sadighi Gilani MA, Eslami S, Sabbaghian M, et al. AI predictive models and advancements in microdissection testicular sperm extraction for non-obstructive azoospermia: a systematic scoping review. Hum Reprod Open. 2024:hoae070. [DOI:10.1093/hropen/hoae070] [PMID] [PMCID]
24. Esteves SC, Humaidan P. The role of luteinizing hormone activity in spermatogenesis: from physiology to clinical practice. Reprod Biol Endocrinol. 2025;23(Suppl 1):6. [DOI:10.1186/s12958-024-01333-4] [PMID] [PMCID]
25. Itoh N, Kumamoto Y, Maruta H, Takagi Y, Mikuma N, Nanbu A, et al. Determination of the normal range of serum LH and FSH levels in normal adult males--comparison with IRMA and RIA. Nihon Naibunpi Gakkai Zasshi. 1990;66(5):572-83. [DOI:10.1507/endocrine1927.66.5_572] [PMID]
26. Hubbard L, Rambhatla A, Colpi GM. Differentiation between nonobstructive azoospermia and obstructive azoospermia: then and now. Asian J Androl. 2025;27(3):298-306. [DOI:10.4103/aja202475] [PMID] [PMCID]
27. Shamohammadi I, Gilani MAS, Kazemeyni SM, Hasanzadeh T, Dizaj AVT, Dizavi A. Evaluation of azoospermic patients to Distinguish Obstructive from Non-obstructive Azoospermia, and necessity of Diagnostic Testis Biopsy: a retrospective study. Int J Fertil Steril. 2022;16(3):156.
28. Esquivel-Zuniga R, Rogol AD. Functional hypogonadism in adolescence: an overlooked cause of secondary hypogonadism. Endocr Connect. 2023;12(11):e230190. [DOI:10.1530/EC-23-0190] [PMID] []
29. Almhmdi NA, Sahab KS, Al Dulaimy HKK, Sadeghi L. Evaluating the blood Serum Hormones, Cholesterol Levels in Seminiferous Plasma and Certain Semen Parameters in Males with Asthenozoospermia. Acad Sci J. 2024;2(4):218-27. [DOI:10.24237/ASJ.02.04.808D]
30. Martin Martins J, Pina Jorge Md, Martins Maia C, Roque J, Lemos C, Nunes D, et al. Primary and secondary hypogonadism in male persons with diabetes mellitus. Int J Endocrinol. 2021;2021(1):8799537. [DOI:10.1155/2021/8799537] [PMID] []
31. Grande G, Barrachina F, Soler-Ventura A, Jodar M, Mancini F, Marana R, et al. The role of testosterone in spermatogenesis: lessons from proteome profiling of human spermatozoa in testosterone deficiency. Front Endocrinol. 2022;13:852661. [DOI:10.3389/fendo.2022.852661] [PMID] [PMCID]
32. Nansunga M, Manabe YC, Alele PE, Kasolo J. Association of testosterone levels with socio-demographic characteristics in a sample of Ugandan men. Afr Health Sci. 2014;14(2):348-55. [DOI:10.4314/ahs.v14i2.9] [PMID] [PMCID]
33. Abdalla M, Ibrahim I, Rizk A, El Agouz W, Girgis S, Etriby A, et al. Endocrine studies of azoospermia, II. Serum steroid levels in obstructive azoospermia. Arch Androl. 1979;3(2):163-6. [DOI:10.3109/01485017908985064] [PMID]
34. Marcelli M, Mediwala SN. Male hypogonadism: a review. J Investig Med. 2020;68(2):335-56. [DOI:10.1136/jim-2019-001233] [PMID]
35. Caroppo E, Colpi GM. Successful Bilateral Sperm Retrieval in a Hypogonadal Patient with Non-Obstructive Azoospermia Showing Normal Serum 17-Hydroxyprogesterone Levels Suggestive of Normal Intratesticular Testosterone Production: A Case Report. J Clin Med. 2023;12(10):3594. [DOI:10.3390/jcm12103594] [PMID] [PMCID]
36. Seminara SB, Hayes FJ, Crowley Jr WF. Gonadotropin-releasing hormone deficiency in the human (idiopathic hypogonadotropic hypogonadism and Kallmann's syndrome): pathophysiological and genetic considerations. Endocr Rev. 1998;19(5):521-39.
https://doi.org/10.1210/er.19.5.521 [DOI:10.1210/edrv.19.5.0344] [PMID]
37. Check J, Lurie D, Vetter B. Sera gonadotropins, testosterone, and prolactin levels in men with oligozoospermia or asthenozoospermia. Arch Androl. 1995;35(1):57-61. [DOI:10.3109/01485019508987854] [PMID]
38. Spaggiari G, Costantino F, Dalla Valentina L, Romeo M, Furini C, Roli L, et al. Are they functional hypogonadal men? Testosterone serum levels unravel male idiopathic infertility subgroups. Endocrine. 2024;84(2):757-67. [DOI:10.1007/s12020-024-03717-3] [PMID] [PMCID]
39. Di Guardo F, Vloeberghs V, Bardhi E, Blockeel C, Verheyen G, Tournaye H, et al. Low testosterone and semen parameters in male partners of infertile couples undergoing IVF with a total sperm count greater than 5 million. J Clin Med. 2020;9(12):3824. [DOI:10.3390/jcm9123824] [PMID] [PMCID]
40. Herndon CC, Godart ES, Turek PJ. Testosterone levels among non-obstructive azoospermic patients 2 years after failed bilateral microdissection testicular sperm extraction: a nested case-cohort study. J Assist Reprod Genet. 2022;39(6):1297-303. [DOI:10.1007/s10815-022-02497-x] [PMID] [PMCID]
41. Mohammadzadeh M, Montazeri F, Poodineh J, Vatanparast M, Koshkaki ER, Esmailabad SG, et al. Therapeutic potential of testosterone on sperm parameters and chromatin status in fresh and thawed normo and asthenozoospermic samples. Rev Int Androl. 2023;21(3):100352. [DOI:10.1016/j.androl.2023.100352] [PMID]
42. Aziz N. The importance of semen analysis in the context of azoospermia. Clinics. 2013;68:35-8. [DOI:10.6061/clinics/2013(Sup01)05] [PMID]
43. Grande G, Vincenzoni F, Mancini F, Barrachina F, Giampietro A, Castagnola M, et al. Quantitative analysis of the seminal plasma proteome in secondary hypogonadism. J Clin Med. 2019;8(12):2128. [DOI:10.3390/jcm8122128] [PMID] [PMCID]
44. Liu F-H, Wang X-B, Wen Z-Y, Wang H-Y, Zhang M, Zhang S, et al. Dietary inflammatory index and risk of asthenozoospermia: a hospital-based case-controlled study in China. Front Nutr. 2021;8:706869. [DOI:10.3389/fnut.2021.706869] [PMID] [PMCID]
45. Atmoko W, Savira M, Shah R, Chung E, Agarwal A. Isolated teratozoospermia: revisiting its relevance in male infertility: a narrative review. Transl Androl Urol. 2024;13(2):260. [DOI:10.21037/tau-23-397] [PMID] [PMCID]
46. Cooper TG, Noonan E, Von Eckardstein S, Auger J, Baker HG, Behre HM, et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update. 2010;16(3):231-45. [DOI:10.1093/humupd/dmp048] [PMID]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |