title: Relationship amongst teratozoospermia, seminal oxidative stress and male infertility.
abstract: BACKGROUND
  Spermatozoa morphology is an important and complex characteristic of the fertilization capacity of male germ cells. Morphological abnormalities have been observed to be accompanied by reactive oxygen species (ROS) overproduction and further damage to spermatozoa, ultimately leading to infertility. Therefore, this study aimed to examine the relationship between seminal ROS production and sperm morphology in infertile teratozoospermic patients as well as in healthy men of proven and unproven fertility.
  
  
  METHODS
  Semen samples were collected from 79 patients classified as teratozoospermic and 56 healthy donors (control). Standard semen analysis was performed and spermatozoa morphology was assessed according to the WHO 2010 guidelines. Seminal ROS was measured by chemiluminescence assay. Receiver operating characteristic (ROC) curves were generated, and sensitivity, specificity, cutoff value and area under curve (AUC) were determined.
  
  
  RESULTS
  Sperm morphology was significantly poor in the Teratozoospermic Group compared with the 3 Donor Groups (P < 0.05). Significantly higher levels of ROS (RLU/sec/10⁶ sperm) were seen in the Teratozoospermic group (145.4 (41.5; 555.4) compared to the Donor Groups: All Donors (64.8 (21.1; 198.2), Proven Donors (58.8 (14.2; 79.2) and Proven Donors < 2 years (58.8 (14.2; 79.2) (P < 0.05). ROS correlated negatively with sperm concentration in the All Donor group (r = -0.354; P = 0.021) as well as in the Teratozospermic group (r -0.356; P = 0.002). Using ROC analysis, we established the cutoff values for concentration, morphology and ROS.
  
  
  CONCLUSIONS
  The incidence of teratozoospermia may be directly related to the overproduction of seminal ROS. Therefore, besides sperm concentration and motility, spermatozoa morphology should receive an equally important consideration in the overall assessment of male fertility.
authors.affiliation: Center for Reproductive Medicine, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. agarwaa@ccf.org.
authors.forename: Ashok
authors.initials: A
authors.lastname: Agarwal
authors.forename: Eva
authors.initials: E
authors.lastname: Tvrda
authors.forename: Rakesh
authors.initials: R
authors.lastname: Sharma
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D048430:Cell Shape; D005298:Fertility; D006801:Humans; D007248:Infertility, Male / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology*; D008297:Male; D009820:Ohio; D018384:Oxidative Stress; D012372:ROC Curve; D017382:Reactive Oxygen Species / Q000378:metabolism*; D012661:Semen / Q000378:metabolism*; D055101:Semen Analysis; D012680:Sensitivity and Specificity; D013094:Spermatozoa / Q000378:metabolism / Q000473:pathology*; D014019:Tissue Donors; D015854:Up-Regulation; D055815:Young Adult
chemical_list: D015415:Biomarkers; D017382:Reactive Oxygen Species