Oxidative Stress, DNA Damage, and Apoptosis in Male Infertility

  • Tamer M. Said
  • Constanze Fischer-Hammadeh
  • Mohammed Hamad
  • Khaled Refaat
  • Mohamad Eid Hammadeh
Part of the Oxidative Stress in Applied Basic Research and Clinical Practice book series (OXISTRESS)


Oxidative stress, sperm DNA damage, and apoptosis are associated with male infertility as a cause and as a manifestation. Several clinical conditions and laboratory findings may be indicative of the presence of oxidative stress, sperm DNA damage, and apoptosis. The use of standardized assays for the diagnosis of oxidative stress, sperm DNA damage, and apoptosis should be limited to cases where these conditions are suspected. The identifications of the causative factor for infertility will lead to a specific and subsequently more successful treatment option. In this chapter, we provide a description of the clinical conditions associated with oxidative stress, sperm DNA damage, and apoptosis that lead to male infertility. The different signs and results of laboratory investigations will be provided to highlight manifestations of these conditions. We also describe the impact of oxidative stress, sperm DNA damage, and apoptosis on male fertility and the different approaches that could be used for diagnosis and prevention.


Oxidative stress Apoptosis Male infertility Reactive oxygen species Spermatozoa DNA damage Apoptosis 


  1. 1.
    Halliwell B, Aruoma OI. DNA damage by oxygen-derived species. Its mechanisms and measurement in mammalian systems. FEBS Lett. 1991;281:9–19.PubMedCrossRefGoogle Scholar
  2. 2.
    Halliwell B. Free radicals, antioxidants, and human disease: curiosity, cause, or consequence? Lancet. 1994;344:721–4.PubMedCrossRefGoogle Scholar
  3. 3.
    Janssen YMW, van Houten B, Borm PJA, Mossman BT. Cell and tissue responses to oxidative damage. Lab Invest. 1993;69:261–74.PubMedGoogle Scholar
  4. 4.
    Agarwal A, Gupta S, Sikka S. The role of free radicals and antioxidants in reproduction. Curr Opin Obstet Gynecol. 2006;18(3):325–32.PubMedCrossRefGoogle Scholar
  5. 5.
    Bagchi K, Puri S. Free radicals and antioxidants in health and disease. East Mediterr Health J. 1998;4:350–60.Google Scholar
  6. 6.
    Gil-Guzman E, Ollero M, Lopez MC, Sharma RK, Alvarez JG, Thomas Jr AJ, Agarwal A. Differential production of reactive oxygen species by subsets of human spermatozoa at different stages of maturation. Hum Reprod. 2001;16:1922–30.PubMedCrossRefGoogle Scholar
  7. 7.
    Hendin BN, Kolettis PN, Sharma RK, Thomas Jr AJ, Agarwal A. Varicocele is associated with elevated spermatozoal reactive oxygen species production and diminished seminal plasma antioxidant capacity. J Urol. 1999;161:1831–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Plante M, de Lamirande E, Gagnon C. Reactive oxygen species released by activated neutrophils, but not by deficient spermatozoa, are sufficient to affect normal sperm motility. Fertil Steril. 1994;62:87–393.Google Scholar
  9. 9.
    Aitken RJ, Baker MA. Reactive oxygen species generation by human spermatozoa: a continuing enigma. Int J Androl. 2002;25:191–4.PubMedCrossRefGoogle Scholar
  10. 10.
    Aitken RJ, West KM. Analysis of the relationship between reactive oxygen species production and leukocyte infiltration in fractions of human semen separated on Percoll gradients. Int J Androl. 1990;13:433–51.PubMedCrossRefGoogle Scholar
  11. 11.
    Padron OF, Brackett NL, Sharma RK, Lynne CM, Thomas Jr AJ, Agarwal A. Seminal reactive oxygen species and sperm motility and morphology in men with spinal cord injury. Fertil Steril. 1997;67:1115–20.PubMedCrossRefGoogle Scholar
  12. 12.
    Hammadeh ME, Al Hasani S, Rosenbaum P, Schmidt W, Fischer-Hammadeh C. Reactive oxygen species (ROS), total antioxidants (TAS) concentration of seminal plasma and their effect on sperm parameters and outcome of IVF/ICSI patients. Arch Gynecol Obstet. 2008;277:515–26.PubMedCrossRefGoogle Scholar
  13. 13.
    Hammadeh ME, Radwan M, Al-Hasani S, Micu R, Rosenbaum P, Lorenz M, Schmidt W. Comparison between reactive oxygen species (ROS) concentration in seminal plasma and semen parameters in partners of patients who became pregnant after IVF/ICSI and those who did not. Reprod Biomed Online. 2006;13(5):696–706.PubMedCrossRefGoogle Scholar
  14. 14.
    Mossman BT. Signal transduction by oxidants: look who’s talking. Free Radic Biol Med. 2000;28:1315–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Thannickal VJ, Fanburg BL. Reactive oxygen species in cell signalling. Am J Physiol Lung Cell Mol Physiol. 2000;279:L1005–28.Google Scholar
  16. 16.
    Allen RG, Tresini M. Oxidative stress and gene regulation. Free Radic Biol Med. 2000;28:463–99.PubMedCrossRefGoogle Scholar
  17. 17.
    Gagnon C, Iwasaki A, De Lamirande E, Kovalski N. Reactive oxygen species and human spermatozoa. Ann N Y Acad Sci. 1991;637:436–44.PubMedCrossRefGoogle Scholar
  18. 18.
    Aitken RJ, Fisher HM, Fulton N, Gomez E, Knox W, Lewis B, Irvine S. Reactive oxygen species generation by human spermatozoa is induced by exogenous NADPH and inhibited by the flavoprotein inhibitors diphenylene iodonium and quinacrine. Mol Reprod Dev. 1997;47:468–82.PubMedCrossRefGoogle Scholar
  19. 19.
    de Lamirande E, Gagnon C. Human sperm hyperactivation and capacitation as parts of an oxidative process. Free Radic Biol Med. 1993;14:255–65.Google Scholar
  20. 20.
    Said TM, Aziz N, Sharma RK, Lewis-Jones I, Thomas Jr AJ, Agarwal A. A novel association between sperm deformity index and oxidative stress-induced DNA damage in infertile male patients. Asian J Androl. 2005;7:121–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Agarwal A, Said T. Role of sperm chromatin abnormalities and DNA damage in male infertility. Hum Reprod Update. 2003;9:331–45.PubMedCrossRefGoogle Scholar
  22. 22.
    Berry EM, Kohen R. Is the biological antioxidant system integrated and regulated? Med Hypotheses. 1999;53:397–401.PubMedCrossRefGoogle Scholar
  23. 23.
    Agarwal A, Saleh RA, Bedaiwy MA. Role of reactive oxygen species in the pathophysiology of human reproduction. Fertil Steril. 2003;79(4):829–43.PubMedCrossRefGoogle Scholar
  24. 24.
    Agarwal A, Gupta S, Sharma RK. Role of oxidative stress in female reproduction. Reprod Biol Endocrinol. 2005;3:28–37.PubMedCrossRefGoogle Scholar
  25. 25.
    Shiota K, Yamada S. Intrauterine environment-genome interaction and children’s development (3): assisted reproductive technologies and developmental disorders. J Toxicol Sci. 2009;34 Suppl 2:SP287–91.PubMedCrossRefGoogle Scholar
  26. 26.
    Rhee SG. Cell signaling: H2O2, a necessary evil for cell signaling. Science. 2006;312(5782):1882–3.PubMedCrossRefGoogle Scholar
  27. 27.
    Krieger-Liszkay A. Singlet oxygen production in photosynthesis. J Exp Bot. 2004;56(411):337–46.PubMedCrossRefGoogle Scholar
  28. 28.
    Sakkas D, Mariethoz E, St John JC. Abnormal sperm parameters in humans are indicative of an abortive apoptotic mechanism linked to the Fas-mediated pathway. Exp Cell Res. 1999;251:350–5.PubMedCrossRefGoogle Scholar
  29. 29.
    Barroso G, Morshedi M, Oehninger S. Analysis of DNA fragmentation, plasma membrane translocation of phosphatidylserine and oxidative stress in human spermatozoa. Hum Reprod. 2000;15:1338–44.PubMedCrossRefGoogle Scholar
  30. 30.
    Shen HM, Dai J, Chia SE, Lim A, Ong CN. Detection of apoptotic alterations in sperm in subfertile patients and their correlations with sperm quality. Hum Reprod. 2002;17:1266–73.PubMedCrossRefGoogle Scholar
  31. 31.
    Jurisicova A, Lopes S, Meriano J, Oppedisano L, Casper RF, Varmuza S. DNA damage in round spermatids of mice with a targeted disruption of the Pp1cgamma gene and in testicular biopsies of patients with non-obstructive azoospermia. Mol Hum Reprod. 1999;5:323–30.PubMedCrossRefGoogle Scholar
  32. 32.
    Taylor SL, Weng SL, Fox P, Duran EH, Morshedi MS, Oehninger S, Beebe SJ. Somatic cell apoptosis markers and pathways in human ejaculated sperm: potential utility as indicators of sperm quality. Mol Hum Reprod. 2004;10:825–34.PubMedCrossRefGoogle Scholar
  33. 33.
    Grunewald S, Paasch U, Wuendrich K, Glander HJ. Sperm caspases become more activated in infertility patients than in healthy donors during cryopreservation. Arch Androl. 2005;51:449–60.PubMedCrossRefGoogle Scholar
  34. 34.
    Tesarik J, Martinez F, Rienzi L, Iacobelli M, Ubaldi F, Mendoza C, Greco E. In-vitro effects of FSH and testosterone withdrawal on caspase activation and DNA fragmentation in different cell types of human seminiferous epithelium. Hum Reprod. 2002;17:1811–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Lachaud C, Tesarik J, Canadas ML, Mendoza C. Apoptosis and necrosis in human ejaculated spermatozoa. Hum Reprod. 2004;19:607–10.PubMedCrossRefGoogle Scholar
  36. 36.
    Pentikainen V, Erkkila K, Dunkel L. Fas regulates germ cell apoptosis in the human testis in vitro. Am J Physiol. 1999;276:310–6.Google Scholar
  37. 37.
    Burrello N, Arcidiacono G, Vicari E, Asero P, Di BD, De PA, et al. Morphologically normal spermatozoa of patients with secretory oligo-asthenoteratozoospermia have an increased aneuploidy rate. Hum Reprod. 2004;19:2298–302.PubMedCrossRefGoogle Scholar
  38. 38.
    Paasch U, Grunewald S, Agarwal A, Glandera HJ. Activation pattern of caspases in human spermatozoa. Fertil Steril. 2004;81 Suppl 1:802–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Koppers AJ, de Iuliis GN, Finnie JM, McLaughlin EA, Aitken RJ. Significance of mitochondrial reactive oxygen species in the generation of oxidative stress in spermatozoa. J Clin Endocrinol Metab. 2008;93:3199–207.PubMedCrossRefGoogle Scholar
  40. 40.
    Paasch U, Sharma RK, Gupta AK, et al. Cryopreservation and thawing is associated with varying extent of activation of apoptotic machinery in subsets of ejaculated human spermatozoa. Biol Reprod. 2004;71:1828–37.PubMedCrossRefGoogle Scholar
  41. 41.
    Cande C, Cecconi F, Dessen P, Kroemer G. Apoptosis-inducing factor (AIF): key to the conserved caspase-independent pathways of cell death? J Cell Sci. 2002;115:4727–34.PubMedCrossRefGoogle Scholar
  42. 42.
    Said T, Paasch U, Glander H, Agarwal A. Role of caspases in male infertility. Hum Reprod Update. 2004;10:39–51.PubMedCrossRefGoogle Scholar
  43. 43.
    de Iuliis GN, Thomson LK, Mitchell LA, Finnie JM, Koppers AJ, et al. DNA damage in human spermatozoa is highly correlated with the efficiency of chromatin remodelling and the formation of 8-hydroxy-29-deoxyguanosine, a marker of oxidative stress. Biol Reprod. 2009;81:517–24.PubMedCrossRefGoogle Scholar
  44. 44.
    Sotolongo B, Huang TT, Isenberger E, Ward WS. An endogenous nuclease in hamster, mouse, and human spermatozoa cleaves DNA into loop-sized fragments. J Androl. 2005;26:272–80.PubMedGoogle Scholar
  45. 45.
    Nagata S. Apoptotic DNA fragmentation. Exp Cell Res. 2000;256:12–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Barkett M, Gilmore TD. Control of apoptosis by Rel/NFkB transcription factors. Oncogene. 1999;18:6910–24.PubMedCrossRefGoogle Scholar
  47. 47.
    Lee J, Richburg JH, Younkin SC, Boekelheide K. The Fas system is a key regulator of germ cell apoptosis in the testis. Endocrinology. 1997;138:2081–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Kane DJ, Sarafian TA, Anton R, Hahn H, Gralla EB, Valentine JS, et al. Bcl-2 inhibition of neural death: decreased generation of reactive oxygen species. Science. 1993;262:1274–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Wang X, Sharma R, Sikka S, Thomas Jr A, Falcone T, Agarwal A. Oxidative stress is associated with increased apoptosis leading to spermatozoa DNA damage in patients with male factor infertility. Fertil Steril. 2003;80:531–5.PubMedCrossRefGoogle Scholar
  50. 50.
    Moustafa MH, Sharma RK, Thornton J, Mascha E, Abdel-Hafez M, Thomas AJ, Agarwal A. Relationship between ROS production, apoptosis and DNA denaturation in spermatozoa from patients examined for infertility. Hum Reprod. 2004;19:129–38.PubMedCrossRefGoogle Scholar
  51. 51.
    Aitken RJ, Koppers AJ. Apoptosis and DNA damage in human spermatozoa. Asian J Androl. 2011;13:36–42.PubMedCrossRefGoogle Scholar
  52. 52.
    Agarwal A, Said TM. Oxidative stress, DNA damage and apoptosis in male infertility: a clinical approach. BJU Int. 2005;95:503–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Oltvai ZN, Milliman CL, Korsmeyer SJ. Bcl-2 heterodimerizes in vivo with a conserved homolog, Bax, that accelerates programmed cell death. Cell. 1993;74:609–19.PubMedCrossRefGoogle Scholar
  54. 54.
    Adams JM, Cory S. The Bcl-2 protein family: arbiters of cell survival. Science. 1998;281:1322–6.PubMedCrossRefGoogle Scholar
  55. 55.
    Kelekar A, Thompson CB. Bcl-2-family proteins: the role of the BH3 domain in apoptosis. Trends Cell Biol. 1998;8:324–30.PubMedCrossRefGoogle Scholar
  56. 56.
    Sakkas D, Mariethoz E, Manicardi G, Bizzaro D, Bianchi PG, Bianchi U. Origin of DNA damage in ejaculated human spermatozoa. Rev Reprod. 1999;4:31–7.PubMedCrossRefGoogle Scholar
  57. 57.
    Shen H, Ong C. Detection of oxidative DNA damage in human sperm and its association with sperm function and male infertility. Free Radic Biol Med. 2000;28:529–36.PubMedCrossRefGoogle Scholar
  58. 58.
    Cisternas P, Moreno RD. Comparative analysis of apoptotic pathways in rat, mouse, and hamster spermatozoa. Mol Reprod Dev. 2006;73:1318–25.PubMedCrossRefGoogle Scholar
  59. 59.
    Said TM, Agarwal A, Sharma RK, Thomas Jr AJ, Sikka SC. Impact of sperm morphology on DNA damage caused by oxidative stress induced by beta-nicotinamide adenine dinucleotide phosphate. Fertil Steril. 2005;83:95–103.PubMedCrossRefGoogle Scholar
  60. 60.
    Twigg J, Fulton N, Gomez E, Irvine DS, Aitken RJ. Analysis of the impact of intracellular reactive oxygen species generation on the structural and functional integrity of human spermatozoa: lipid peroxidation, DNA fragmentation and effectiveness of antioxidants. Hum Reprod. 1998;13:1429–36.PubMedCrossRefGoogle Scholar
  61. 61.
    Agarwal A, Saleh RA, Bedaiwy MA. Role of reactive oxygen species in the pathophysiology of human reproduction. Fertil Steril. 2003;79:829–43.PubMedCrossRefGoogle Scholar
  62. 62.
    Alvarez JG. The predictive value of sperm chromatin structure assay. Hum Reprod. 2005;20:2365–7.PubMedCrossRefGoogle Scholar
  63. 63.
    Singh NP, Muller CH, Berger RE. Effects of age on DNA double-strand breaks and apoptosis in human sperm. Fertil Steril. 2003;80:1420–30.PubMedCrossRefGoogle Scholar
  64. 64.
    Saleh R, Agarwal A, Sharma R, Said T, Sikka S, Thomas Jr A. Evaluation of nuclear DNA damage in spermatozoa from infertile men with varicocele. Fertil Steril. 2003;80:1431–6.PubMedCrossRefGoogle Scholar
  65. 65.
    O’Donovan M. An evaluation of chromatin condensation and DNA integrity in the spermatozoa of men with cancer before and after therapy. Andrologia. 2005;37:83–90.PubMedCrossRefGoogle Scholar
  66. 66.
    Erenpreiss J, Hlevicka S, Zalkalns J, Erenpreisa J. Effect of leukocytospermia on sperm DNA integrity: a negative effect in abnormal semen samples. J Androl. 2002;23:717–23.PubMedGoogle Scholar
  67. 67.
    Evenson DP, Jost LK, Corzett M, Balhorn R. Characteristics of human sperm chromatin structure following an episode of influenza and high fever: a case study. J Androl. 2000;21:739–46.PubMedGoogle Scholar
  68. 68.
    Hammadeh ME, Hamad MF, Montenarh M, Fischer-Hammadeh C. Protamine contents and P1/P2 ratio in human spermatozoa from smokers and non-smokers patients. Hum Reprod. 2010;00:1–13.Google Scholar
  69. 69.
    Aitken RJ, Bennetts LE, Sawyer D, Wiklendt AM, King BV. Impact of radio frequency electromagnetic radiation on DNA integrity in the male germline. Int J Androl. 2005;28:171–9.PubMedCrossRefGoogle Scholar
  70. 70.
    Lozano GM, Bejarano I, Espino J, González D, Ortiz A, et al. Relationship between caspase activity and apoptotic markers in human sperm in response to hydrogen peroxide and progesterone. J Reprod Dev. 2009;55:615–21.PubMedCrossRefGoogle Scholar
  71. 71.
    Henkel RR, Schill WB. Sperm preparation for ART. Reprod Biol Endocrinol. 2003;1:108.PubMedCrossRefGoogle Scholar
  72. 72.
    Rhemrev JP, van Overveld FW, Haenen GR, Teerlink T, Bast A, et al. Quantification of the nonenzymatic fast and slow TRAP in a postaddition assay in human seminal plasma and the antioxidant contributions of various seminal compounds. J Androl. 2000;21:913–20.PubMedGoogle Scholar
  73. 73.
    Greco E, Iacobelli M, Rienzi L, Ubaldi F, Ferrero S, et al. Reduction of the incidence of sperm DNA fragmentation by oral antioxidant treatment. J Androl. 2005;26:349–53.PubMedCrossRefGoogle Scholar
  74. 74.
    Aitken RJ, Clarkson JS. Significance of reactive oxygen species and antioxidants in defining the efficacy of sperm preparation techniques. J Androl. 1988;9:367–76.PubMedGoogle Scholar
  75. 75.
    Baker HW, Brindle J, Irvine DS, Aitken RJ. Protective effect of antioxidants on the impairment of sperm motility by activated polymorphonuclear leukocytes. Fertil Steril. 1996;65:411–9.PubMedGoogle Scholar
  76. 76.
    Moskovtsev SI, Willis J, White J, Mullen JB. Leukocytospermia: relationship to sperm deoxyribonucleic acid integrity in patients evaluated for male factor infertility. Fertil Steril. 2007;88:737–40.PubMedCrossRefGoogle Scholar
  77. 77.
    Henkel R, Kierspel E, Stalf T, Mehnert C, Menkveld R, et al. Effect of reactive oxygen species produced by spermatozoa and leukocytes on sperm functions in nonleukocytospermic patients. Fertil Steril. 2005;83:635–42.PubMedCrossRefGoogle Scholar
  78. 78.
    Barbieri E, Hidalgo M, Venegas A, Smith R, Lissi E. Varicocele-associated decrease in antioxidant defenses. J Androl. 1999;20:713–7.PubMedGoogle Scholar
  79. 79.
    Ozbek E, Turkoz Y, Gokdeniz R, Davarci M, Ozugurlu F. Increased nitric oxide production in the spermatic vein of patients with varicocele. Eur Urol. 2000;37:172–5.PubMedCrossRefGoogle Scholar
  80. 80.
    Weinberg JB, Doty E, Bonaventura J, Haney AF. Nitric oxide inhibition of human sperm motility. Fertil Steril. 1995;64:408–13.PubMedGoogle Scholar
  81. 81.
    Saleh R, Agarwal A, Nada E, et al. Negative effects of increased sperm DNA damage in relation to seminal oxidative stress in men with idiopathic and male factor infertility. Fertil Steril. 2003;79:79–87.Google Scholar
  82. 82.
    Vicari E, La Vignera S, Calogero AE. Antioxidant treatment with carnitines is effective in infertile patients with prostatovesiculoepididymitis and elevated seminal leukocyte concentrations after treatment with non steroidal anti-inflammatory compounds. Fertil Steril. 2002;78:1203–8.PubMedCrossRefGoogle Scholar
  83. 83.
    Pasqualotto F, Sharma R, Kobayashi H, Nelson D, Thomas Jr A, Agarwal A. Oxidative stress in normospermic men undergoing infertility evaluation. J Androl. 2001;73:459–64.Google Scholar
  84. 84.
    Alkan I, Simsek F, Haklar G, et al. Reactive oxygen species production by the spermatozoa of patients with idiopathic infertility: relationship to seminal plasma antioxidants. J Urol. 1997;157:140–3.PubMedCrossRefGoogle Scholar
  85. 85.
    Host E, Lindenberg S, Smidt-Jensen S. DNA strand breaks in human spermatozoa: correlation with fertilization in vitro in oligozoospermic men and in men with unexplained infertility. Acta Obstet Gynecol Scand. 2000;79:189–93.PubMedCrossRefGoogle Scholar
  86. 86.
    Sun JG, Jurisicova A, Casper RF. Detection of deoxyribonucleic acid fragmentation in human sperm: correlation with fertilization in vitro. Biol Reprod. 1997;56:602–7.PubMedCrossRefGoogle Scholar
  87. 87.
    Shoukir Y, Chardonnens D, Campana A, Sakkas D. Blastocyst development from supernumerary embryos after intracytoplasmic sperm injection: a paternal influence? Hum Reprod. 1998;13:1632–7.PubMedCrossRefGoogle Scholar
  88. 88.
    Saleh R, Agarwal A, Kandirali E, et al. Leukocytospermia is associated with increased reactive oxygen species production by human sperm. Fertil Steril. 2002;78:1215–24.PubMedCrossRefGoogle Scholar
  89. 89.
    Agarwal A, Nallella K, Allamaneni S, Said T. Role of antioxidants in treatment of male infertility: an overview of the literature. Reprod Biomed Online. 2004;8:616–27.PubMedCrossRefGoogle Scholar
  90. 90.
    Agarwal A, Allamaneni SS, Said TM. Chemiluminescence technique for measuring reactive oxygen species. Reprod Biomed Online. 2004;9:466–8.PubMedCrossRefGoogle Scholar
  91. 91.
    Comhaire FH, Vermeulen L, Pieters O. Study of the accuracy of physical and biochemical markers in semen to detect infectious dysfunction of the accessory sex glands. J Androl. 1989;10:50–3.PubMedGoogle Scholar
  92. 92.
    Kjellberg S, Bjorndahl L, Kvist U. Sperm chromatin stability and zinc binding properties in semen from men in barren unions. Int J Androl. 1992;15:103–13.PubMedCrossRefGoogle Scholar
  93. 93.
    Said TM, Tellez S, Evenson DP, Del Valle AP. Assessment of sperm quality, DNA integrity and cryopreservation protocols in men diagnosed with testicular and systemic malignancies. Andrologia. 2009;41:377–82.PubMedCrossRefGoogle Scholar
  94. 94.
    Kobayashi H, Larson K, Sharma R, et al. DNA damage in cancer patients before treatment as measured by the sperm chromatin structure assay. Fertil Steril. 2001;75:469–75.PubMedCrossRefGoogle Scholar
  95. 95.
    Aitken RJ, De Iuliis GN. Origins and consequences of DNA damage in male germ cells. Reprod Biomed Online. 2007;14:727–33.PubMedCrossRefGoogle Scholar
  96. 96.
    Ward WS, Coffey DS. DNA packaging and organization in mammalian spermatozoa: comparison with somatic cells. Biol Reprod. 1991;44:569–74.PubMedCrossRefGoogle Scholar
  97. 97.
    Agarwal A, Makker K, Sharma R. Clinical relevance of oxidative stress in male factor infertility: an update. Am J Reprod Immunol. 2008;59(1):2–11.PubMedCrossRefGoogle Scholar
  98. 98.
    Agarwal A, Said TM, Bedaiwy MA, Banerjee J, Alvarez JG. Oxidative stress in an assisted reproductive techniques setting. Fertil Steril. 2006;86:503–12.PubMedCrossRefGoogle Scholar
  99. 99.
    Bedaiwy MA, Falcone T, Mohamed MS, et al. Differential growth of human embryos in vitro: role of reactive oxygen species. Fertil Steril. 2004;82:593–600.PubMedCrossRefGoogle Scholar
  100. 100.
    Sharma R, Said T, Agarwal A. Sperm DNA damage and its clinical relevance in assessing reproductive outcome. Asian J Androl. 2004;6:139–48.PubMedGoogle Scholar
  101. 101.
    World Health Organization. WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction. 4th ed. Cambridge: Cambridge University Press; 2010.Google Scholar
  102. 102.
    Close CE, Roberts PL, Berger RE. Cigarettes, alcohol and marijuana are related to pyospermia in infertile men. J Urol. 1990;144:900–3.PubMedGoogle Scholar
  103. 103.
    Saleh R, Agarwal A, Sharma R, Nelson D, Thomas AJ. Effect of cigarette smoking on levels of seminal oxidative stress in infertile men: a prospective study. Fertil Steril. 2002;78:491–9.PubMedCrossRefGoogle Scholar
  104. 104.
    Sharma R, Pasqualotto A, Nelson D, Thomas Jr A, Agarwal A. Relationship between seminal white blood cell counts and oxidative stress in men treated at an infertility clinic. J Androl. 2001;22:575–83.PubMedGoogle Scholar
  105. 105.
    Maruyama Jr DK, Hale RW, Rogers BJ. Effects of white blood cells on the in vitro penetration of zona-free hamster eggs by human spermatozoa. J Androl. 1985;6:127–35.PubMedGoogle Scholar
  106. 106.
    Kodama H, Yamaguchi R, Fukuda J, Kasai H, Tanaka T. Increased oxidative deoxyribonucleic acid damage in the spermatozoa of infertile male patients. Fertil Steril. 1997;68:519–24.PubMedCrossRefGoogle Scholar
  107. 107.
    Lackner JE, Agarwal A, Mahfouz R, du Plessis SS, Schatzl G. The association between leukocytes and sperm quality is concentration dependent. Reprod Biol Endocrinol. 2010;8:12.PubMedCrossRefGoogle Scholar
  108. 108.
    Weng S, Taylor S, Morshedi M, et al. Caspase activity and apoptotic markers in ejaculated human sperm. Mol Hum Reprod. 2002;8:984–91.PubMedCrossRefGoogle Scholar
  109. 109.
    Tesarik J, Greco E, Cohen-Bacrie P, Mendoza C. Germ cell apoptosis in men with complete and incomplete spermiogenesis failure. Mol Hum Reprod. 1998;4:757–62.PubMedCrossRefGoogle Scholar
  110. 110.
    Pasqualotto F, Sharma R, Nelson D, Thomas Jr A, Agarwal A. Relationship between oxidative stress, semen characteristics, and clinical diagnosis in men undergoing fertility investigation. Fertil Steril. 2000;73:459–64.PubMedCrossRefGoogle Scholar
  111. 111.
    Aitken R. The Amoroso Lecture. The human spermatozoon—a cell in crisis? J Reprod Fertil. 1999;115:1–7.PubMedCrossRefGoogle Scholar
  112. 112.
    Aziz N, Saleh R, Sharma R, et al. Novel association between sperm reactive oxygen species production, sperm morphological defects, and the sperm deformity index. Fertil Steril. 2004;81:349–54.PubMedCrossRefGoogle Scholar
  113. 113.
    Collins JA, Barnhart KT, Schlegel PN. Do sperm DNA integrity tests predict pregnancy with in vitro fertilization? Fertil Steril. 2008;89:823–31.PubMedCrossRefGoogle Scholar
  114. 114.
    Desai NR, Mahfouz R, Sharma R, Gupta S, Agarwal A. Reactive oxygen species levels are independent of sperm concentration, motility, and abstinence in a normal, healthy, proven fertile man: a longitudinal study. Fertil Steril. 2010;94(4):1541–3.PubMedCrossRefGoogle Scholar
  115. 115.
    Athayde KS, Cocuzza M, Agarwal A, et al. Development of normal reference values for seminal reactive oxygen species and their correlation with leukocytes and semen parameters in a fertile population. J Androl. 2007;28:613–20.PubMedCrossRefGoogle Scholar
  116. 116.
    Mahfouz R, Sharma R, Lackner J, Aziz N, Agarwal A. Evaluation of chemiluminescence and flow cytometry as tools in assessing production of hydrogen peroxide and superoxide anion in human spermatozoa. Fertil Steril. 2009;92:819–27.PubMedCrossRefGoogle Scholar
  117. 117.
    Said T, Kattal N, Sharma R, et al. Enhanced chemiluminescence assay vs colorimetric assay for measurement of the total antioxidant capacity of human seminal plasma. J Androl. 2003;24:676–80.PubMedGoogle Scholar
  118. 118.
    Schlegel PN, Paduch DA. Yet another test of sperm chromatin structure. Fertil Steril. 2005;84:854–9.PubMedCrossRefGoogle Scholar
  119. 119.
    Sharma RK, Sabanegh E, Mahfouz R, Gupta S, Thiyagarajan A, Agarwal A. TUNEL as a test for sperm DNA damage in the evaluation of male infertility. Urology. 2010;76:1380–6.PubMedCrossRefGoogle Scholar
  120. 120.
    Henkel R, Hoogendijk CF, Bouic PJ, Kruger TF. TUNEL assay and SCSA determine different aspects of sperm DNA damage. Andrologia. 2010;42:305–13.PubMedCrossRefGoogle Scholar
  121. 121.
    Sakkas D, Alvarez G. Sperm DNA fragmentation: mechanisms of origin, impact on reproductive outcome, and analysis. Fertil Steril. 2010;93:1027–37.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Tamer M. Said
    • 1
  • Constanze Fischer-Hammadeh
    • 2
  • Mohammed Hamad
    • 3
  • Khaled Refaat
    • 4
  • Mohamad Eid Hammadeh
    • 2
  1. 1.Andrology Laboratory and Reproductive Tissue BankThe Toronto Institute for Reproductive MedicineTorontoCanada
  2. 2.Department of Obstetrics and GynecologyUniversity of SaarlandHomburgGermany
  3. 3.Department of Pharmacology and BiosciencePetra UniversityAmmanJordan
  4. 4.Department of Obstetrics and GynecologyAl Azhar UniversityAssuitEgypt

Personalised recommendations