Sperm Disorders and Aetiologies of Male Infertility in Pakistan: Meta-Analyses and Review

A few studies reported spermatogenic abnormalities and factors of infertility in Pakistani men with variable results. Therefore, performing meta-analysis was required to generalize the results. The present study is a composite of metaanalyses and review of various aspects of male infertility. Fixed and random effect models were used to analyze the data. We searched international and national electronic databases up to October 2013 including PubMed, Google Scholar and PakMediNet; screened reference lists. We assessed 13 crosssectional studies addressing the prevalence of spermatogenic disorders and factors of infertility among men. The prevalence of primary and secondary infertility in infertile men was 78.19% and 21.81%, respectively. Rates of overall sperm count abnormalities were 34.97% (95% CI=24.98, 44.96) among infertile men. Oligospermia was the greatest problem 22.92% (95% CI=16.01, 29.83) followed by asthenospermia 18.78% (95%CI=6.52, 31.04) and azoospermia 18.33% (95% CI=14.78, 21.88). Morphological sperm abnormalities were prevalent in 13.61% (95% CI=1.68, 25.54) in infertile men. The major factor of male infertility was a stringent physical activity (35.9%) followed by iatrogenic cause (26.65%). Smoking is another significant factor 25.90% (95% CI=19.23, 32.56) followed by various infections 23.85% (95% CI=17.93, 29.78). Congenital testicular disorders were prevalent in 17.41%, while 12.69% (95% CI=6.11, 19.26) of the men had inguinal/abdominal surgery or trauma in the past. Varicocele was a cause of infertility in 9.74% (95% CI=4.33, 15.14) of infertile men and drug addiction was prevalent in 88.36% (95% CI=2.62, 14.09). Data showed 1.93% men with sperm abnormalities had one or more azoospermia factor regions deleted on Y-chromosome. A total of 72% respondents reported previous infections of the urinary tract, 24% reported smoking, 65% reported psychological stress, 58% reported obesity and 13% reported stringent exercise could be the factors of infertility. Sperm count, physical activity, iatrogenic effects and smoking are the major factors of male infertility in Pakistan.