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Infertility

Infertility, particularly male infertility is a major matter of concern, as it is a clinical challenge of increasing significance. Worldwide, an estimate of 50-80×106 couples are infertile, which equals 7-15% of all couples at reproductive age (15-45years of age). These numbers include both primary (couples have never conceived before) and secondary infertility (couples have difficulties to conceive before). However, due to high rates of infection-induces infertility in certain regions in the so called “invertility belt” of sub-Saharan Africa, the prevalence of secondary infertility is amounting to up to 30%.

Among all involuntary childless couples, male infertility accounts for approximately 30-50% of the cases. This means that more than 7% of men are affected by infertility during their reproductive lifetime. Thus, the prevalence of male infertility is even higher than that for diabetes mellitus Type I and II, which, with an overall estimate of 2.8% in the year 2000 and 4.4% in 2030 is considered as a common disease.

(Reference: Agarwal et al.; Ralf Henkel: ROS and Semen Quality, page 301, Humana Press, 2012)

The Cause

Evidence now suggests that reactive oxygen species (ROS) mediated damage to sperm (“oxidative stress”) is a significant contributing pathology in 30-80% of cases of male infertility. ROS produce infertility by two principal mechanisms. First, ROS damage the sperm membrane, which in turn reduces the sperm´s motility and ability to fuse with the oocyte (impaired fertilization). Second, ROS directly damage the sperm DNA, compromising the paternal genomic contribution to the embryo. While IVF-ICSI undoubtedly overcomes any oxidative impairment of fertilization, it has no therapeutic effect on the quality of the paternal genome. Therefore, the injection of sperm with oxidatively damaged DNA may result in impaired blastocyst development, an increase risk of miscarriage and the birth of a child with a sub-optimal paternal genetic compliment, potentially leading to disease in later life.