Comparison of Ischemia-Modified Albumin Levels in Infertile Men with Mild, Moderate, and Severe Oligozoospermia

Comparison of Ischemia-Modified Albumin Levels in Infertile Men with Mild, Moderate, and Severe Oligozoospermia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of Ischemia-Modified Albumin Levels in Infertile Men with Mild, Moderate, and Severe Oligozoospermia Miraç Ataman, Ercan Yuvanç, Erdal Yılmaz, Mehmet Emin Ataman, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7339502/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: The objective of this study is to determine whether IMA (Ischemic Modified Albumin), a new oxidative stress marker, can be used to predict the degree of oligozoospermia in infertile men. Materials and Methods: Oligozoospermic male patients (n=113) who remained infertile despite regular, unprotected sexual intercourse for more than 12 months were included in the study. Those with sperm counts of 10–16 × 10⁶/ml were classified as having mild oligozoospermia (group 1, n=32), those with counts of 5–9. 9 × 10⁶/ml were classified as moderate oligozoospermia (group 2, n=42), and those with 16 × 10⁶/ml) fertile men with at least one child (group 4, n=47) were included as the control group. Results: When IMA levels were compared between the infertile group and the control group, they were found to be statistically significantly higher in the infertile group (p=0.002). When the oligozoospermia groups were compared with the control group, the difference between the groups was found to be statistically significant (p=0.017). The IMA level of the severe oligozoospermia group was found to be significantly higher than the IMA levels of the control, moderate, and mild oligozoospermia groups (p0.05). The IMA levels of the general study group were found to show a statistically significant difference according to sperm motility (p=0.001). In addition, the IMA levels of patients with varicocele were found to be significantly higher (p=0.035). IMA showed a positive correlation with estradiol (p = 0.004) and triiodothyronine (p = 0.022) levels. Conclusion: This study suggests that IMA may be used as a potential biomarker for predicting severe oligozoospermia in infertile men. infertility oligozoospermia ischemia-modified albumin Figures Figure 1 INTRODUCTION Infertility is a condition that negatively affects individuals psychosocially and medically, affecting approximately 15% of couples worldwide. This condition is defined as the failure to conceive despite at least one year of regular, unprotected, and appropriately timed sexual intercourse. Male infertility plays a role in approximately 20-70% of infertility cases and therefore constitutes a significant problem [1, 2]. The etiology of male infertility is multifactorial, with oxidative stress being one of the main causes. Reactive oxygen species (ROS) are inevitable byproducts of oxygen metabolism. Although known as toxic metabolites, these species perform important biological functions by regulating cellular signaling pathways. Intracellular ROS concentrations depend on the balance between ROS production rate and the cell's various antioxidant defense mechanisms. At normal physiological levels, ROS contribute to the regulation of fundamental processes such as sperm maturation, hyperactivation, capacitation, acrosome reaction, and fertilization . However, when ROS levels exceed physiological limits, oxidative stress (OS) occurs, causing damaging effects on cellular components. Carbohydrates, nucleic acids, proteins, and lipids are negatively affected by this process. Spermatozoa, in particular, are highly sensitive to OS due to their inadequate antioxidant defenses and high content of polyunsaturated fatty acids. Lipid peroxidation disrupts the permeability of plasma membranes, leading to ATP loss and impaired flagellar movement. All these effects can lead to infertility problems in men [3, 4]. The increase in ROS synthesis and the development of acidosis associated with OS and chronic hypoxia (ischemia) cause a series of biochemical alterations and modifications in the N-terminal sequence of serum albumin (Asp1-Ala2-His3-Lys4). Conformation changes in the albumin molecule particularly reduce its cobalt-binding capacity. Under the influence of OS, histidine residues in the N-terminal region are modified, thereby inhibiting metal binding. As a result, albumin's ability to bind to transition metals such as cobalt, copper, and nickel decreases, and these changes are defined as IMA [5, 6]. A review of the current literature shows that IMA has been proposed as an early biomarker with low specificity in diseases associated with oxidative stress and ischemic processes, such as cardiovascular and cerebrovascular events and diabetes mellitus [5, 6]. It is known that there are a limited number of studies investigating IMA levels in infertile men [7–9]. In this study, the efficacy of IMA, a new oxidative stress marker, in predicting the degree of oligozoospermia in infertile men was investigated. MATERIALS AND METHODS 1. STUDY PARTICIPANTS Between April 2024 and December 2024, 160 men aged 18–45 who visited the urology clinic were included in the study. Men with oligozoospermia who had been infertile for more than 12 months despite regular, unprotected sexual intercourse (n=113) were included in the study. Those with a sperm count of 10–16 × 10⁶/ml were classified as having mild oligozoospermia (group 1, n=32), those with 5–9. 9 × 10⁶/ml were classified as moderate oligozoospermia (group 2, n=42), and those with 16 × 10⁶/ml) fertile men with at least one child (group 4, n = 47) were included in the study as a control group. After obtaining approval from the local ethics committee (reference number: 2024.04.15), the study was initiated. All participants voluntarily agreed to participate in the study by signing informed consent forms. Ethical principles were adhered to in accordance with the World Medical Association's Declaration of Helsinki, which outlines guidelines for medical research involving human subjects. Study participants underwent a detailed routine medical history, physical examination, semen analysis (in accordance with WHO 2021 criteria), hormonal evaluation, scrotal color Doppler ultrasound, and genetic analysis when necessary[10]. Blood samples routinely collected from participants during their outpatient visits were centrifuged. The resulting serum samples were stored at -80°C in a deep freezer until the IMA levels were analyzed after the relevant parameters were studied. Participants with infectious or malignant findings, diabetes or immune system disorders, genetic abnormalities, or hormonal imbalances were not included in the study. 2. Semen Analysis Semen analysis was performed after at least 48-72 hours of sexual abstinence, in a special room, through masturbation, with two samples taken at least 15 days apart in sterile sample containers. The samples were kept in a 37°C incubator for at least 20 minutes. The semen samples were then examined under a microscope by an experienced urologist in accordance with WHO 2021 criteria. Microscopic evaluation was performed using the Makler count. Ten different squares were counted four times, and the average count was calculated as millions/ml of spermatozoa. Sperm motility was evaluated under a phase contrast microscope at 200x magnification and grouped into progressive motility, non-progressive motility, and immotility. For sperm morphology assessment, semen smears were air-dried. They were then stained using the Diff-Quick sperm staining kit. Immersion oil was dropped onto the slide and examined under 10x100 magnification. 3. Biochemical Assessment Blood samples were collected from all participants before 10 a.m., after at least 12 hours of fasting. Serum TSH, T3, T4, prolactin, FSH, LH, E2, and total testosterone levels were assessed on the day of sampling. Additionally, blood samples collected from participants during their outpatient clinic visit were centrifuged at 1,500 g for 10 minutes to assess IMA levels. The resulting serum samples were stored at -80°C until IMA levels were analyzed. IMA Measurement The ACB test was performed for IMA measurement. In this process, 0.1% cobalt (II) chloride was added to the patient's serum and incubated for 10 minutes for cobalt binding to albumin. Then, DTT was added to the mixture and incubated for another 2 minutes, and a 0.9% sodium chloride solution was added to reduce the binding capacity. Instead of DTT, a blank solution was prepared using distilled water. The absorption of the samples was measured at 470 nm using a spectrophotometer, and the results were expressed in absorption units (AU). 4. Statistical Analysis The SPSS v26.0 program was used to analyze the data. Descriptive statistics were presented as frequency, percentage frequency, and, where necessary, mean, standard deviation, median, minimum, and maximum. A significance level of 0.05 was selected for the analyses. According to the Shapiro-Wilk test, the data were found not to follow a normal distribution (p<0.05). Therefore, the Mann-Whitney U test was used for comparisons between two groups, and the Kruskal-Wallis test was used for comparisons between multiple groups. In the correlation tests, the significance of the correlation coefficient was tested. RESULTS The sociodemographic characteristics and findings of the study participants are summarized in Table 1. Table 1: Some sociodemographic characteristics and findings of study participants OLIGOZOOSPERMIA LEVEL CONTROL GROUP 4 Normo-spermia mean ± sd GROUP 1 Mild O.Spermia, mean ± sd GROUP 2 Moderate O.Spermia mean ± sd GROUP 3 Severe O. Spermia mean ± sd N 32 42 39 47 Age 31.03 ± 5.53 32.64 ± 8 30.85 ± 7.36 28.89 ± 5.33 BMI 26.84 ± 3.88 27.55 ± 4.68 26.5 ± 4.72 26.4 ± 3.62 BMI Level, Number Underweight (<18.5) 0 0 1 1 Normal (18.5 - 24.9) 12 12 14 14 Overweight (25-29.9) 15 20 13 25 Obese (≥ 30) 5 9 10 7 Mean Sperm Concentration (million/ml), Number 11.68 6.64 1.72 24.12 Motile Sperm Average (%) 45.3 35.6 21.6 50.8 Infertility, Number Primary 25 36 35 0 Secondary 7 6 4 0 Varicocele, Number Yes 24 34 27 19 No 8 8 12 28 According to the Shapiro-Wilk test, it was determined that the observations did not show a normal distribution (p<0.05). Table 2: Comparison of IMA levels between patient and control groups IMA Mann-Whitney U Mean ± SD Min. Max. Z p Control 0,63 ± 0,19 0,08 0,86 -3,036 0,002 Infertile 0,74 ± 0,17 0,22 1,13 The results of the Mann–Whitney U test conducted between the control group and the infertile patient group showed that IMA levels in infertile individuals were statistically significantly higher than in the control group (p = 0.002)(Table 2). Table 3: Comparison of IMA levels between oligozoospermia groups and the control group IMA Kruskal-Wallis Mean ± SD Min. Max. H p Control 0,63 ± 0,19 1 0,08 0,86 10,214 0,017 Severe o.spermia 0,76 ± 0,18 2 0,48 1,13 Moderate o.spermia 0,74 ± 0,14 1 0,49 1,00 Mild o.spermia 0,70 ± 0,19 1 0,22 0,93 The Kruskal–Wallis test performed between the oligozoospermia subgroups and the control group also indicated the presence of intergroup differences and was found to be statistically significant (p=0.017)(Table 3). According to the post-hoc test results (groups showing statistical differences in subindices are indicated), the IMA level of the severe oligozoospermia group was found to be significantly higher than that of the mild, moderate oligozoospermia, and control groups (p0.05)(Figure 1). Table 4: Comparison of IMA levels on sperm motility IMA Mann-Whitney U Motility = %40 Z p N 65 95 -3,222 0,001 Mean ± SD 0,77±0,15 0,67±0,19 Table 4 shows that IMA levels show a significant difference according to sperm motility (p = 0.001). Table 5: Comparison between varicocele and IMA IMA Mann-Whitney U No Varicocele Varicocele Z p N 56 104 -2,107 0,035 Mean ± SD 0,66±0,2 0,73±0,16 Table 5 shows that IMA levels are significantly higher in patients with varicocele (p = 0.035). Table 6: Correlations between parameters in the general participants of the study - Pearson correlation test LH Prolactin Estradiol Total Testosterone TSH T3 T4 Sperm Concentration IMA FSH r 0.573** 0,086 0,098 -0,014 -0,122 0,075 0,087 -0.275** 0,124 p 0,000 0,354 0,293 0,882 0,188 0,458 0,357 0,002 0,174 LH r 1 0.198* 0.260** 0.312** -0,074 0.261** 0,082 -0.259** 0,134 p 0,032 0,004 0,001 0,431 0,009 0,387 0,004 0,144 Prolactin r 1 0.188* 0,172 -0,027 0,034 0,090 -0,022 0,012 p 0,042 0,062 0,774 0,737 0,341 0,811 0,898 Estradiol r 1 0.456** 0,050 0.260** -0,058 -0,040 0.262** p 0,000 0,595 0,009 0,541 0,666 0,004 Total Testosterone r 1 0,046 0.264** 0,106 0,030 0,058 p 0,623 0,008 0,257 0,741 0,522 TSH r 1 -0.386** -0,006 0,043 -0,065 p 0,000 0,947 0,634 0,466 T3 r 1 0.283** 0,091 0.219* p 0,003 0,346 0,022 T4 r 1 0,045 0,024 p 0,623 0,787 Sperm Concentration r 1 -0,145 p 0,083 **Correlation is significant at the 0.01 level (2-tailed). *Correlation is significant at the 0.05 level (2-tailed). Among the general participants of the study, there were no significant correlations between FSH (r: 0.124, p>0.05), LH (r: 0.134, p>0.05), prolactin (r: 0.012, p>0.05), TSH (r: -0.065, p>0.05), T4 (thyroxine) (r: 0.024, p>0.05), and total testosterone (r: 0.058, p>0.05) were not significant. However, a positive and significant correlation was found between IMA and E2 (estradiol) (r: 0.262, p: 0.004) and between IMA and T3 (triiodothyronine) (r: 0.219, p: 0.022) among the general participants of the study. Accordingly, as the IMA value increases, a significant increase in E2 and T3 values is expected( Table 6). When comparing fertile and infertile groups, no significant difference was observed in terms of BMI (p>0.05). Additionally, the differences in BMI levels and IMA observations between the general participants of the study and the infertile group were statistically insignificant (p>0.05). DISCUSSION Semen samples from infertile men have higher ROS levels compared to the fertile control group. These findings support the disruptive effect of OS on sperm function and its role in the infertility process [3, 8, 11, 12]. Increased ROS during ischemia causes certain modifications to albumin, negatively affecting its normal antioxidant properties and metal ion binding capacity and leading to the formation of IMA. Thus, IMA becomes a biochemical marker of ischemia and oxidative stress [5, 6, 13]. A systematic review of IMA found that it can be used as a biomarker in many cardiovascular diseases, cerebrovascular events, neurodegenerative diseases, psychiatric disorders, traumatic brain injuries, neonatal hypoxic-ischemic encephalopathy, diabetes mellitus and its complications, thyroid disorders, acute and chronic kidney damage, various types of cancer, gynecological disorders, pregnancy, preeclampsia, and abortion [5]. According to these studies, IMA has been found to be a low-specificity biomarker for various diseases associated with ischemia and oxidative stress. Nevertheless, it has been predicted that the evaluation of IMA levels could provide important information about the duration of the disease and possible complications and could be used in the differential diagnosis of some pathological conditions [5, 6]. The greatest advantage of IMA as a biomarker compared to other markers is its ability to detect ischemic conditions at earlier stages [5, 6, 13]. Although many studies have been conducted to identify OS biomarkers associated with male infertility, there are only a limited number of studies investigating the relationship between IMA and infertility[7–9]. In their study investigating the relationship between sperm motility and IMA levels in infertile men, Inal et al. found a negative correlation between total progressive motile sperm count and serum IMA levels [7]. In our study, when we compared IMA levels between the infertile group and the control group, we found that they were statistically significantly higher. When comparing the oligozoospermia groups with the control group, we found that the difference between the groups was statistically significant. The IMA level of the severe oligozoospermia group was found to be significantly higher than the IMA levels of the control, moderate, and mild oligozoospermia groups, while the moderate and mild oligozoospermia groups did not show a statistically significant difference from the control group. Additionally, IMA levels were found to show a statistically significant difference according to sperm motility. These results support the effect of IMA on sperm concentration and function while also emphasizing the role of oxidative stress in the mechanism of infertility. Oxidative stress is one of the most common factors causing infertility in men with varicocele. Changes in testicular venous drainage can exacerbate the effects of oxidative stress by causing hypoxic-induced ischemic damage in both testes. To assess this condition, the degree of oxidative damage can be estimated by measuring reactive nitrogen species (RNS) and other oxidative stress biomarkers [11, 12, 14]. Çoban et al., in their study investigating oxidative stress in the spermatic veins of infertile patients with varicocele, found that IMA was statistically significantly higher than the peripheral vein [8]. In a study conducted by Aliyazıcıoğlu et al. on varicocele patients, they found that IMA levels between the internal spermatic vein and the brachial vein were not statistically significant [9]. In our study, IMA levels of patients with varicocele were statistically significantly higher than those without varicocele. The significant difference observed in IMA levels stands out as an important finding supporting the effect of varicocele on infertility through biochemical mechanisms. Hormonal regulation plays a key role in the etiology of male infertility. Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH) are essential in the regulation of spermatogenesis and testosterone production in the testes. Testosterone is a critical biological component in maintaining male reproductive health; low serum levels can impair sperm production and sexual function, leading to infertility. Prolactin (PRL) can inhibit gonadotropin secretion in hyperprolactinemia, leading to infertility. Thyroid hormones may indirectly affect male reproductive function through their effects on hormonal balance as well as metabolic homeostasis. The interaction and homeostatic balance of these hormones have an important role in the evaluation and treatment of male infertility [2, 7, 15, 16]. Inal et al. found a statistically significant difference between serum FSH, LH, E2, and PRL and IMA levels, whereas no statistically significant difference was observed between serum testosterone levels and IMA [7]. The correlations observed between FSH, LH, PRL, TSH, T4, total testosterone levels, and IMA were not significant in the general participants of our study. This implies that IMA may not be linked to these hormonal parameters or that other factors may be more important. However, there was a significant positive correlation between IMA and E2 and IMA and T3 values in general participants. Accordingly, as the IMA value increases, a significant increase in E2 and T3 values is expected. Optimal levels of E2 are necessary for reproductive functions in men; high levels of E2 may lead to infertility by negatively affecting sperm production and motility [17, 18]. The positive correlation between IMA and E2 in our study suggests that IMA may be associated with the regulation of E2. Öncel et al. evaluated the relationship between IMA levels and thyroid hormone levels and showed that IMA levels were significantly lower in the hypothyroidism group compared to the hyperthyroidism and euthyroidism groups [19]. Ma et al. showed that IMA may be a valuable biomarker for oxidative stress in patients with significant thyroid dysfunction [20]. The positive correlation between IMA and T3 in our study suggests that IMA may affect thyroid functions, or thyroid hormones may affect IMA levels. T3 is biologically active and can directly affect cellular metabolism and oxidative stress mechanisms, so it would be expected to be associated with IMA. T4, on the other hand, acts mainly by converting to T3, so it may be natural that it does not show a direct relationship with IMA [21, 22]. One of the strengths of our study is its pioneering evaluation of the utility of IMA as a biomarker in infertile men. In particular, the relationship between IMA levels and different degrees of severity of oligozoospermia was addressed with a large sample size, and statistically significant findings were presented. In addition, in the subgroup analysis of our study, the relationship of IMA with sperm motility, varicocele, and hormonal parameters was addressed, and significant results were observed. These points may shed light for future studies to evaluate the results of the study more comprehensively. In the treatment of infertility, treatment approaches aimed at reducing oxidative stress are of great importance. Antioxidant therapies may be effective in reducing oxidative stress and thus improving sperm quality [3, 23]. In this context, the use of IMA as a biomarker indicating OS in infertility treatment may offer a new approach in monitoring treatment processes and evaluating their efficacy. Declarations AUTHOR CONTRIBUTIONS Miraç Ataman : Study design, knowledge transfer, critical discussion of data, drafting and revision of the manuscript . Ercan Yuvanç, Erdal Yılmaz, and Mehmet Emin Ataman: Knowledge transfer, critical discussion of data, and manuscript revision . Özcan Erel and Salim Neşelioğlu: Data collection, laboratory analyses, and sample processing. All authors have read and approved the final version of the manuscript. CONFLİCT OF INTEREST AND FUNDİNG STATEMENT The authors declare no conflicts of interest that could influence the objectivity or integrity of the research presented. The authors received no financial support for the research, authorship, or publication of this article. REFERENCES Agarwal A, Mulgund A, Hamada A, Chyatte MR (2015) A unique view on male infertility around the globe. 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Eur J Intern Med 23:e136-140. https://doi.org/10.1016/j.ejim.2012.04.011 Hall, John E (2016) Guyton and Hall Textbook of Medical Physiology. In: Thyroid Metabolic Hormones, 14th ed. Elsevier, Philadelphia, PA Armstrong M, Asuka E, Fingeret A (2025) Physiology, Thyroid Function. In: StatPearls. StatPearls Publishing, Treasure Island (FL) Agarwal A, Panner Selvam MK, Samanta L, et al (2019) Effect of Antioxidant Supplementation on the Sperm Proteome of Idiopathic Infertile Men. Antioxid Basel Switz 8:488. https://doi.org/10.3390/antiox8100488 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7339502","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":499261271,"identity":"6a1115b1-d28d-40e0-81ae-b26f11a98217","order_by":0,"name":"Miraç Ataman","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIiWNgGAWjYDACZgST8WHDARCdQJQWAzDTEK7lAGG7wFrYJInSotvO+/DDj5o/8rrtZ49VzjhzmIGfPceA+eMe3FrMDrMbS/YcMzDcdiYv7eaGG4cZJHveGDAceIZPCxuDNAObAeO2AzlmNx98OMxgcCMHqAWPy4BamH8z/DOw33b+jVkhSIs9EVrYpBnbDBK33cgxYwQ5zECCCC2WvX3GydtuvDGWnHEmnUfizLOCA2fwaTl/jPnGj29yttvO5xh+7DlmLcffnrzxQQUeLRiAB0SQomEUjIJRMApGARYAAPIEWewfz92mAAAAAElFTkSuQmCC","orcid":"","institution":"Kırıkkale University Faculty of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Miraç","middleName":"","lastName":"Ataman","suffix":""},{"id":499261272,"identity":"08cd96fc-bff8-4cb9-926c-8c152ad504f2","order_by":1,"name":"Ercan Yuvanç","email":"","orcid":"","institution":"Kırıkkale University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ercan","middleName":"","lastName":"Yuvanç","suffix":""},{"id":499261273,"identity":"4b7941fd-fde7-486f-a190-f768c152ecfa","order_by":2,"name":"Erdal Yılmaz","email":"","orcid":"","institution":"Kırıkkale University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Erdal","middleName":"","lastName":"Yılmaz","suffix":""},{"id":499261274,"identity":"db559589-ba49-426a-a215-3abc71f87ce0","order_by":3,"name":"Mehmet Emin Ataman","email":"","orcid":"","institution":"Kırıkkale University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Mehmet","middleName":"Emin","lastName":"Ataman","suffix":""},{"id":499261275,"identity":"28756571-3a5e-46e1-8e03-4bf8faff1b3e","order_by":4,"name":"Özcan Erel","email":"","orcid":"","institution":"Yıldırım Beyazıt University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Özcan","middleName":"","lastName":"Erel","suffix":""},{"id":499261276,"identity":"fea56494-0ab4-4b9c-b930-308eb72bfb35","order_by":5,"name":"Salim Neşelioğlu","email":"","orcid":"","institution":"Yıldırım Beyazıt University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Salim","middleName":"","lastName":"Neşelioğlu","suffix":""}],"badges":[],"createdAt":"2025-08-10 14:53:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7339502/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7339502/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89386867,"identity":"ef88fa83-f90f-4a91-bfe9-a33d192b044a","added_by":"auto","created_at":"2025-08-19 12:37:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":37826,"visible":true,"origin":"","legend":"\u003cp\u003eGraph comparing IMA levels between patient and control groups\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7339502/v1/2ccfcc2b8ab0d30fa39d4f51.png"},{"id":89388904,"identity":"57f8bf3f-dd6f-414a-9c7b-16b73fe4c2f7","added_by":"auto","created_at":"2025-08-19 12:45:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":767633,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7339502/v1/376f424b-39cd-487f-8623-dc6878dfe17e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of Ischemia-Modified Albumin Levels in Infertile Men with Mild, Moderate, and Severe Oligozoospermia","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eInfertility is a condition that negatively affects individuals psychosocially and medically, affecting approximately 15% of couples worldwide. This condition is defined as the failure to conceive despite at least one year of regular, unprotected, and appropriately timed sexual intercourse. Male infertility plays a role in approximately 20-70% of infertility cases and therefore constitutes a significant problem [1, 2]. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe etiology of male infertility is multifactorial, with oxidative stress being one of the main causes. Reactive oxygen species (ROS) are inevitable byproducts of oxygen metabolism. Although known as toxic metabolites, these species perform important biological functions by regulating cellular signaling pathways. Intracellular ROS concentrations depend on the balance between ROS production rate and the cell's various antioxidant defense mechanisms. At normal physiological levels, ROS contribute to the regulation of fundamental processes such as sperm maturation, hyperactivation, capacitation, acrosome reaction, and fertilization .\u003c/p\u003e\n\u003cp\u003eHowever, when ROS levels exceed physiological limits, oxidative stress (OS) occurs, causing damaging effects on cellular components. Carbohydrates, nucleic acids, proteins, and lipids are negatively affected by this process. Spermatozoa, in particular, are highly sensitive to OS due to their inadequate antioxidant defenses and high content of polyunsaturated fatty acids. Lipid peroxidation disrupts the permeability of plasma membranes, leading to ATP loss and impaired flagellar movement. All these effects can lead to infertility problems in men [3, 4].\u003c/p\u003e\n\u003cp\u003eThe increase in ROS synthesis and the development of acidosis associated with OS and chronic hypoxia (ischemia) cause a series of biochemical alterations and modifications in the N-terminal sequence of serum albumin (Asp1-Ala2-His3-Lys4). Conformation changes in the albumin molecule particularly reduce its cobalt-binding capacity. Under the influence of OS, histidine residues in the N-terminal region are modified, thereby inhibiting metal binding. As a result, albumin's ability to bind to transition metals such as cobalt, copper, and nickel decreases, and these changes are defined as IMA\u0026nbsp;[5, 6].\u003c/p\u003e\n\u003cp\u003eA review of the current literature shows that IMA has been proposed as an early biomarker with low specificity in diseases associated with oxidative stress and ischemic processes, such as cardiovascular and cerebrovascular events and diabetes mellitus [5, 6]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIt is known that there are a limited number of studies investigating IMA levels in infertile men\u0026nbsp;[7–9]. In this study, the efficacy of IMA, a new oxidative stress marker, in predicting the degree of oligozoospermia in infertile men was investigated.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003e1. STUDY PARTICIPANTS\u003c/p\u003e\n\u003cp\u003eBetween April 2024 and December 2024, 160 men aged 18–45 who visited the urology clinic were included in the study. Men with oligozoospermia who had been infertile for more than 12 months despite regular, unprotected sexual intercourse (n=113) were included in the study. Those with a sperm count of 10–16 × 10⁶/ml were classified as having mild oligozoospermia (group 1, n=32), those with 5–9. 9 × 10⁶/ml were classified as moderate oligozoospermia (group 2, n=42), and those with \u0026lt;5 × 10⁶/ml were classified as severe oligozoospermia (group 3, n=39). Additionally, normospermic (\u0026gt;16 × 10⁶/ml) fertile men with at least one child (group 4, n = 47) were included in the study as a control group.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAfter obtaining approval from the local ethics committee (reference number: 2024.04.15), the study was initiated. All participants voluntarily agreed to participate in the study by signing informed consent forms. Ethical principles were adhered to in accordance with the World Medical Association's Declaration of Helsinki, which outlines guidelines for medical research involving human subjects.\u003c/p\u003e\n\u003cp\u003eStudy participants underwent a detailed routine medical history, physical examination, semen analysis (in accordance with WHO 2021 criteria), hormonal evaluation, scrotal color Doppler ultrasound, and genetic analysis when necessary[10].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBlood samples routinely collected from participants during their outpatient visits were centrifuged. The resulting serum samples were stored at -80°C in a deep freezer until the IMA levels were analyzed after the relevant parameters were studied.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipants with infectious or malignant findings, diabetes or immune system disorders, genetic abnormalities, or hormonal imbalances were not included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Semen Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSemen analysis was performed after at least 48-72 hours of sexual abstinence, in a special room, through masturbation, with two samples taken at least 15 days apart in sterile sample containers. The samples were kept in a 37°C incubator for at least 20 minutes. The semen samples were then examined under a microscope by an experienced urologist in accordance with WHO 2021 criteria. Microscopic evaluation was performed using the Makler count. Ten different squares were counted four times, and the average count was calculated as millions/ml of spermatozoa. Sperm motility was evaluated under a phase contrast microscope at 200x magnification and grouped into progressive motility, non-progressive motility, and immotility. For sperm morphology assessment, semen smears were air-dried. They were then stained using the Diff-Quick sperm staining kit. Immersion oil was dropped onto the slide and examined under 10x100 magnification.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Biochemical Assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBlood samples were collected from all participants before 10 a.m., after at least 12 hours of fasting. Serum TSH, T3, T4, prolactin, FSH, LH, E2, and total testosterone levels were assessed on the day of sampling. Additionally, blood samples collected from participants during their outpatient clinic visit were centrifuged at 1,500 g for 10 minutes to assess IMA levels. The resulting serum samples were stored at -80°C until IMA levels were analyzed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIMA Measurement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ACB test was performed for IMA measurement. In this process, 0.1% cobalt (II) chloride was added to the patient's serum and incubated for 10 minutes for cobalt binding to albumin. Then, DTT was added to the mixture and incubated for another 2 minutes, and a 0.9% sodium chloride solution was added to reduce the binding capacity. Instead of DTT, a blank solution was prepared using distilled water. The absorption of the samples was measured at 470 nm using a spectrophotometer, and the results were expressed in absorption units (AU).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4. Statistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe SPSS v26.0 program was used to analyze the data. Descriptive statistics were presented as frequency, percentage frequency, and, where necessary, mean, standard deviation, median, minimum, and maximum. A significance level of 0.05 was selected for the analyses. According to the Shapiro-Wilk test, the data were found not to follow a normal distribution (p\u0026lt;0.05). Therefore, the Mann-Whitney U test was used for comparisons between two groups, and the Kruskal-Wallis test was used for comparisons between multiple groups. In the correlation tests, the significance of the correlation coefficient was tested.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe sociodemographic characteristics and findings of the study participants are summarized in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1:\u0026nbsp;\u003c/strong\u003eSome sociodemographic characteristics and findings of study participants\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOLIGOZOOSPERMIA LEVEL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCONTROL\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eGROUP 4\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNormo-spermia mean \u0026plusmn; sd\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGROUP 1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMild O.Spermia, mean \u0026plusmn; sd\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGROUP 2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eModerate O.Spermia mean \u0026plusmn; sd\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGROUP 3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSevere \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; O. Spermia mean \u0026plusmn; sd\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e31.03 \u0026plusmn; 5.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e32.64 \u0026plusmn; 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e30.85 \u0026plusmn; 7.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e28.89 \u0026plusmn; 5.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e26.84 \u0026plusmn; 3.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e27.55 \u0026plusmn; 4.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e26.5 \u0026plusmn; 4.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e26.4 \u0026plusmn; 3.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 587px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; BMI Level, Number\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eUnderweight (\u0026lt;18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eNormal (18.5 - 24.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eOverweight (25-29.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eObese (\u0026ge; 30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean Sperm Concentration (million/ml), Number\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e11.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e6.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e1.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e24.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMotile Sperm Average (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e45.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e35.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e50.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 587px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Infertility, Number\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 587px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Varicocele, Number\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAccording to the Shapiro-Wilk test, it was determined that the observations did not show a normal distribution (p\u0026lt;0.05).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e Comparison of IMA levels between patient and control groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIMA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMann-Whitney U\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMax.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eZ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e0,63 \u0026plusmn; 0,19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0,08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0,86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-3,036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0,002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eInfertile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e0,74 \u0026plusmn; 0,17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0,22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e1,13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe results of the Mann\u0026ndash;Whitney U test conducted between the control group and the infertile patient group showed that IMA levels in infertile individuals were statistically significantly higher than in the control group (p = 0.002)(Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e Comparison of IMA levels between oligozoospermia groups and the control group\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIMA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 41px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKruskal-Wallis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMax.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0,63 \u0026plusmn; 0,19\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0,08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0,86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 20px;\"\u003e\n \u003cp\u003e10,214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0,017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eSevere o.spermia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0,76 \u0026plusmn; 0,18\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0,48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1,13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eModerate o.spermia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0,74 \u0026plusmn; 0,14\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0,49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eMild o.spermia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0,70 \u0026plusmn; 0,19\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0,22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0,93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe Kruskal\u0026ndash;Wallis test performed between the oligozoospermia subgroups and the control group also indicated the presence of intergroup differences and was found to be statistically significant (p=0.017)(Table 3). According to the post-hoc test results (groups showing statistical differences in subindices are indicated), the IMA level of the severe oligozoospermia group was found to be significantly higher than that of the mild, moderate oligozoospermia, and control groups (p\u0026lt;0.05), while the IMA levels of the moderate and mild oligozoospermia groups did not show a statistically significant difference from the control group (p\u0026gt;0.05)(Figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u0026nbsp;\u003c/strong\u003eComparison of IMA levels on sperm motility\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"617\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 117px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 273px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIMA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMann-Whitney U\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eMotility\u0026nbsp;\u0026lt; %40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eMotility\u0026nbsp;\u0026gt;= %40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 123px;\"\u003e\n \u003cp\u003e-3,222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e0,77\u0026plusmn;0,15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e0,67\u0026plusmn;0,19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 4 shows that IMA levels show a significant difference according to sperm motility (p = 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5:\u0026nbsp;\u003c/strong\u003eComparison between varicocele and IMA\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 219px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIMA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMann-Whitney U\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo Varicocele\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVaricocele\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eZ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 127px;\"\u003e\n \u003cp\u003e-2,107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0,035\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e0,66\u0026plusmn;0,2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0,73\u0026plusmn;0,16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 5 shows that IMA levels are significantly higher in patients with varicocele (p = 0.035).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6:\u0026nbsp;\u003c/strong\u003eCorrelations between parameters in the general participants of the study - Pearson correlation test\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"621\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProlactin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEstradiol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Testosterone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTSH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSperm Concentration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIMA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFSH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.573**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0,086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0,098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0,014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e-0,122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0,075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0,087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.275**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0,124\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0,354\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0,293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0,882\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0,188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0,458\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0,357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0,002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0,174\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.198*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.260**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.312**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e-0,074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.261**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0,082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.259**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0,134\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0,032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0,004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0,431\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0,009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0,387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0,004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0,144\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProlactin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.188*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0,172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e-0,027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0,034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0,090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e-0,022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0,012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0,042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0,062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0,774\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0,737\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0,341\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0,811\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0,898\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEstradiol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.456**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0,050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.260**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e-0,058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e-0,040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.262**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0,595\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0,009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0,541\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0,666\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0,004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Testosterone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0,046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.264**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0,106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0,030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0,058\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0,623\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0,008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0,257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0,741\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0,522\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTSH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.386**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e-0,006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0,043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e-0,065\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0,947\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0,634\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0,466\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.283**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0,091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.219*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0,003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0,346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0,022\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0,045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0,024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0,623\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0,787\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSperm Concentration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e-0,145\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0,083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e**Correlation is significant at the 0.01 level (2-tailed).\u003cbr\u003e\u0026nbsp;*Correlation is significant at the 0.05 level (2-tailed).\u003c/p\u003e\n\u003cp\u003eAmong the general participants of the study, there were no significant correlations between FSH (r: 0.124, p\u0026gt;0.05), LH (r: 0.134, p\u0026gt;0.05), prolactin (r: 0.012, p\u0026gt;0.05), TSH (r: -0.065, p\u0026gt;0.05), T4 (thyroxine) (r: 0.024, p\u0026gt;0.05), and total testosterone (r: 0.058, p\u0026gt;0.05) were not significant. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, a positive and significant correlation was found between IMA and E2 (estradiol) (r: 0.262, p: 0.004) and between IMA and T3 (triiodothyronine) (r: 0.219, p: 0.022) among the general participants of the study. Accordingly, as the IMA value increases, a significant increase in E2 and T3 values is expected(\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eTable 6).\u003c/p\u003e\n\u003cp\u003eWhen comparing fertile and infertile groups, no significant difference was observed in terms of BMI (p\u0026gt;0.05). Additionally, the differences in BMI levels and IMA observations between the general participants of the study and the infertile group were statistically insignificant (p\u0026gt;0.05).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eSemen samples from infertile men have higher ROS levels compared to the fertile control group. These findings support the disruptive effect of OS on sperm function and its role in the infertility process [3, 8, 11, 12].\u003c/p\u003e\n\u003cp\u003eIncreased ROS during ischemia causes certain modifications to albumin, negatively affecting its normal antioxidant properties and metal ion binding capacity and leading to the formation of IMA. Thus, IMA becomes a biochemical marker of ischemia and oxidative stress\u0026nbsp;[5, 6, 13].\u003c/p\u003e\n\u003cp\u003eA systematic review of IMA found that it can be used as a biomarker in many cardiovascular diseases, cerebrovascular events, neurodegenerative diseases, psychiatric disorders, traumatic brain injuries, neonatal hypoxic-ischemic encephalopathy, diabetes mellitus and its complications, thyroid disorders, acute and chronic kidney damage, various types of cancer, gynecological disorders, pregnancy, preeclampsia, and abortion\u0026nbsp;[5].\u003c/p\u003e\n\u003cp\u003eAccording to these studies, IMA has been found to be a low-specificity biomarker for various diseases associated with ischemia and oxidative stress. Nevertheless, it has been predicted that the evaluation of IMA levels could provide important information about the duration of the disease and possible complications and could be used in the differential diagnosis of some pathological conditions\u0026nbsp;[5, 6]. \u0026nbsp;The greatest advantage of IMA as a biomarker compared to other markers is its ability to detect ischemic conditions at earlier stages\u0026nbsp;[5, 6, 13].\u003c/p\u003e\n\u003cp\u003eAlthough many studies have been conducted to identify OS biomarkers associated with male infertility, there are only a limited number of studies investigating the relationship between IMA and infertility[7–9].\u003c/p\u003e\n\u003cp\u003eIn their study investigating the relationship between sperm motility and IMA levels in infertile men, Inal et al. found a negative correlation between total progressive motile sperm count and serum IMA levels [7].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn our study, when we compared IMA levels between the infertile group and the control group, we found that they were statistically significantly higher. When comparing the oligozoospermia groups with the control group, we found that the difference between the groups was statistically significant. The IMA level of the severe oligozoospermia group was found to be significantly higher than the IMA levels of the control, moderate, and mild oligozoospermia groups, while the moderate and mild oligozoospermia groups did not show a statistically significant difference from the control group. Additionally, IMA levels were found to show a statistically significant difference according to sperm motility. These results support the effect of IMA on sperm concentration and function while also emphasizing the role of oxidative stress in the mechanism of infertility.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOxidative stress is one of the most common factors causing infertility in men with varicocele. Changes in testicular venous drainage can exacerbate the effects of oxidative stress by causing hypoxic-induced ischemic damage in both testes. To assess this condition, the degree of oxidative damage can be estimated by measuring reactive nitrogen species (RNS) and other oxidative stress biomarkers [11, 12, 14]. Çoban et al., in their study investigating oxidative stress in the spermatic veins of infertile patients with varicocele, found that IMA was statistically significantly higher than the peripheral vein [8]. In a study conducted by Aliyazıcıoğlu et al. on varicocele patients, they found that IMA levels between the internal spermatic vein and the brachial vein were not statistically significant [9].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn our study, IMA levels of patients with varicocele were statistically significantly higher than those without varicocele. The significant difference observed in IMA levels stands out as an important finding supporting the effect of varicocele on infertility through biochemical mechanisms.\u003c/p\u003e\n\u003cp\u003eHormonal regulation plays a key role in the etiology of male infertility. Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH) are essential in the regulation of spermatogenesis and testosterone production in the testes. Testosterone is a critical biological component in maintaining male reproductive health; low serum levels can impair sperm production and sexual function, leading to infertility. Prolactin (PRL) can inhibit gonadotropin secretion in hyperprolactinemia, leading to infertility. Thyroid hormones may indirectly affect male reproductive function through their effects on hormonal balance as well as metabolic homeostasis. The interaction and homeostatic balance of these hormones have an important role in the evaluation and treatment of male infertility\u0026nbsp;[2, 7, 15, 16].\u0026nbsp;Inal et al. found a statistically significant difference between serum FSH, LH, E2, and PRL and IMA levels, whereas no statistically significant difference was observed between serum testosterone levels and IMA\u0026nbsp;[7].\u003c/p\u003e\n\u003cp\u003eThe correlations observed between FSH, LH, PRL, TSH, T4, total testosterone levels, and IMA were not significant in the general participants of our study. This implies that IMA may not be linked to these hormonal parameters or that other factors may be more important. However, there was a significant positive correlation between IMA and E2 and IMA and T3 values in general participants. Accordingly, as the IMA value increases, a significant increase in E2 and T3 values is expected.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOptimal levels of E2 are necessary for reproductive functions in men; high levels of E2 may lead to infertility by negatively affecting sperm production and motility\u0026nbsp;[17, 18]. \u0026nbsp; The positive correlation between IMA and E2 in our study suggests that IMA may be associated with the regulation of E2.\u003c/p\u003e\n\u003cp\u003eÖncel et al. evaluated the relationship between IMA levels and thyroid hormone levels and showed that IMA levels were significantly lower in the hypothyroidism group compared to the hyperthyroidism and euthyroidism groups [19].\u0026nbsp;Ma et al. showed that IMA may be a valuable biomarker for oxidative stress in patients with significant thyroid dysfunction [20]. The positive correlation between IMA and T3 in our study suggests that IMA may affect thyroid functions, or thyroid hormones may affect IMA levels. T3 is biologically active and can directly affect cellular metabolism and oxidative stress mechanisms, so it would be expected to be associated with IMA. T4, on the other hand, acts mainly by converting to T3, so it may be natural that it does not show a direct relationship with IMA [21, 22].\u003c/p\u003e\n\u003cp\u003eOne of the strengths of our study is its pioneering evaluation of the utility of IMA as a biomarker in infertile men. In particular, the relationship between IMA levels and different degrees of severity of oligozoospermia was addressed with a large sample size, and statistically significant findings were presented. In addition, in the subgroup analysis of our study, the relationship of IMA with sperm motility, varicocele, and hormonal parameters was addressed, and significant results were observed. These points may shed light for future studies to evaluate the results of the study more comprehensively. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the treatment of infertility, treatment approaches aimed at reducing oxidative stress are of great importance. Antioxidant therapies may be effective in reducing oxidative stress and thus improving sperm quality [3, 23]. In this context, the use of IMA as a biomarker indicating OS in infertility treatment may offer a new approach in monitoring treatment processes and evaluating their efficacy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMiraç Ataman\u003c/strong\u003e: Study design, knowledge transfer, critical discussion of data, drafting and revision of the manuscript\u003cstrong\u003e. Ercan Yuvanç, Erdal Yılmaz,\u0026nbsp;\u003c/strong\u003eand\u003cstrong\u003e\u0026nbsp;Mehmet Emin Ataman:\u0026nbsp;\u003c/strong\u003eKnowledge transfer, critical discussion of data, and manuscript revision\u003cstrong\u003e. Özcan Erel\u0026nbsp;\u003c/strong\u003eand\u003cstrong\u003e\u0026nbsp;Salim Neşelioğlu:\u0026nbsp;\u003c/strong\u003eData collection, laboratory analyses, and sample processing. All authors have read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONFLİCT OF INTEREST AND FUNDİNG STATEMENT\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest that could influence the objectivity or integrity of the research presented. The authors received no financial support for the research, authorship, or publication of this article.\u003c/p\u003e"},{"header":"REFERENCES","content":"\u003col\u003e\n \u003cli\u003eAgarwal A, Mulgund A, Hamada A, Chyatte MR (2015) A unique view on male infertility around the globe. Reprod Biol Endocrinol RBE 13:37. https://doi.org/10.1186/s12958-015-0032-1\u003c/li\u003e\n \u003cli\u003eMinhas S, Bettocchi C, Boeri L, et al (2021) European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2021 Update on Male Infertility. Eur Urol 80:603\u0026ndash;620. https://doi.org/10.1016/j.eururo.2021.08.014\u003c/li\u003e\n \u003cli\u003eTremellen K (2008) Oxidative stress and male infertility--a clinical perspective. Hum Reprod Update 14:243\u0026ndash;258. https://doi.org/10.1093/humupd/dmn004\u003c/li\u003e\n \u003cli\u003eAgarwal A, Virk G, Ong C, du Plessis SS (2014) Effect of oxidative stress on male reproduction. World J Mens Health 32:1\u0026ndash;17. https://doi.org/10.5534/wjmh.2014.32.1.1\u003c/li\u003e\n \u003cli\u003eShevtsova A, Gordiienko I, Tkachenko V, Ushakova G (2021) Ischemia-Modified Albumin: Origins and Clinical Implications. Dis Markers 2021:9945424. https://doi.org/10.1155/2021/9945424\u003c/li\u003e\n \u003cli\u003eSbarouni E, Georgiadou P, Voudris V (2011) Ischemia modified albumin changes - review and clinical implications. Clin Chem Lab Med 49:177\u0026ndash;184. https://doi.org/10.1515/CCLM.2011.037\u003c/li\u003e\n \u003cli\u003eInal HA, Ozturk Inal Z, Mermer S, et al (2020) Investigation of serum vitamin D and ischaemia-modified albumin levels in infertile Turkish men. Andrologia 52:e13507. https://doi.org/10.1111/and.13507\u003c/li\u003e\n \u003cli\u003eCoban S, Ustundag Y, Turkoglu AR, et al (2019) Thiol-disulphide balance in infertility secondary to varicocele. Andrologia 51:e13300. https://doi.org/10.1111/and.13300\u003c/li\u003e\n \u003cli\u003eAliyazicioglu Y, Ozbek E, Ozcan L, et al (2013) Lack of significant difference between internal spermatic vein and brachial vein ischemia modified albumin levels in patients with varicocele. Arch Ital Urol Androl Organo Uff Soc Ital Ecogr Urol E Nefrol 85:34\u0026ndash;35. https://doi.org/10.4081/aiua.2013.1.34\u003c/li\u003e\n \u003cli\u003eWHO laboratory manual for the examination and processing of human semen, 6th ed. https://www.who.int/publications/i/item/9789240030787. Accessed 13 Jul 2025\u003c/li\u003e\n \u003cli\u003eGul M, Bugday MS, Erel O (2018) Thiol-disulphide homoeostasis as an oxidative stress marker in men with varicocele. Andrologia. https://doi.org/10.1111/and.12982\u003c/li\u003e\n \u003cli\u003eAgarwal A, Sharma RK, Desai NR, et al (2009) Role of oxidative stress in pathogenesis of varicocele and infertility. Urology 73:461\u0026ndash;469. https://doi.org/10.1016/j.urology.2008.07.053\u003c/li\u003e\n \u003cli\u003eBar-Or D, Lau E, Winkler JV (2000) A novel assay for cobalt-albumin binding and its potential as a marker for myocardial ischemia-a preliminary report. J Emerg Med 19:311\u0026ndash;315. https://doi.org/10.1016/s0736-4679(00)00255-9\u003c/li\u003e\n \u003cli\u003eMottola F, Palmieri I, Carannante M, et al (2024) Oxidative Stress Biomarkers in Male Infertility: Established Methodologies and Future Perspectives. Genes 15:539. https://doi.org/10.3390/genes15050539\u003c/li\u003e\n \u003cli\u003eSigman M, Jarow JP (1997) Endocrine evaluation of infertile men. Urology 50:659\u0026ndash;664. https://doi.org/10.1016/S0090-4295(97)00340-3\u003c/li\u003e\n \u003cli\u003eKrassas GE, Pontikides N (2004) Male reproductive function in relation with thyroid alterations. Best Pract Res Clin Endocrinol Metab 18:183\u0026ndash;195. https://doi.org/10.1016/j.beem.2004.03.003\u003c/li\u003e\n \u003cli\u003eCarreau S, Lambard S, Delalande C, et al (2003) Aromatase expression and role of estrogens in male gonad : a review. Reprod Biol Endocrinol RBE 1:35. https://doi.org/10.1186/1477-7827-1-35\u003c/li\u003e\n \u003cli\u003eCarreau S, Hess RA (2010) Oestrogens and spermatogenesis. Philos Trans R Soc Lond B Biol Sci 365:1517\u0026ndash;1535. https://doi.org/10.1098/rstb.2009.0235\u003c/li\u003e\n \u003cli\u003eOncel M, Kıyıcı A, Onen S (2015) Evaluation of the Relationship Between Ischemia-Modified Albumin Levels and Thyroid Hormone Levels. J Clin Lab Anal 29:427\u0026ndash;431. https://doi.org/10.1002/jcla.21789\u003c/li\u003e\n \u003cli\u003eMa S, Yang L, Bai F, et al (2012) Ischemia-modified albumin in patients with hyperthyroidism and hypothyroidism. Eur J Intern Med 23:e136-140. https://doi.org/10.1016/j.ejim.2012.04.011\u003c/li\u003e\n \u003cli\u003eHall, John E (2016) Guyton and Hall Textbook of Medical Physiology. In: Thyroid Metabolic Hormones, 14th ed. Elsevier, Philadelphia, PA\u003c/li\u003e\n \u003cli\u003eArmstrong M, Asuka E, Fingeret A (2025) Physiology, Thyroid Function. In: StatPearls. StatPearls Publishing, Treasure Island (FL)\u003c/li\u003e\n \u003cli\u003eAgarwal A, Panner Selvam MK, Samanta L, et al (2019) Effect of Antioxidant Supplementation on the Sperm Proteome of Idiopathic Infertile Men. Antioxid Basel Switz 8:488. https://doi.org/10.3390/antiox8100488\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"infertility, oligozoospermia, ischemia-modified albumin","lastPublishedDoi":"10.21203/rs.3.rs-7339502/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7339502/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjective: The objective of this study is to determine whether IMA (Ischemic Modified Albumin), a new oxidative stress marker, can be used to predict the degree of oligozoospermia in infertile men.\u003c/p\u003e\n\u003cp\u003eMaterials and Methods: Oligozoospermic male patients (n=113) who remained infertile despite regular, unprotected sexual intercourse for more than 12 months were included in the study. Those with sperm counts of 10–16 × 10⁶/ml were classified as having mild oligozoospermia (group 1, n=32), those with counts of 5–9. 9 × 10⁶/ml were classified as moderate oligozoospermia (group 2, n=42), and those with \u0026lt;5 × 10⁶/ml were classified as severe oligozoospermia (group 3, n=39). Additionally, normospermic (\u0026gt;16 × 10⁶/ml) fertile men with at least one child (group 4, n=47) were included as the control group.\u003c/p\u003e\n\u003cp\u003eResults: When IMA levels were compared between the infertile group and the control group, they were found to be statistically significantly higher in the infertile group (p=0.002). When the oligozoospermia groups were compared with the control group, the difference between the groups was found to be statistically significant (p=0.017). The IMA level of the severe oligozoospermia group was found to be significantly higher than the IMA levels of the control, moderate, and mild oligozoospermia groups (p\u0026lt;0.05); however, the IMA levels of the moderate and mild oligozoospermia groups did not show a statistically significant difference from the control group (p\u0026gt;0.05). The IMA levels of the general study group were found to show a statistically significant difference according to sperm motility (p=0.001). In addition, the IMA levels of patients with varicocele were found to be significantly higher (p=0.035). IMA showed a positive correlation with estradiol (p = 0.004) and triiodothyronine (p = 0.022) levels.\u003c/p\u003e\n\u003cp\u003eConclusion: This study suggests that IMA may be used as a potential biomarker for predicting severe oligozoospermia in infertile men.\u003c/p\u003e","manuscriptTitle":"Comparison of Ischemia-Modified Albumin Levels in Infertile Men with Mild, Moderate, and Severe Oligozoospermia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-19 12:37:04","doi":"10.21203/rs.3.rs-7339502/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cbde1f5c-2374-4c21-a399-0c8ff0254b90","owner":[],"postedDate":"August 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-19T12:37:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-19 12:37:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7339502","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7339502","identity":"rs-7339502","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}