The Effect of Age and Abstinence Time on Semen Quality and Specific Sperm Morphological Anomalies

The Effect of Age and Abstinence Time on Semen Quality and Specific Sperm Morphological Anomalies | 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 The Effect of Age and Abstinence Time on Semen Quality and Specific Sperm Morphological Anomalies Duygu Dursunoglu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7851337/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Aging is known to cause a significant decrease in semen quality, but its association with specific sperm morphological anomalies is unclear. The study aimed to investigate the effects of age and abstinence time on semen quality and specific morphological anomalies. Methods This study is a cross-sectional study including 5491 male participants between the ages of 17–57. Semen parameters and morphological anomalies analyzed according to the World Health Organization (WHO) criteria were compared in different age and abstinence time groups. Correlations between semen variables and age were analyzed by linear regression analysis after adjusting for body mass index and abstinence time. Results Increasing age caused a decrease in all semen parameters and an increase in the incidence of total head and tail anomalies, elongated heads and coiled tails. Increasing abstinence time resulted in an increase in semen parameters other than progressive and rapid progressive motility, and amorphous, round, and tapered heads, irregular acrosomal distribution, coiled and short tails, and excessive residual cytoplasma, and a decrease in rapid progressive motility and pin, elongated, large, and small heads decreased. Conclusions Semen variables appear to be affected by abstinence time. Aging is a significant risk factor for poor semen quality and particularly elongated heads and coiled tails in individuals over 40 years of age. Clinical trial number: Not applicable. Male infertility age semen quality sperm morphology specific sperm morphological anomalies sperm head anomalies sperm tail anomalies coiled tail Figures Figure 1 Background Infertility is an important health problem worldwide, and male infertility accounts for approximately half of all infertility cases [ 1 ]. Male infertility is diagnosed by spermiogram, which is based on the assessment of sperm count, motility, and normal morphology parameters determined according to the World Health Organization (WHO) guideline [ 2 ]. It is known that aging, a physiological process, significantly affects male fertility capacity3. Several possible mechanisms have been proposed to explain how aging process affect male reproductive functions. Several structural and functional changes in the reproductive organs caused by aging directly affect spermatogenesis, leading to poor semen quality [ 3 ]. Aging causes a decrease in testicular volume and the number of Leydig, Sertoli and germ cells, due to testicular atrophy, resulting in decreased testosterone levels and increased gonadotropin levels [ 4 , 5 , 6 ]. Aging also is an important cause of erectile dysfunction [ 7 ]. In addition, oxidative stress and impairment in the antioxidant defense system that occur with aging lead to impaired germ cell DNA integrity, compromising sperm fertilization capacity [ 8 , 9 ]. Aging has been clearly shown to negatively affect semen volume, sperm concentration and motility parameters [ 10 , 11 ], but its effect on morphology parameters is unclear. A decrease in the rate of morphologically normal spermatozoa has been reported in older men [ 12 , 13 ]. However, other studies have not found a link between age and morphology parameters [ 9 , 10 , 11 ]. No threshold value of male age has been established for the risk of infertility and poor in vitro fertilization (IVF) outcomes, but the risk is believed to increase after the age of 40 [ 14 ]. Sperm morphology is known to be an important parameter for male infertility. Morphologically abnormal spermatozoa generally have lower fertilization potential and a higher rate of DNA damage [ 15 , 16 ]. However, the predictive potential of normal morphology rate in the diagnosis and prognosis of male infertility and in the outcomes of IVF treatment is controversial. Certain morphological anomalies have been more strongly associated with sperm fertilization potential and DNA damage [ 17 ]. Therefore, in the assesment of sperm morphology, instead of morphology criteria based solely on normal morphology rate, detailed characterization of morphological patterns may provide a better predictive value for sperm fertilization potential. It is possible that the incidence of some morphological anomalies may increase as a result of increased sperm DNA damage with aging. However, little data are available on the effect of advanced age on specific sperm morphological patterns. It has also been observed that sexual abstinence time could affect semen quality parameters and that prolonged abstinence causes an increase in sperm DNA fragmentation. However, abstinence time has not been associated with sperm morphological parameters. The present study aimed to investigate the effect of sexual abstinence time on sperm morphological parameters and age-related changes in conventional semen parameters and spesific morphological anomalies after adjusting for potential confounding factors that may affect semen variables, such as obesity and abstinence time. Methods Study population Approval was provided for the current study by the institutional ethics review board of the Ethics Committee of Selcuk University, Faculty of Medicine. The study population consisted of male participants aged 17–57 years who applied to Selcuk University Hospital Andrology Clinic for standard semen analysis between 2020–2023 years. All participants were provided with comprehensive information about the study, and written informed consent was obtained. Informed consent was obtained from the parents and/or legal guardians of minör participants aged 17 years. Exclusion criteria in the study included testicular tumor, clinical varicocele, genital tract infection, azoospermia, and severe oligozoospermia. Semen parameters except sperm morphology, vitality, and rapid progressive motility were obtained from 5491 participants. Sperm rapid progressive motility, vitality, and morphology parameters were obtained from 5390, 1502, and 2943 participants, respectively. In order to investigate the effect of age on semen quality and sperm morphological anomalies, all participants were divided into five age groups: Group 1: 17–24 years, Group 2: 25–29 years, Group 3: 30–34 years, Group 4: 35–39 years and Group 5: 40–57. Participants were also divided into six groups according to different abstinence time: 2 days, 3 days, 4 days and 5 days. Additionally, participants' height and weight were measured and body mass index (BMI) was calculated by dividing weight in kilograms by the square of height in meters. Semen analysis Semen parameters were analyzed according to the “WHO laboratory manual for the examination and processing of human semen (2010)” guideline and included sperm concentration, total count, total motility, progressive motility, rapid progressive motility, vitality and normal morphology [ 2 ]. Semen samples were obtained through masturbation into a sterile plastic container at the Andrology Clinic after a 2–5 day period of sexual abstinence. The participants' abstinence times were recorded. The samples were allowed to liquefy at 37°C for 30–60 minutes. Semen volume was measured using a graduated test tube, into which the entire ejaculate was collected, and the volume was subsequently recorded in millilitres (mL). Liquefied semen samples were evaluated for sperm concentration and motility characteristics using a Makler counting chamber (Sefi Medical Instruments, Haifa, Israel) under an Olympus CX41 microscope (Olympus, Tokyo, Japan) with a phase contrast objective, at ×200–400 magnification. For this, a 5 µL drop of liquefied semen was placed in the center of the chamber's lower platform and the cover glass was immediately applied. All assessments were performed in duplicate on at least 200 sperm by an experienced researcher, and the results were compared. If the differences between the results exceeded the acceptance limits, the assessments were repeated. Total sperm count was calculated by multiplying sperm concentration and semen volume. Sperm motility was classified as total sperm motility (WHO class A + B + C), progressive motility (WHO class A + B) and rapid progressive motility (WHO class A) [ 2 ]. Eosin-nigrosin staining was performed to assess sperm vitality. In the staining protocol, approximately equal volumes (50 µL) of liquefied semen sample and eosin-nigrosin stain (Sperm VitalStain, Nidacon International AB, Gothenburg, Sweden) were mixed in an eppendorf tube. After incubating the mixture for 30 seconds at room temperature, a 10-µL droplet of the mixture was placed on a slide and smear preparations were prepared. Air-dried smears were examined under an Olympus CX41 microscope (Olympus, Tokyo, Japan) with a bright-field objective, using oil immersion, at ×1000 magnification. At least 200 spermatozoa were counted for each semen sample. Brightly colored sperm cells that were impermeable to the stain were considered live, and colored cells that absorbed the stain were considered dead. Percentage of sperm viability was calculated as the ratio of live cells to total cells. Sperm morphological analysis Sperm morphology was assesed according to the WHO 2010 guideline [ 2 ] and Kruger's strict criteria [ 18 ]. After liquefaction, semen smears were prepared and allowed to air dry. Air-dried smears were then stained with Spermac (Spermac stain®; FertiPro N.V., Belgium) method. In the Spermac method, semen smears were fixed with formaldehyde solution for 5 minutes and stained by dipping for 1 min in solutions A, B and C. The smears were washed with distilled water between each staining process (5 times). Finally, they were air-dried at room temperature. Morphological details were examined under an Olympus CX41 microscope (Olympus, Tokyo, Japan) with bright field objective, using oil immersion, at × 1000 magnification on at least 200 spermatozoa for each semen sample. Morphological assessments were performed at least twice in random and blinded manner by a single experienced researcher. Specific anomalies were assesed in 4 regions of the sperm, namely the head (nucleus and acrosome), neck-midpiece, tail, and cytoplasmic residue. Spermatozoa that met the criteria for normal morphology specified by Kruger's strict criteria were classified as normal. Others and spermatozoa with borderline morphology were considered abnormal. The percentage of normal sperm morphology was calculated by dividing the number of spermatozoa with normal morphology by the total number of spermatozoa. Teratozoospermia index (TZI), which expresses the number of anomalies per sperm, was calculated. Images of sperm morphological anomalies were taken using an Olympus BX51 microscope (Olympus, Tokyo, Japan) with an Olympus DP72 camera and DP2 BSW software (Olympus, Tokyo, Japan). Sperm classified as normal according to strict criteria had the following characteristics: a sperm head that was smooth, regularly contoured, and oval in shape, 3 to 5 µm in length and 2 to 3 µm in width, with a length-to-width ratio of 1.5; an acrosomal region covering 40–70% of the head area, free of large vacuoles or more than two small vacuoles occupying no more than one-fifth of the sperm head; and a post-acrosomal region free of vacuoles; a midpiece that was thin, regular, and about the same length as the sperm head and aligned with the main axis of the sperm head; a principal piece that was regular, thinner than the midpiece and about 45 µm in length and without sharp angulation; and free of excessive residual cytoplasm (ERC) that exceeded one-third of the normal sperm head size. Specific sperm head anomalies included amorphous head, irregular acrosomal distribution, vacuolated head (acrosomal, equatorial and post-acrosomal vacuoles), round head, pin head, large head, small head, elongated head, and multiple head anomalies. Sperm neck midpiece anomalies included defects of asymmetrical insertion, thin midpiece, and bent neck. Tail anomalies included multiple, coiled, and short tails. Statistical analysis All statistical analysis was performed using R version 4.1.2 (The R Foundation for Statistical Computing. Vienna. Austria; https://www.r-project.org ). Kolmogorov-Smirnov test was applied to determine whether the analyzed parameters were normally distributed. Kruskal Wallis analysis and multiple comparison tests were used to compare semen parameters and sperm morphological anomalies among the age groups and the abstinence time groups. Correlations between semen parameters and specific morphological anomalies, and abstinence time were evaluated by Spearman’s rank correlation. Correlations between semen parameters and specific morphological anomalies, and age were analyzed by linear regression analyze after adjusting BMI and abstinence time. Odds ratios were calculated with 95% confidence intervals. Values were given as mean ± standard deviation and median. P value < 0.05 was considered statistically significant. Results General characteristics of the study population The mean age was 29.5 ± 6.8 (median: 29) years, and the mean duration of sexual abstinence was 3.5 ± 0.7 (median: 3) days. Table 1 shows the mean and median values of semen parameters of the entire population. Specific sperm morphological anomalies were most frequently observed in the sperm head (79.0% ± 5.0%, median: 79%). This was followed by tail anomalies (15.8% ± 5.8%, median: 16%), neck-midpiece anomalies (13% ± 3.7%, median: 13%), and ERC anomaly (4.5% ± 2.5%, median: 4%). Head anomalies, in order of frequency, included amorphous heads, vacuolated heads, pin heads, round heads, large heads, irregular acrosomal distribution, tapered heads, elongated heads, small heads, and multiple heads. The most common tail anomalies were coiled, short, and multiple tails, respectively. The most common neck-midpiece anomalies were thin midpiece, bent neck, and asymmetrical insertion. Table 1 Comparision of semen parameters among the abstinence time groups Abstinence Time Groups Semen Parameters 2 day N = 172 3 day N = 2585 4 day N = 2288 5 day N = 446 Total N = 5491 P -value Significant subgroups ( p 0.05 Semen volume (ml) 2.8 ± 1.3 (2.6) 3.2 ± 1.4 (3) 3.4 ± 1.5 (3) 3.6 ± 1.5 (3.5) 3.3 ± 1.5 (3) < 0.001 2:3 * ;2:4 ** ;2:5 ** ;3:4 ** ;3:5 ** Sperm concentration (×10 6 / ml) 23.0 ± 23.3 (17) 32.2 ± 33.3 (21) 36.1 ± 34.5 (26) 36.4 ± 32.8 (26) 33.9 ± 33.6 (24) < 0.001 2:4 ** ;2:5 ** ;3:4 ** ;3:5 * Total sperm count (×10 6 / ejaculat) 60.9 ± 67.9 (39) 102.5 ± 117.1 (62) 120.1 ± 128.1 (82.2) 124.9 ± 124.1 (90) 110.3 ± 121.9 (72) < 0.001 2:3 * ;2:4 ** ;2:5 ** ;3:4 ** ;3:5 ** Total sperm motility (%) 56.1 ± 20.2 (60) 59.3 ± 22.5 (65) 60.7 ± 21.5 (67) 59.2 ± 20.9 (65) 59.8 ± 21.9 (65) 0.05 Rapid progressive sperm motility (%) 9.6 ± 6.3 (9) N = 171 4.9 ± 5.5 (3) N = 2526 4.2 ± 4.8 (3) N = 2253 5.2 ± 5.3 (3) N = 440 4.8 ± 5.3 (3) N = 5390 < 0.001 2:3 ** ;2:4 ** ;2:5 ** ;3:4 * ;4:5 * Sperm vitality (%) 20.5 ± 17.8 (23) N = 25 40.3 ± 29.2 (45) N = 730 44.0 ± 29.8 (48) N = 629 42.6 ± 27.4 (45) N = 118 41.7 ± 29.3 (45) N = 1502 < 0.001 2:3 * ;2:4 ** ;2:5 * Normal sperm morphology (%) 1.3 ± 0.6 (1) N = 44 2.3 ± 1.2 (2) N = 1358 2.4 ± 1.3 (2) N = 1302 2.3 ± 1.4 (2) N = 239 2.3 ± 1.2 (2) N = 2943 < 0.001 2:3 ** ;2:4 ** ;2:5 ** Values are presented mean ± standard deviation (SD) (median). * P < 0.05, ** P < 0.001. Effects of abstinence time on sperm quality and specific sperm morphological anomalies Age did not differ significantly between the abstinence time groups. Semen volume, sperm concentration, total sperm count, total sperm motility, rapid progressive sperm motility, sperm vitality and normal sperm morphology rate were statistically different among the abstinence time groups (all P 0.05). Semen volume, sperm concentration, total sperm count, total sperm motility, sperm vitality and normal morphology showed an increase with the increase of abstinence time. These parameters reached their highest values on days 4 and 5 of abstinence. Rapid progressive sperm motility decreased with the increase of abstinence time. Rapid sperm motility was lowest on day 4 of abstinence and showed a nonsignificant trend toward an increase on day 5 (Table 1 ). There were significantly positive correlations between abstinence time and semen parameters except for progressive and rapid progressive sperm motility (all P < 0.05). Rapid progressive motility was negatively correlated with abstinence time ( P 0.05) (Table 2 ). Table 2 Spearman’s correlations of age and abtinence time with semen parameters and sperm morphological anomalies Variables Age Abstinence time (day) R P R P Age (years) – – – > 0.05 Volume (ml) -0.039 0.004 0.099 < 0.001 Sperm concentration (×106 / ml) -0.094 < 0.001 0.076 < 0.001 Total sperm count (×106 / ejaculat) -0.107 < 0.001 0.099 < 0.001 Total sperm motility (%) -0.153 < 0.001 0.035 0.009 Progressive sperm motility (%) -0.150 0.05 Rapid progressive sperm motility (%) -0.094 < 0.001 -0.066 < 0.001 Sperm vitality (%) -0.133 < 0.001 0.073 0.005 Normal sperm morphology (%) -0.085 0.05 Irregular acrosomal distribution (%) – > 0.05 0.055 0.003 Amorphous head (%) – > 0.05 0.048 0.009 Round head (%) – > 0.05 0.072 0.05 Elongated head (%) 0.044 0.017 -0.081 < 0.001 Large head (%) 0.049 0.008 -0.079 0.05 0.046 0.012 Tail anomalies (%) 0.049 0.008 0.053 0.004 Coiled tail (%) 0.078 < 0.001 0.067 0.05 0.036 0.049 ERC (%) – > 0.05 0.042 0.022 P -value < 0.05 was considered statistically significant. ERC: Excessive residual cytoplasma. Only morphological anomalies with statistically significant differences are given in the table. Among the specific morphological anomalies examined, the incidences of irregular acrosomal distribution, amorphous, round, pin, tapered, elongated, large, and small heads, total tail anomalies, coiled and short tails, and ERC were observed to be significantly different among the abstinence time groups (all P < 0.05). While the incidences of irregular acrosomal distribution, amorphous, round and tapered heads, total tail anomalies, coiled and short tails, and ERC were found to significantly increase with increasing abstinence time, the incidences of pin, elongated, large and small heads were found to significantly decrease with increasing abstinence time. TZI did not show any significant differences between the abstinence duration groups (Table 3 ). Irregular acrosomal distribution, amorphous, round and tapered heads, total tail anomalies, coiled and short tails and ERC were significantly positively correlated with abstinence time, while elongated, large and small heads were negatively correlated with abstinence time (Table 2 ). No significant correlations were found between other specific anomalies examined and TZI, and abstinence time ( P > 0.05). Table 3 Comparision of sperm morphological anomalies in the abstinence time groups Sperm Morphological Anomalies (%) Abstinence Time Groups 2 day N = 44 3 day N = 1358 4 day N = 1302 5 day N = 239 Total N = 2943 P -value Significant subgroups ( p < 0.05) Irregular acrosomal distribution 4.9 ± 1.9 (5) 5.5 ± 1.9 (5) 5.6 ± 1.8 (6) 5.8 ± 1.8 (6) 5.6 ± 1.8 (6) 0.002 2:3 * ; 2:4 * ; 2:5 * Amorphous head 18.5 ± 4.3 (18) 24.3 ± 5.2 (25) 24.7 ± 4.9 (25) 24.0 ± 5.2 (25) 24.4 ± 5.1 (25) < 0.001 2:3 ** ; 2:4 ** ;2:5 ** Round head 4.3 ± 2.2 (4.5) 6.2 ± 2.8 (6) 6.5 ± 2.9 (6) 6.3 ± 2.6 (6) 6.3 ± 2.8 (6) < 0.001 2:3 ** ; 2:4 ** ; 2:5 ** ;3:4 * Pin head 8.3 ± 2.6 (8.5) 7.4 ± 2.7 (7) 7.3 ± 2.5 (7) 7.7 ± 2.7 (7) 7.4 ± 2.6 (7) 0.007 2:3 * ; 2:4 * Tapered head 3.1 ± 1.7 (3) 5.3 ± 2.2 (6) 5.5 ± 2.2 (6) 5.2 ± 2.4 (6) 5.3 ± 2.3 (6) < 0.001 2:3 ** ; 2:4 ** ;2:5 ** Elongated head 9.7 ± 2.9 (10) 4.5 ± 3.4 (4) 4.0 ± 3.1 (3) 4.5 ± 3.5 (4) 4.4 ± 3.4 (4) < 0.001 2:3 ** ; 2:4 ** ; 2:5 ** ;3:4 * Large head 8.6 ± 3.1 (9) 5.8 ± 3.2 (5) 5.5 ± 3.2 (5) 5.7 ± 3.5 (5) 5.7 ± 3.3 (5) < 0.001 2:3 ** ; 2:4 ** ; 2:5 ** ;3:4 * Small head 4.4 ± 2.2 (4) 2.9 ± 2.3 (3) 2.7 ± 2.3 (2) 3.0 ± 2.3 (3) 2.8 ± 2.3 (3) < 0.001 2:3 ** ; 2:4 ** ;2:5 * Tail anomalies 13.8 ± 4.7 (14) 15.6 ± 5.7 (15) 16.0 ± 5.7 (16) 16.1 ± 6.6 (16) 15.8 ± 5.8 (16) 0.007 2:4 * ;2:5 * Coiled tail 6.4 ± 2.9 (7) 7.5 ± 3.6 (7) 7.9 ± 3.6 (7) 8.0 ± 3.5 (8) 7.7 ± 3.6 (7) 0.002 2:4 * ;2:5 * ;3:4 * ;3:5 * Short tail 4.2 ± 2.7 (4) 6.2 ± 3.2 (6) 6.3 ± 3.3 (6) 6.4 ± 4.1 (6) 6.2 ± 3.3 (6) < 0.001 2:3 ** ; 2:4 ** ;2:5 ** ERC 2.8 ± 1.7 (3) 4.4 ± 2.5 (4) 4.6 ± 2.5 (4) 4.5 ± 2.7 (4) 4.5 ± 2.5 (4) < 0.001 2:3 ** ; 2:4 ** ;2:5 ** Values are presented mean ± standard deviation (SD) (median). * P < 0.05, ** P < 0.001. ERC: Excessive residual cytoplasma. Only morphological anomalies with statistically significant differences among abstinence time groups are given in the table. Effects of the age on sperm quality and specific morphological anomalies Significant differences were observed in all semen parameters among the age groups (all P < 0.001). All parameters decreased significantly with increasing age groups. Semen volume was found to decrease significantly in the 40–57 age group compared to other age groups. Sperm concentration, total count, total motility, progressive motility, vitality and normal morphology decreased in age groups over 25, while rapid progressive motility decreased in age groups over 30 (Table 4 ). There were significantly positive correlations between age and all semen parameters (all P < 0.05) (Table 2 ). Moreover, correlations between age and semen parameters were observed to persist after adjustment for BMI and abstinence time (all P < 0.05) (Table 5 ). Table 4 Comparison of semen parameters and sperm morphological anomalies in the age groups Variables Age Groups Group 1 (17–24) N = 1357 Group 2 (25–29) N = 1576 Group 3 (30–34) N = 1341 Group 4 (35–39) N = 761 Group 5 (40–57) N = 456 P -value Significant subgroups Age (years) 21.5 ± 2.1 (22) 27.1 ± 1.4 (27) 31.7 ± 1.4 (32) 36.6 ± 1.3 (36) 43.7 ± 4.5 (42) 0.05 Semen volume (ml) 3.4 ± 1.6 (3) 3.3 ± 1.5 (3) 3.3 ± 1.4 (3) 3.3 ± 1.4 (3) 3.0 ± 1.3 (3) < 0.001 1:5 ** ;2:5 * ;3:5 * ;4:5 * Sperm concentration (×10 6 / ml) 37.6 ± 34.0 (30) 34.6 ± 34.3 (25) 32.4 ± 33.6 (20) 29.8 ± 31.7 (20) 31.2 ± 31.8 (20) < 0.001 1:2 * ;1:3 ** ;1:4 ** ;1:5 ** ;2:4 * Total sperm count (×10 6 / ejaculat) 126.9 ± 127.9 (95) 113.1 ± 125.6 (72) 103.0 ± 118.4 (60) 99.6 ± 118.4 (55.5) 90.6 ± 97.8 (60) < 0.001 1:2 ** ;1:3 ** ;1:4 ** ;1:5 ** ;2:4 * ;2:5 * Total sperm motility (%) 64.4 ± 18.4 (68) 60.3 ± 22.6 (67) 58.4 ± 22.2 (64) 56.5 ± 23.1 (63) 54.0 ± 23.4 (60) < 0.001 1:2 * ;1:3 ** ;1:4 ** ;1:5 ** ;2:3 * ;2:4 ** ;2:5 ** ;3:5 * Progressive sperm motility (%) 49.5 ± 16.6 (52) 45.9 ± 19.5 (50) 44.0 ± 19.2 (48) 42.6 ± 19.7 (47) 39.8 ± 19.6 (43) < 0.001 1:2 ** ;1:3 ** ;1:4 ** ;1:5 ** ;2:3 * ;2:4 ** ;2:5 ** ;4:5 * Rapid progressive sperm motility (%) 5.3 ± 5.4 (3) N = 1330 4.9 ± 5.4 (3) N = 1548 4.7 ± 5.4 (3) N = 1320 4.3 ± 5.1 (3) N = 744 4.1 ± 5.1 (3) N = 448 < 0.001 1:3 ** ;1:4 ** ;1:5 ** ;2:4 * ;2:5 * Sperm vitality (%) 50.0 ± 29.8 (55) N = 282 40.7 ± 30.5 (45) N = 413 42.2 ± 28.9 (45) N = 398 36.3 ± 27.3 (41) N = 241 36.9 ± 26.5 (41) N = 168 < 0.001 1:2 * ;1:3 * ;1:4 ** ;1:5 ** Normal sperm morphology (%) 2.5 ± 1.2 (2) N = 795 2.3 ± 1.3 (2) N = 857 2.3 ± 1.2 (2) N = 686 2.3 ± 1.2 (2) N = 385 2.1 ± 1.1 (2) N = 220 < 0.001 1:2 * ;1:3 * ;1:5 * Head Anomaly (%) 78.7 ± 4.7 (79) 79.0 ± 5.3 (79) 79.1 ± 5.1 (79) 79.1 ± 4.6 (79) 80.1 ± 5.7 (80) 0.004 1:5 * ;2:5 * ;3:5 * ;4:5 * Elongated head (%) 4.1 ± 3.2 (3) 4.4 ± 3.3 (4) 4.6 ± 3.5 (4) 4.4 ± 3.3 (4) 4.8 ± 3.8 (4) 0.04 1:3 * ;1:5 * Large head (%) 5.4 ± 3.2 (5) 5.8 ± 3.3 (5) 5.8 ± 3.3 (5) 5.9 ± 3.1 (5) 5.8 ± 3.5 (5) 0.03 1:4 * Tail anomaly (%) 15.5 ± 5.4 (15) 15.7 ± 5.9 (16) 15.8 ± 5.5 (15) 15.8 ± 6.0 (15.5) 17.3 ± 6.6 (17) 0.01 1:5 * ;2:5 * ;3:5 * Coiled tail ( %) 7.4 ± 3.3 (7) 7.5 ± 3.4 (7) 7.6 ± 3.5 (7) 8.1 ± 4.0 (7) 8.8 ± 4.3 (8) < 0.001 1:5 ** ;2:5 ** ;3:5 * Values are presented mean ± standard deviation (SD) (median). * P < 0.05, ** P < 0.001. TZI: Teratozoospermia index. Only morphological anomalies with statistically significant differences among age groups are given in the table. Table 5 Linear regression analysis of age with semen parameters and sperm morphological anomalies Semen Variables Age (year) β 95% Confidence Intervals Adjusted P Volume (ml) -0.040 -0.303 / -0.058 0.004 Sperm concentration (×10 6 / ml) -0.052 -0.016 / -0.005 < 0.001 Total sperm count (×10 6 ) -0.067 -0.005 / -0.002 < 0.001 Total sperm motility (%) -0.119 -0.044 / -0.028 < 0.001 Progressive sperm motility (%) -0.125 -0.053 / -0.034 < 0.001 Rapid progressive sperm motility (%) -0.062 -0.110 / -0.042 < 0.001 Sperm vitality (%) -0.104 -0.036 / -0.012 < 0.001 Normal sperm morphology (%) -0.053 -0.467 / -0.094 0.003 Head anomalies (%) 0.041 0.007 / 0.099 0.023 Pin head (%) 0.056 0.053 / 0.228 0.002 Elongated head (%) 0.036 0.001 / 0.137 0.048 Tail anomalies (%) 0.054 0.021 / 0.101 0.003 Coiled tail (%) 0.100 0.118 / 0.246 < 0.001 P values were adjusted for BMI and abstinence time. P -value < 0.05 was considered statistically significant. Only morphological anomalies with statistically significant differences are given in the table. The incidence of all five categories of morphological anomalies (head anomalies, elongated and large heads, tail anomalies, and coiled tails) differed significantly among the five age categories. It was noted that the incidence of total head and tail anomalies and coiled tails increased significantly in the 40–57 age group compared to other age groups. Elongated heads were significantly more frequently in the 30–34 age group and the 40–57 age group, and large heads were significantly more frequently in the 35–39 age group, compared to the 17–24 age group (Table 4 ). TZI did not differ significantly among the age groups. In the analysis of correlations of age with specific morphological anomalies, age was positively correlated with total head anomalies, pin heads, large heads, elongated heads, total tail anomalies and coiled tails (Table 2 ). After adjusting for confounding factors, the correlations between age and specific anomalies, except for large head persisted (Table 5 ). No significant correlations were observed between other sperm anomalies examined and TZI, and age ( P > 0.05). Discussion Previous studies have addressed the role of age and the duration of sexual abstinence on sperm count and motility parameters and the rate of normal morphology. In the present study, we investigated the effects of age and abstinence time on sperm morphology in more detail by considering their associations with specific morphological anomalies. It has been shown that there is a decline in male reproductive functions with aging [ 19 ] and that advanced age of the male partner is associated with a decrease in pregnancy rates [ 20 ]. The male age threshold for increased risk for infertility and poor IVF outcomes has not been established, but the risk is believed to increase after age 40 [ 14 ]. Many studies have shown that semen volume, sperm concentration, total sperm motility and progressive motility decrease with the increase of male age [ 9 , 10 , 11 , 13 , 21 ]. However, studies on the role of age on sperm morphology have yielded conflicting results. In addition to evidence that the rate of normal sperm morphology decreases with increasing age [ 12 , 13 ], it has also been reported that age does not affect normal morphology rate [ 9 , 10 , 11 , 22 ]. The present study showed that increasing age is associated with a significant decrease in all semen parameters, including normal sperm morphology. Different threshold values ​​of male age for the risk of low semen parameters have been reported in the literature. Pino et al. showed that semen volume and sperm concentration significantly decreased in men over 50 years of age, total sperm count over 41 years of age and progressive sperm motility over 31 years of age [ 10 ]. However, they did not find any relationship between age and normal morphology rate. Paoli et al. revealed that the most significant risk for decreased total sperm count, progressive motility and morphology occurs after the age of 50 [ 13 ]. Others have suggested a threshold age of 40 for sperm concentration and normal morphology [ 23 ] and 25 for sperm motility [ 24 ]. According to our findings, semen volume decreased over age 40, while sperm concentration, total count, total motility, progressive motility, vitality, and normal morphology decreased over age 25, and rapid progressive motility decreased over age 30. Semen volume mainly reflects male accessory gland functions, and thus it is possible that testicular or epididymal functions, which are related to other sperm parameters, may be affected at an earlier age than the accessory gland functions. This discrepancy across the studies may be due to significant racial differences in semen variables. Moreover, it is known that semen parameters can be affected by the duration of abstinence11 and the presence of additional pathological conditions such as obesity and smoking [ 25 ]. Therefore, in our study, the role of age on semen quality was revealed more accurately by controlling the confounding factors that may affect semen parameters. After adjusting for BMI and abstinence time, it was observed that age remained associated with all semen parameters. The present study also showed that the abstinence time was significantly associated with semen parameters, except for progressive motility. Semen volume, sperm concentration, total count, total motility and normal morphology rate increased with the increase of the abstinence time. Rapid progressive motility decreased with the increase of the abstinence time. A previous study showed that the abstinence time was positively correlated with semen volume and sperm concentration and negatively correlated with progressive motility, but morphology parameters were not affected by the abstinence time. However, they did not evaluate rapid progressive motility. They also reported that increasing the abstinence time caused a significant increase in sperm DNA fragmentation index and suggested that DNA damage may be responsible for the motility defect in particular [ 11 ]. After their production in the testes through spermatogenesis and spermiogenesis processes, spermatozoa acquire progressive motility and further chromatin condensation during their storage in the ductus epididymis, known as epididimal maturation process [ 26 ]. Sperm production is affected by many factors, including genetic factors, obesity, hormonal changes, and environmental factors such as temperature, radiation, environmental pollutants, reactive oxygen species (ROS), smoking and varicocele [ 27 , 28 , 29 , 30 ]. The decline in semen quality with aging may be explained by decreased testosterone production due to decreased testicular volume and the number of Leydig cells [ 4 , 6 ]. Another important mechanism underlying the effect of age on semen quality is the deterioration of sperm DNA integrity due to increased oxidative stress or abnormal sperm apoptosis with aging [ 9 , 10 , 11 , 13 ]. DNA damage may also arise from defect in the chromatin condensation process. Sperm DNA undergoes epigenetic changes during aging, resulting in abnormal chromatin condensation and increased DNA fragmentation, reducing the stability of the paternal genome [ 27 ]. Sperm DNA damage is also associated with mitochondrial DNA damage and may particularly lead to deterioration of sperm motility parameters [ 31 ]. However, sperm DNA damage has been associated with different semen parameters such as sperm concentration, motility parameters and normal morphology [ 32 ], or with sperm motility and normal morphology [ 33 ] in various studies. Therefore, with increasing age and abstinence duration, increased exposure of sperm to ROS levels in the genital tract may be responsible for the alterations in semen parameters by causing sperm DNA damage and abnormal sperm apoptosis. Our results suggest that there may be a widespread increase in ROS with aging, affecting all testicular, epididymal or accessory gland functions, leading to deterioration of all sperm parameters. However, total and progressive sperm motility and sperm vitality were more sensitive to aging than other semen parameters, emphasizing a significant deterioration in epididymal functions with aging. The increase of abstinence time which leads to increased exposure of sperm to epididymal ROS may have a defective epididymal mechanism, resulting in specifically impaired sperm rapid progressive motility. It has been shown that morphologically abnormal sperm have a higher rate of DNA damage [ 16 , 29 , 33 ]. Moreover, DNA fragmentation has been reported to be more closely associated with certain morphological anomalies than with the rate of normal morphology [ 17 ]. Amorphous, round, tapered and elongated heads, bent necks, coiled and short tails, and ERC have been frequently associated with abnormal sperm DNA status such as DNA fragmentation and chromatin condensation defects [ 17 , 34 , 35 , 36 , 37 ]. Therefore, it can be predicted that the cumulative effect of aging and negative external factors that can lead to sperm DNA damage, such as obesity, smoking and environmental pollution, may be associated with an increase in the incidence of certain morphological anomalies. In the present study, we observed that aging causes an increase in the incidence of total head and tail anomalies, elongated and large heads and coiled tails, especially in those over 40 years of age. Moreover, after adjusting for confounding factors, age showed weak positive correlations with total head anomalies, elongated heads, pin heads and total tail anomalies, but a relatively stronger positive correlation with coiled tails. Therefore, aging may be associated with defects in sperm morphogenesis, including spermiogenesis and epididymal maturation processes, related to sperm head and especially tail formation. Epididymal structure and function have been shown to be affected by environmental factors and to deteriorate with aging [ 28 , 38 ]. Coiled tails may arise from impaired epididymal maturation due to genetics or environmental factors such as varicocele and smoking, resulting in oxidation of the outer dense fibers and fibrous sheath, increased membrane permeability, and hypoosmotic stress [ 39 ]. Coiled tails have been significantly associated with male infertility and unsuccessful IVF outcomes [ 40 ]. Kleshchev et al. have reported increased frequencies of coiled and short tails in men over the age of 40. They also have observed the increased frequency of combinations of coiled tails with amorphous, elongated, or vacuolated heads over the age of 40 [ 22 ]. Sperm head elongation is an important stage of spermiogenesis in which, in addition to head shaping, chromatin rearrangement and tail assembly [ 41 ] are carried out. Therefore, any disruption at this stage may result not only in head defects but also in midpiece and tail defects. Abnormal head elongation occurs especially in the presence of infection and varicocele and is generally associated with severe DNA damage, chromosomal abnormalities and impaired chromatin compaction [ 36 ]. Our results indicate that aging is associated with disruption of spermiogenesis and/or epididymal maturation processes, resulting in elongated head and coiled tail defects. Thus, the increase in the incidence of these anomalies may conribute to the decrease in fertilization capacity observed with aging. The present study demonstrated for the first time the association of sperm morphological anomalies with the duration of abstinence. We found that as the duration of abstinence increased, there was a significant increase in the incidence of amorphous, tapered and round heads, irregular acrosomal distribution, total tail anomalies, coiled and short tails and ERC. However, there was a decrease in the incidence of elongated, large and pin heads. The results of our unpublished study show that head and tail anomalies were more strongly associated with sperm motility parameters than neck-midpiece anomalies, and that amorphous, tapered and round heads, irregular acrosomal distribution and coiled and short tails were strongly associated with progressive and especially rapid progressive motility, supporting that the duration of abstinence is associated with epididymal dysfunction, probably related to increased epididymal ROS, specifically responsible for the increase of certain morphological anomalies and the decrease of rapid progressive motility, as well as the impairment of spermiogenesis. The fact that head anomalies negatively affected by the duration of abstinence exhibit an abnormal acrosomal structure as a common feature suggests that abstinence duration may be associated with acrosomal deterioration, and this may explain the impairment of rapid progressive motility in particular. Because an intact acrosomal structure and rapid progressive motility are the most important parameters required for sperm to attach to the zona, undergo the acrosome reaction and fertilize the oocyte [ 42 , 43 ]. ERC are the excess cytoplasmic fragments that remain around the midpiece of sperm that does not disappear in the final maturation phase of spermiogenesis. It is also associated with impaired sperm maturation in the epididymis [ 2 ]. It has been reported that ERC causes DNA damage [ 44 ] and poor semen quality and infertility [ 15 ] due to excessive ROS production. It is known that the manchett-transient cytoskeleton structure in spermatids is necessary for the removal of excess cytoplasm and the formation of the tail [ 45 ]. As the duration of abstinence increases, it is likely that, in addition to the impaired of epididymal maturation, dysfunction of this structure may also occur. The main limitation of this study is that computer-assisted semen analysis (CASA) was not employed. Although manual assessment is widely accepted according to WHO guidelines, the absence of CASA data may reduce the precision and objectivity of motility evaluation. Therefore, future research incorporating CASA-based assessments would be valuable to strengthen these findings. Conclusions The present study demonstrates the association of age with semen quality and specific morphological anomalies in a large population and after controlling for factors that may affect semen quality. Aging causes significant deterioration in semen quality and an increase in the incidence of certain morphological anomalies including elongated heads and coiled tails, particularly in individuals over 40 years of age. The association between abstinence time and specific morphological anomalies is unknown. The present study shows that with increasing abstinence time, there is a significant increase in the incidence of amorphous, tapered and round heads, irregular acrosomal distribution, total tail defects, coiled and short tails, and ERC, and a significant decrease in rapid progressive sperm motility. It is noteworthy that while age and abstinence time are associated with sperm head and tail anomalies and ERC, there is no association with neck-midpiece anomalies. Therefore, aging and the increase of abstinence may be associated with defects in sperm morphogenesis, which involves spermiogenesis and epididymal maturation processes, especially related to sperm head and tail formation, leading to increased genital ROS levels and sperm DNA damage, possibly with the contribution of external factors. However, sperm formation is a complex process affected by many factors, and the molecular mechanisms underlying the association of specific morphological defects with age and their contribution to male infertility need to be further investigated. Abbreviations BMI Body mass index CASA Computer-assisted semen analysis ERC Excessive residual cytoplasm IVF In vitro fertilization ROS Reactive oxygen species TZI Teratozoospermia index WHO World Health Organization Declarations Ethics approval and consent to participate This study was conducted in compliance with the principles outlined in the Declaration of Helsinki and was approved by the institutional ethics review board of the Ethics Committee of Selcuk University, Faculty of Medicine. All participants were provided with comprehensive information about the study and written informed consent was obtained. Informed consent was obtained from the parents and/or legal guardians of minör participants aged 17 years. Consent for publication Not applicable. Availability of data and materials All relevant data presented in this study are included in the article. Any other data that support the findings discussed here are available from the corresponding author upon request. Competing interests There are no conflicts of interest, such as financial or other potential interests, that could undermine the objectivity of the research. Funding No funding was received to support this study. Authors' contributions D.D. was involved in the conceptualization, design, analysis, interpretation and writing of the manuscript. Acknowledgements I would like to thank Rukiye Erdogan and Ozlem Sahin, the staff members of the Andrology Laboratory at Selcuk University Faculty of Medicine Hospital, for their valuable assistance in collecting the study materials. References Agarwal A, Baskaran S, Parekh N, Cho CL, Henkel R, Vij S, et al. Male infertility. Lancet. 2021;397(10271):319–33. 10.1016/S0140-6736(20)32667-2 . Epub 2020 Dec 10. PMID: 33308486. WHO. WHO Laboratory Manual for the Examination and Processing of Human Semen. 5th ed. Geneva: WHO; 2010. pp. 49–98. Gunes S, Hekim GN, Arslan MA, Asci R. Effects of aging on the male reproductive system. J Assist Reprod Genet. 2016;33(4):441–54. 10.1007/s10815-016-0663-y . Kaufman JM, Lapauw B, Mahmoud A, T'Sjoen G, Huhtaniemi IT. Aging and the Male Reproductive System. Endocr Rev. 2019;40(4):906–72. 10.1210/er.2018-00178 . Ajayi AF, Onaolapo MC, Omole AI, Adeyemi WJ, Oluwole DT. Mechanism associated with changes in male reproductive functions during ageing process. Exp Gerontol. 2023;179:112232. 10.1016/j.exger.2023.112232 . Petersen PM, Seierøe K, Pakkenberg B. The total number of Leydig and Sertoli cells in the testes of men across various age groups - a stereological study. J Anat. 2015;226(2):175–9. 10.1111/joa.12261 . Colson MH, Cuzin B, Faix A, Grellet L, Huyghes E. Current epidemiology of erectile dysfunction, an update. Sexologies. 2018;27:e7–13. Matzkin ME, Calandra RS, Rossi SP, Bartke A, Frungieri MB. Hallmarks of Testicular Aging: The Challenge of Anti-Inflammatory and Antioxidant Therapies Using Natural and/or Pharmacological Compounds to Improve the Physiopathological Status of the Aged Male Gonad. Cells. 2021;10(11):3114. 10.3390/cells10113114 . Colasante A, Minasi MG, Scarselli F, Casciani V, Zazzaro V, Ruberti A, et al. The aging male: Relationship between male age, sperm quality and sperm DNA damage in an unselected population of 3124 men attending the fertility centre for the first time. Arch Ital Urol Androl. 2019;90(4):254–9. 10.4081/aiua.2018.4.254 . Pino V, Sanz A, Valdés N, Crosby J, Mackenna A. The effects of aging on semen parameters and sperm DNA fragmentation. JBRA Assist Reprod. 2020;24(1):82–6. 10.5935/1518-0557.20190058 . Chen GX, Li HY, Lin YH, Huang ZQ, Huang PY, Da LC, et al. The effect of age and abstinence time on semen quality: a retrospective study. Asian J Androl. 2022;24(1):73–7. 10.4103/aja202165 . Cito G, Picone R, Fucci R, Giachini C, Micelli E, Cocci A, et al. Sperm morphology: What implications on the assisted reproductive outcomes? Andrology. 2020;8(6):1867–74. 10.1111/andr.12883 . Paoli D, Pecora G, Pallotti F, Faja F, Pelloni M, Lenzi A, et al. Cytological and molecular aspects of the ageing sperm. Hum Reprod. 2019;34(2):218–27. 10.1093/humrep/dey357 . Brandt JS, Cruz Ithier MA, Rosen T, Ashkinadze E. Advanced paternal age, infertility, and reproductive risks: A review of the literature. Prenat Diagn. 2019;39(2):81–7. 10.1002/pd.5402 . Epub 2019 Jan 10. Auger J, Jouannet P, Eustache F. Another look at human sperm morphology. Hum Reprod. 2016;31(1):10–23. 10.1093/humrep/dev251 . Agarwal A, Tvrda E, Sharma R. Relationship amongst teratozoospermia, seminal oxidative stress and male infertility. Reprod Biol Endocrinol. 2014;12:45. 10.1186/1477-7827-12-45 . Nguyen HTT, Dang HNT, Nguyen TTT, Nguyen TV, Dang TC, Nguyen QHV, et al. Correlations between abnormalities of morphological details and DNA fragmentation in human sperm. Clin Exp Reprod Med. 2022;49(1):40–8. 10.5653/cerm.2021.04777 . Menkveld R, Stander FS, Kotze TJ, Kruger TF, van Zyl JA. The evaluation of morphological characteristics of human spermatozoa according to stricter criteria. Hum Reprod. 1990;5(5):586–92. 10.1093/oxfordjournals.humrep.a137150 . De La Rochebrochard E, McElreavey K, Thonneau P. Paternal age over 40 years: the amber light in the reproductive life of men? J Androl. 2003;24(4):459–65. 10.1002/j.1939-4640.2003.tb02694.x . Ford WC, North K, Taylor H, Farrow A, Hull MG, Golding J. Increasing paternal age is associated with delayed conception in a large population of fertile couples: evidence for declining fecundity in older men. The ALSPAC Study Team (Avon Longitudinal Study of Pregnancy and Childhood). Hum Reprod. 2000;15(8):1703–8. 10.1093/humrep/15.8.1703 . Li WN, Jia MM, Peng YQ, Ding R, Fan LQ, Liu G. Semen quality pattern and age threshold: a retrospective cross-sectional study of 71,623 infertile men in China, between 2011 and 2017. Reprod Biol Endocrinol. 2019;17(1):107. 10.1186/s12958-019-0551-2 . Kleshchev M, Osadchuk L, Osadchuk A. Age-Related Changes in Sperm Morphology and Analysis of Multiple Sperm Defects. Front Biosci (Schol Ed). 2023;15(3):12. 10.31083/j.fbs1503012 . Stone BA, Alex A, Werlin LB, Marrs RP. Age thresholds for changes in semen parameters in men. Fertil Steril. 2013;100(4):952–8. 10.1016/j.fertnstert.2013.05.046 . Levitas E, Lunenfeld E, Weisz N, Friger M, Potashnik G. Relationship between age and semen parameters in men with normal sperm concentration: analysis of 6022 semen samples. Andrologia. 2007;39(2):45–50. 10.1111/j.1439-0272.2007.00761.x . Salas-Huetos A, Maghsoumi-Norouzabad L, James ER, Carrell DT, Aston KI, Jenkins TG, et al. Male adiposity, sperm parameters and reproductive hormones: An updated systematic review and collaborative meta-analysis. Obes Rev. 2021;22(1):e13082. 10.1111/obr.13082 . James ER, Carrell DT, Aston KI, Jenkins TG, Yeste M, Salas-Huetos A. The Role of the Epididymis and the Contribution of Epididymosomes to Mammalian Reproduction. Int J Mol Sci. 2020;21(15):5377. 10.3390/ijms21155377 . Vaughan DA, Tirado E, Garcia D, Datta V, Sakkas D. DNA fragmentation of sperm: a radical examination of the contribution of oxidative stress and age in 16 945 semen samples. Hum Reprod. 2020;35(10):2188–96. 10.1093/humrep/deaa159 . Selvaraju V, Baskaran S, Agarwal A, Henkel R. Environmental contaminants and male infertility: Effects and mechanisms. Andrologia. 2021;53(1):e13646. 10.1111/and.13646 . Antoniassi MP, Belardin LB, Camargo M, Intasqui P, Carvalho VM, Cardozo KHM, et al. Seminal plasma protein networks and enriched functions in varicocele: Effect of smoking. Andrologia. 2020;52(5):e13562. 10.1111/and.13562 . Leisegang K, Henkel R, Agarwal A. Obesity and metabolic syndrome associated with systemic inflammation and the impact on the male reproductive system. Am J Reprod Immunol. 2019;82(5):e13178. 10.1111/aji.13178 . Sharbatoghli M, Valojerdi MR, Amanlou M, Khosravi F, Jafar-abadi MA. Relationship of sperm DNA fragmentation, apoptosis and dysfunction of mitochondrial membrane potential with semen parameters and ART outcome after intracytoplasmic sperm injection. Arch Gynecol Obstet. 2012;286(5):1315–22. 10.1007/s00404-012-2440-1 . Jakubik-Uljasz J, Gill K, Rosiak-Gill A, Piasecka M. Relationship between sperm morphology and sperm DNA dispersion. Transl Androl Urol. 2020;9(2):405–15. 10.21037/tau.2020.01.31 . Okubo T, Onda N, Hayashi T, Kobayashi T, Omi K, Segawa T. Performing a sperm DNA fragmentation test in addition to semen examination based on the WHO criteria can be a more accurate diagnosis of IVF outcomes. BMC Urol. 2023;23(1):78. 10.1186/s12894-023-01257-y . Ma Y, Xie N, Li Y, Zhang B, Xie D, Zhang W, et al. Teratozoospermia with amorphous sperm head associate with abnormal chromatin condensation in a Chinese family. Syst Biol Reprod Med. 2019;65(1):61–70. 10.1080/19396368.2018.1543481 . Dehghanpour F, Tabibnejad N, Fesahat F, Yazdinejad F, Talebi AR. Evaluation of sperm protamine deficiency and apoptosis in infertile men with idiopathic teratozoospermia. Clin Exp Reprod Med. 2017;44(2):73–8. 10.5653/cerm.2017.44.2.73 . Kleshchev M, Osadchuk A, Osadchuk L. Impaired semen quality, an increase of sperm morphological defects and DNA fragmentation associated with environmental pollution in urban population of young men from Western Siberia, Russia. PLoS ONE. 2021;16(10):e0258900. 10.1371/journal.pone.0258900 . Atshan M, Kakavand K, Hosseini SH, Sadighi Gilani MA, Mohseni Meybodi A, Sabbaghian M. Evaluation of sperm DNA fragmentation and chromatin structure in infertile men with immotile short-tail sperm defect. Andrologia. 2020;52(1):e13445. 10.1111/and.13445 . Serre V, Robaire B. Segment-specific morphological changes in aging Brown Norway rat epididymis. Biol Reprod. 1998;58(2):497–513. 10.1095/biolreprod58.2.497 . Yeung CH, Tüttelmann F, Bergmann M, Nordhoff V, Vorona E, Cooper TG. Coiled sperm from infertile patients: characteristics, associated factors and biological implication. Hum Reprod. 2009;24(6):1288–95. 10.1093/humrep/dep017 . Nikolova S, Parvanov D, Georgieva V, Ivanova I, Ganeva R, Stamenov G. Impact of sperm characteristics on time-lapse embryo morphokinetic parameters and clinical outcome of conventional in vitro fertilization. Andrology. 2020;8(5):1107–16. 10.1111/andr.12781 . Teves ME, Roldan ERS. Sperm bauplan and function and underlying processes of sperm formation and selection. Physiol Rev. 2022;102(1):7–60. 10.1152/physrev.00009.2020 . Comhaire FH, Vermeulen L, Hinting A, Schoonjans F. Accuracy of sperm characteristics in predicting the in vitro fertilizing capacity of semen. J Vitro Fert Embryo Transf. 1988;5(6):326–31. 10.1007/BF01129567 . Menkveld R, Rhemrev JP, Franken DR, Vermeiden JP, Kruger TF. Acrosomal morphology as a novel criterion for male fertility diagnosis: relation with acrosin activity, morphology (strict criteria), and fertilization in vitro. Fertil Steril. 1996;65(3):637–44. 10.1016/s0015-0282(16)58167-9 . Rengan AK, Agarwal A, van der Linde M, du Plessis SS. An investigation of excess residual cytoplasm in human spermatozoa and its distinction from the cytoplasmic droplet. Reprod Biol Endocrinol. 2012;10:92. 10.1186/1477-7827-10-92 . Lehti MS, Sironen A. Formation and function of the manchette and flagellum during spermatogenesis. Reproduction. 2016;151(4):R43–54. 10.1530/REP-15-0310 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 14 Apr, 2026 Reviews received at journal 13 Apr, 2026 Reviews received at journal 29 Mar, 2026 Reviewers agreed at journal 01 Mar, 2026 Reviewers agreed at journal 28 Feb, 2026 Reviewers agreed at journal 03 Feb, 2026 Editor invited by journal 19 Jan, 2026 Reviewers invited by journal 11 Nov, 2025 Editor assigned by journal 14 Oct, 2025 Submission checks completed at journal 14 Oct, 2025 First submitted to journal 13 Oct, 2025 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. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-7851337","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":545048092,"identity":"2343862f-9ed3-4cb5-a986-5759cba6a713","order_by":0,"name":"Duygu Dursunoglu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAUlEQVRIiWNgGAWjYDCCAyCCDcYrYJBjYOAhSYsBgzHpWhIbCGnhu5Fj/Jqn7HC+/Izcgw+/GBxO33D87MEHHxjs5HQbsGuRvJFjZs1z7rDlhht5ycYyBodzN5zJSzacwZBsbHYAuxYDoBZj3rbDBgYSOWbSEiAtB4AMHoYDidsIaZGfAdGSbnD+DUEtxo9BWhiAeiU/GBxOABmCV4vkmWdljHPOpRsYnHljbMxgkG4488YbY8MZBrj9wnc8efOHN2XWBvLtOYYPf1RYy/OdzzF88KHCTg6XFgYGDjMJGJMZFCMKYJUGuJSDAPvjDzAm4w8gId+AT/UoGAWjYBSMRAAAjJlhAuTW7jkAAAAASUVORK5CYII=","orcid":"","institution":"Selcuk University","correspondingAuthor":true,"prefix":"","firstName":"Duygu","middleName":"","lastName":"Dursunoglu","suffix":""}],"badges":[],"createdAt":"2025-10-13 17:23:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7851337/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7851337/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":96377767,"identity":"a3adc6f8-a308-4403-804f-9e1731c33061","added_by":"auto","created_at":"2025-11-20 11:35:37","extension":"jpg","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":90806,"visible":true,"origin":"","legend":"","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7851337/v1/0444c5bba4e76865d5b17e42.jpg"},{"id":96377781,"identity":"14d9fcfb-2d55-4bf5-b7d6-c4c03ed72022","added_by":"auto","created_at":"2025-11-20 11:35:37","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":186795,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscript.docx","url":"https://assets-eu.researchsquare.com/files/rs-7851337/v1/da6b52937ebf88ce69851a28.docx"},{"id":96452920,"identity":"780c3dba-a19b-4753-a40d-cdf2792d2fa0","added_by":"auto","created_at":"2025-11-21 09:53:58","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":42629,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7851337/v1/3e675672bbf19809cb04a5cc.docx"},{"id":96453356,"identity":"1dfafbf7-644f-4031-97a0-0ad132a193ec","added_by":"auto","created_at":"2025-11-21 09:59:25","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":32983,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7851337/v1/62f4eb95e43e916a2a597e7d.docx"},{"id":96453376,"identity":"17e36ea7-315b-476b-a549-93118c12284d","added_by":"auto","created_at":"2025-11-21 09:59:33","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":45414,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.docx","url":"https://assets-eu.researchsquare.com/files/rs-7851337/v1/ea27e819e04b2089b9af3e6f.docx"},{"id":96377771,"identity":"d895cfdf-d86a-4503-8ae5-963c2cb091c7","added_by":"auto","created_at":"2025-11-20 11:35:37","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":51059,"visible":true,"origin":"","legend":"","description":"","filename":"Table4.docx","url":"https://assets-eu.researchsquare.com/files/rs-7851337/v1/1796b22afb34cb03af339a61.docx"},{"id":96377768,"identity":"e9d86d07-e3a2-4a8e-88c5-e4327a3c0de1","added_by":"auto","created_at":"2025-11-20 11:35:37","extension":"docx","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":28101,"visible":true,"origin":"","legend":"","description":"","filename":"Table5.docx","url":"https://assets-eu.researchsquare.com/files/rs-7851337/v1/7afc74730bd9f9ee8f28bd2c.docx"},{"id":96453996,"identity":"3fd30087-4b9b-4fd4-8452-915fa6f55881","added_by":"auto","created_at":"2025-11-21 10:02:14","extension":"json","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":3708,"visible":true,"origin":"","legend":"","description":"","filename":"52cfab2f772d40ff9baabed710da7fcd.json","url":"https://assets-eu.researchsquare.com/files/rs-7851337/v1/7545fd350d036dfe0ad50cbe.json"},{"id":96377777,"identity":"fd1a3298-066e-4939-8a70-fdda9f2f342d","added_by":"auto","created_at":"2025-11-20 11:35:37","extension":"xml","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":235331,"visible":true,"origin":"","legend":"","description":"","filename":"52cfab2f772d40ff9baabed710da7fcd1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7851337/v1/94a073a64c3dc9968dc5670d.xml"},{"id":96377775,"identity":"410d6d11-d3e6-4ed6-baaf-bb63ec3592ae","added_by":"auto","created_at":"2025-11-20 11:35:37","extension":"jpg","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":90806,"visible":true,"origin":"","legend":"","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7851337/v1/37d2db779992efcfcb47b607.jpg"},{"id":96377774,"identity":"5280d976-8d5b-4995-bdc0-c9f22c7384c9","added_by":"auto","created_at":"2025-11-20 11:35:37","extension":"jpeg","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":90806,"visible":true,"origin":"","legend":"","description":"","filename":"Figure1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7851337/v1/d20e3196e26ca82ee520cdec.jpeg"},{"id":96377772,"identity":"f6ca65f5-2089-4fcb-9e27-03194cde87b5","added_by":"auto","created_at":"2025-11-20 11:35:37","extension":"png","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":63454,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFigure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7851337/v1/7891e48e4c604b4a9d216bc9.png"},{"id":96453403,"identity":"ec084ed9-6dc1-45ba-833c-0ce406542a0a","added_by":"auto","created_at":"2025-11-21 09:59:39","extension":"png","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":63454,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7851337/v1/3a030e959a989bc4ad9a4cec.png"},{"id":96377778,"identity":"b7d83642-f13b-47f9-b49e-869983e6968f","added_by":"auto","created_at":"2025-11-20 11:35:37","extension":"xml","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":233505,"visible":true,"origin":"","legend":"","description":"","filename":"52cfab2f772d40ff9baabed710da7fcd1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7851337/v1/85eea17521353908126d6e8b.xml"},{"id":96377780,"identity":"526cf05b-7d50-483a-9075-cafe8ab4f425","added_by":"auto","created_at":"2025-11-20 11:35:37","extension":"html","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":235811,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7851337/v1/c1dbdd706d08af380adc4b3f.html"},{"id":96377766,"identity":"c5b0b43d-d0ff-4b45-8b58-6a6448ec9316","added_by":"auto","created_at":"2025-11-20 11:35:37","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":90806,"visible":true,"origin":"","legend":"\u003cp\u003eImages of specific sperm morphological anomalies. \u003cstrong\u003eA:\u003c/strong\u003e(1) Normal sperm morphology, (2) Coiled tail, (3) Pin head, (4) Large head, (5) Elongated head. \u003cstrong\u003eB:\u003c/strong\u003e(1) Tapered head, (2) Small head, (3) Multiple head, (4) Irregular acrosomal (large) distribution and bent neck. \u003cstrong\u003eC:\u003c/strong\u003e (1) Acrosomal vacuole, excessive residual cytoplasm and short tail, (2) Thin mid-piece. \u003cstrong\u003eD: \u003c/strong\u003eRound head and irregular acrosomal (small) distribution, (2) Amorphous head and asymmetrical insertion. Sperm morphology was assessed with Spermac staining. X1000 magnification with oil immersion.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7851337/v1/4c335b6c9ba079cb66ab2530.jpg"},{"id":97248316,"identity":"2fc00882-8c12-4838-a54b-9646c3079282","added_by":"auto","created_at":"2025-12-02 12:52:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1358934,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7851337/v1/e118456c-68f9-4acf-8a6c-7a130901cba0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Effect of Age and Abstinence Time on Semen Quality and Specific Sperm Morphological Anomalies","fulltext":[{"header":"Background","content":"\u003cp\u003eInfertility is an important health problem worldwide, and male infertility accounts for approximately half of all infertility cases [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Male infertility is diagnosed by spermiogram, which is based on the assessment of sperm count, motility, and normal morphology parameters determined according to the World Health Organization (WHO) guideline [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. It is known that aging, a physiological process, significantly affects male fertility capacity3. Several possible mechanisms have been proposed to explain how aging process affect male reproductive functions. Several structural and functional changes in the reproductive organs caused by aging directly affect spermatogenesis, leading to poor semen quality [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Aging causes a decrease in testicular volume and the number of Leydig, Sertoli and germ cells, due to testicular atrophy, resulting in decreased testosterone levels and increased gonadotropin levels [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Aging also is an important cause of erectile dysfunction [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In addition, oxidative stress and impairment in the antioxidant defense system that occur with aging lead to impaired germ cell DNA integrity, compromising sperm fertilization capacity [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAging has been clearly shown to negatively affect semen volume, sperm concentration and motility parameters [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], but its effect on morphology parameters is unclear. A decrease in the rate of morphologically normal spermatozoa has been reported in older men [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, other studies have not found a link between age and morphology parameters [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. No threshold value of male age has been established for the risk of infertility and poor in vitro fertilization (IVF) outcomes, but the risk is believed to increase after the age of 40 [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSperm morphology is known to be an important parameter for male infertility. Morphologically abnormal spermatozoa generally have lower fertilization potential and a higher rate of DNA damage [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, the predictive potential of normal morphology rate in the diagnosis and prognosis of male infertility and in the outcomes of IVF treatment is controversial. Certain morphological anomalies have been more strongly associated with sperm fertilization potential and DNA damage [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Therefore, in the assesment of sperm morphology, instead of morphology criteria based solely on normal morphology rate, detailed characterization of morphological patterns may provide a better predictive value for sperm fertilization potential. It is possible that the incidence of some morphological anomalies may increase as a result of increased sperm DNA damage with aging. However, little data are available on the effect of advanced age on specific sperm morphological patterns. It has also been observed that sexual abstinence time could affect semen quality parameters and that prolonged abstinence causes an increase in sperm DNA fragmentation. However, abstinence time has not been associated with sperm morphological parameters.\u003c/p\u003e\u003cp\u003eThe present study aimed to investigate the effect of sexual abstinence time on sperm morphological parameters and age-related changes in conventional semen parameters and spesific morphological anomalies after adjusting for potential confounding factors that may affect semen variables, such as obesity and abstinence time.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy population\u003c/h2\u003e\u003cp\u003e Approval was provided for the current study by the institutional ethics review board of the Ethics Committee of Selcuk University, Faculty of Medicine. The study population consisted of male participants aged 17\u0026ndash;57 years who applied to Selcuk University Hospital Andrology Clinic for standard semen analysis between 2020\u0026ndash;2023 years. All participants were provided with comprehensive information about the study, and written informed consent was obtained. Informed consent was obtained from the parents and/or legal guardians of min\u0026ouml;r participants aged 17 years. Exclusion criteria in the study included testicular tumor, clinical varicocele, genital tract infection, azoospermia, and severe oligozoospermia.\u003c/p\u003e\u003cp\u003eSemen parameters except sperm morphology, vitality, and rapid progressive motility were obtained from 5491 participants. Sperm rapid progressive motility, vitality, and morphology parameters were obtained from 5390, 1502, and 2943 participants, respectively. In order to investigate the effect of age on semen quality and sperm morphological anomalies, all participants were divided into five age groups: Group 1: 17\u0026ndash;24 years, Group 2: 25\u0026ndash;29 years, Group 3: 30\u0026ndash;34 years, Group 4: 35\u0026ndash;39 years and Group 5: 40\u0026ndash;57. Participants were also divided into six groups according to different abstinence time: 2 days, 3 days, 4 days and 5 days. Additionally, participants' height and weight were measured and body mass index (BMI) was calculated by dividing weight in kilograms by the square of height in meters.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSemen analysis\u003c/h3\u003e\n\u003cp\u003eSemen parameters were analyzed according to the \u0026ldquo;WHO laboratory manual for the examination and processing of human semen (2010)\u0026rdquo; guideline and included sperm concentration, total count, total motility, progressive motility, rapid progressive motility, vitality and normal morphology [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSemen samples were obtained through masturbation into a sterile plastic container at the Andrology Clinic after a 2\u0026ndash;5 day period of sexual abstinence. The participants' abstinence times were recorded. The samples were allowed to liquefy at 37\u0026deg;C for 30\u0026ndash;60 minutes. Semen volume was measured using a graduated test tube, into which the entire ejaculate was collected, and the volume was subsequently recorded in millilitres (mL). Liquefied semen samples were evaluated for sperm concentration and motility characteristics using a Makler counting chamber (Sefi Medical Instruments, Haifa, Israel) under an Olympus CX41 microscope (Olympus, Tokyo, Japan) with a phase contrast objective, at \u0026times;200\u0026ndash;400 magnification. For this, a 5 \u0026micro;L drop of liquefied semen was placed in the center of the chamber's lower platform and the cover glass was immediately applied. All assessments were performed in duplicate on at least 200 sperm by an experienced researcher, and the results were compared. If the differences between the results exceeded the acceptance limits, the assessments were repeated. Total sperm count was calculated by multiplying sperm concentration and semen volume. Sperm motility was classified as total sperm motility (WHO class A\u0026thinsp;+\u0026thinsp;B\u0026thinsp;+\u0026thinsp;C), progressive motility (WHO class A\u0026thinsp;+\u0026thinsp;B) and rapid progressive motility (WHO class A) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEosin-nigrosin staining was performed to assess sperm vitality. In the staining protocol, approximately equal volumes (50 \u0026micro;L) of liquefied semen sample and eosin-nigrosin stain (Sperm VitalStain, Nidacon International AB, Gothenburg, Sweden) were mixed in an eppendorf tube. After incubating the mixture for 30 seconds at room temperature, a 10-\u0026micro;L droplet of the mixture was placed on a slide and smear preparations were prepared. Air-dried smears were examined under an Olympus CX41 microscope (Olympus, Tokyo, Japan) with a bright-field objective, using oil immersion, at \u0026times;1000 magnification. At least 200 spermatozoa were counted for each semen sample. Brightly colored sperm cells that were impermeable to the stain were considered live, and colored cells that absorbed the stain were considered dead. Percentage of sperm viability was calculated as the ratio of live cells to total cells.\u003c/p\u003e\n\u003ch3\u003eSperm morphological analysis\u003c/h3\u003e\n\u003cp\u003eSperm morphology was assesed according to the WHO 2010 guideline [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] and Kruger's strict criteria [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. After liquefaction, semen smears were prepared and allowed to air dry. Air-dried smears were then stained with Spermac (Spermac stain\u0026reg;; FertiPro N.V., Belgium) method. In the Spermac method, semen smears were fixed with formaldehyde solution for 5 minutes and stained by dipping for 1 min in solutions A, B and C. The smears were washed with distilled water between each staining process (5 times). Finally, they were air-dried at room temperature. Morphological details were examined under an Olympus CX41 microscope (Olympus, Tokyo, Japan) with bright field objective, using oil immersion, at \u0026times; 1000 magnification on at least 200 spermatozoa for each semen sample. Morphological assessments were performed at least twice in random and blinded manner by a single experienced researcher. Specific anomalies were assesed in 4 regions of the sperm, namely the head (nucleus and acrosome), neck-midpiece, tail, and cytoplasmic residue. Spermatozoa that met the criteria for normal morphology specified by Kruger's strict criteria were classified as normal. Others and spermatozoa with borderline morphology were considered abnormal. The percentage of normal sperm morphology was calculated by dividing the number of spermatozoa with normal morphology by the total number of spermatozoa. Teratozoospermia index (TZI), which expresses the number of anomalies per sperm, was calculated. Images of sperm morphological anomalies were taken using an Olympus BX51 microscope (Olympus, Tokyo, Japan) with an Olympus DP72 camera and DP2 BSW software (Olympus, Tokyo, Japan).\u003c/p\u003e\u003cp\u003eSperm classified as normal according to strict criteria had the following characteristics: a sperm head that was smooth, regularly contoured, and oval in shape, 3 to 5 \u0026micro;m in length and 2 to 3 \u0026micro;m in width, with a length-to-width ratio of 1.5; an acrosomal region covering 40\u0026ndash;70% of the head area, free of large vacuoles or more than two small vacuoles occupying no more than one-fifth of the sperm head; and a post-acrosomal region free of vacuoles; a midpiece that was thin, regular, and about the same length as the sperm head and aligned with the main axis of the sperm head; a principal piece that was regular, thinner than the midpiece and about 45 \u0026micro;m in length and without sharp angulation; and free of excessive residual cytoplasm (ERC) that exceeded one-third of the normal sperm head size.\u003c/p\u003e\u003cp\u003eSpecific sperm head anomalies included amorphous head, irregular acrosomal distribution, vacuolated head (acrosomal, equatorial and post-acrosomal vacuoles), round head, pin head, large head, small head, elongated head, and multiple head anomalies. Sperm neck midpiece anomalies included defects of asymmetrical insertion, thin midpiece, and bent neck. Tail anomalies included multiple, coiled, and short tails.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eAll statistical analysis was performed using R version 4.1.2 (The R Foundation for Statistical Computing. Vienna. Austria; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.r-project.org\u003c/span\u003e\u003cspan address=\"https://www.r-project.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). Kolmogorov-Smirnov test was applied to determine whether the analyzed parameters were normally distributed. Kruskal Wallis analysis and multiple comparison tests were used to compare semen parameters and sperm morphological anomalies among the age groups and the abstinence time groups. Correlations between semen parameters and specific morphological anomalies, and abstinence time were evaluated by Spearman\u0026rsquo;s rank correlation. Correlations between semen parameters and specific morphological anomalies, and age were analyzed by linear regression analyze after adjusting BMI and abstinence time. Odds ratios were calculated with 95% confidence intervals. Values were given as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and median. P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eGeneral characteristics of the study population\u003c/h2\u003e\u003cp\u003eThe mean age was 29.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8 (median: 29) years, and the mean duration of sexual abstinence was 3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 (median: 3) days. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the mean and median values of semen parameters of the entire population. Specific sperm morphological anomalies were most frequently observed in the sperm head (79.0% \u0026plusmn; 5.0%, median: 79%). This was followed by tail anomalies (15.8% \u0026plusmn; 5.8%, median: 16%), neck-midpiece anomalies (13% \u0026plusmn; 3.7%, median: 13%), and ERC anomaly (4.5% \u0026plusmn; 2.5%, median: 4%). Head anomalies, in order of frequency, included amorphous heads, vacuolated heads, pin heads, round heads, large heads, irregular acrosomal distribution, tapered heads, elongated heads, small heads, and multiple heads. The most common tail anomalies were coiled, short, and multiple tails, respectively. The most common neck-midpiece anomalies were thin midpiece, bent neck, and asymmetrical insertion.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparision of semen parameters among the abstinence time groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e\u003cp\u003eAbstinence Time Groups\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSemen Parameters\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 day\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 day\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;2585\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 day\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;2288\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 day\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;446\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;5491\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSignificant subgroups\u003c/p\u003e\u003cp\u003e(\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2 (28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.7 (29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9 (29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e29.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8 (29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e29.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8 (29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSemen volume (ml)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3 (2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 (3.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2:3\u003csup\u003e*\u003c/sup\u003e;2:4\u003csup\u003e**\u003c/sup\u003e;2:5\u003csup\u003e**\u003c/sup\u003e;3:4\u003csup\u003e**\u003c/sup\u003e;3:5\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSperm concentration (\u0026times;10\u003csup\u003e6\u003c/sup\u003e / ml)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.0\u0026thinsp;\u0026plusmn;\u0026thinsp;23.3 (17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.2\u0026thinsp;\u0026plusmn;\u0026thinsp;33.3 (21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.1\u0026thinsp;\u0026plusmn;\u0026thinsp;34.5 (26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e36.4\u0026thinsp;\u0026plusmn;\u0026thinsp;32.8 (26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e33.9\u0026thinsp;\u0026plusmn;\u0026thinsp;33.6 (24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2:4\u003csup\u003e**\u003c/sup\u003e;2:5\u003csup\u003e**\u003c/sup\u003e;3:4\u003csup\u003e**\u003c/sup\u003e;3:5\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal sperm count (\u0026times;10\u003csup\u003e6\u003c/sup\u003e / ejaculat)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60.9\u0026thinsp;\u0026plusmn;\u0026thinsp;67.9 (39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e102.5\u0026thinsp;\u0026plusmn;\u0026thinsp;117.1 (62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e120.1\u0026thinsp;\u0026plusmn;\u0026thinsp;128.1 (82.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e124.9\u0026thinsp;\u0026plusmn;\u0026thinsp;124.1 (90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e110.3\u0026thinsp;\u0026plusmn;\u0026thinsp;121.9 (72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2:3\u003csup\u003e*\u003c/sup\u003e;2:4\u003csup\u003e**\u003c/sup\u003e;2:5\u003csup\u003e**\u003c/sup\u003e;3:4\u003csup\u003e**\u003c/sup\u003e;3:5\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal sperm motility (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56.1\u0026thinsp;\u0026plusmn;\u0026thinsp;20.2 (60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59.3\u0026thinsp;\u0026plusmn;\u0026thinsp;22.5 (65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e60.7\u0026thinsp;\u0026plusmn;\u0026thinsp;21.5 (67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e59.2\u0026thinsp;\u0026plusmn;\u0026thinsp;20.9 (65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e59.8\u0026thinsp;\u0026plusmn;\u0026thinsp;21.9 (65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2:3\u003csup\u003e*\u003c/sup\u003e; 2:4\u003csup\u003e**\u003c/sup\u003e; 2:5\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProgressive sperm motility (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45.8\u0026thinsp;\u0026plusmn;\u0026thinsp;19.1 (49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45.2\u0026thinsp;\u0026plusmn;\u0026thinsp;19.6 (49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45.7\u0026thinsp;\u0026plusmn;\u0026thinsp;18.6 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e44.8\u0026thinsp;\u0026plusmn;\u0026thinsp;18.0 (49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e45.4\u0026thinsp;\u0026plusmn;\u0026thinsp;19.0 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRapid progressive sperm motility (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3 (9)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5 (3)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;2526\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8 (3)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;2253\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3 (3)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;440\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3 (3)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;5390\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2:3\u003csup\u003e**\u003c/sup\u003e;2:4\u003csup\u003e**\u003c/sup\u003e;2:5\u003csup\u003e**\u003c/sup\u003e;3:4\u003csup\u003e*\u003c/sup\u003e;4:5\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSperm vitality (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20.5\u0026thinsp;\u0026plusmn;\u0026thinsp;17.8 (23)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40.3\u0026thinsp;\u0026plusmn;\u0026thinsp;29.2 (45)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;730\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.0\u0026thinsp;\u0026plusmn;\u0026thinsp;29.8 (48)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;629\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e42.6\u0026thinsp;\u0026plusmn;\u0026thinsp;27.4 (45)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e41.7\u0026thinsp;\u0026plusmn;\u0026thinsp;29.3 (45)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;1502\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2:3\u003csup\u003e*\u003c/sup\u003e;2:4\u003csup\u003e**\u003c/sup\u003e;2:5\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal sperm morphology (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 (1)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 (2)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;1358\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3 (2)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;1302\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 (2)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;239\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 (2)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;2943\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2:3\u003csup\u003e**\u003c/sup\u003e;2:4\u003csup\u003e**\u003c/sup\u003e;2:5\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eValues are presented mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) (median). \u003csup\u003e*\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, \u003csup\u003e**\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEffects of abstinence time on sperm quality and specific sperm morphological anomalies\u003c/h3\u003e\n\u003cp\u003eAge did not differ significantly between the abstinence time groups. Semen volume, sperm concentration, total sperm count, total sperm motility, rapid progressive sperm motility, sperm vitality and normal sperm morphology rate were statistically different among the abstinence time groups (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant difference was observed in progressive sperm motility (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Semen volume, sperm concentration, total sperm count, total sperm motility, sperm vitality and normal morphology showed an increase with the increase of abstinence time. These parameters reached their highest values on days 4 and 5 of abstinence. Rapid progressive sperm motility decreased with the increase of abstinence time. Rapid sperm motility was lowest on day 4 of abstinence and showed a nonsignificant trend toward an increase on day 5 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). There were significantly positive correlations between abstinence time and semen parameters except for progressive and rapid progressive sperm motility (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Rapid progressive motility was negatively correlated with abstinence time (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant correlation was observed between progressive motility and abstinence time (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSpearman\u0026rsquo;s correlations of age and abtinence time with semen parameters and sperm morphological anomalies\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eAbstinence time (day)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVolume (ml)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.039\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.099\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSperm concentration (\u0026times;106 / ml)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.094\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.076\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal sperm count (\u0026times;106 / ejaculat)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.099\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal sperm motility (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.035\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProgressive sperm motility (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRapid progressive sperm motility (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.094\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.066\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSperm vitality (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.073\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal sperm morphology (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.085\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.026\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHead anomalies (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.056\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIrregular acrosomal distribution (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.055\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAmorphous head (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.048\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRound head (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.072\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePin head (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElongated head (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.044\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.081\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLarge head (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.049\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.079\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTapered head (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.046\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTail anomalies (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.049\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.053\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoiled tail (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.078\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.067\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShort tail (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.049\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eERC (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.042\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.022\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eP\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. ERC: Excessive residual cytoplasma. Only morphological anomalies with statistically significant differences are given in the table.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAmong the specific morphological anomalies examined, the incidences of irregular acrosomal distribution, amorphous, round, pin, tapered, elongated, large, and small heads, total tail anomalies, coiled and short tails, and ERC were observed to be significantly different among the abstinence time groups (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). While the incidences of irregular acrosomal distribution, amorphous, round and tapered heads, total tail anomalies, coiled and short tails, and ERC were found to significantly increase with increasing abstinence time, the incidences of pin, elongated, large and small heads were found to significantly decrease with increasing abstinence time. TZI did not show any significant differences between the abstinence duration groups (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Irregular acrosomal distribution, amorphous, round and tapered heads, total tail anomalies, coiled and short tails and ERC were significantly positively correlated with abstinence time, while elongated, large and small heads were negatively correlated with abstinence time (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). No significant correlations were found between other specific anomalies examined and TZI, and abstinence time (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparision of sperm morphological anomalies in the abstinence time groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSperm Morphological Anomalies (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e\u003cp\u003eAbstinence Time Groups\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 day\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;44\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 day\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;1358\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 day\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;1302\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 day\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;239\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;2943\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSignificant subgroups\u003c/p\u003e\u003cp\u003e(\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIrregular acrosomal distribution\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2:3\u003csup\u003e*\u003c/sup\u003e; 2:4\u003csup\u003e*\u003c/sup\u003e; 2:5\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAmorphous head\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3 (18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e24.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2:3\u003csup\u003e**\u003c/sup\u003e; 2:4\u003csup\u003e**\u003c/sup\u003e;2:5\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRound head\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2 (4.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2:3\u003csup\u003e**\u003c/sup\u003e; 2:4\u003csup\u003e**\u003c/sup\u003e; 2:5\u003csup\u003e**\u003c/sup\u003e;3:4\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePin head\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6 (8.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2:3\u003csup\u003e*\u003c/sup\u003e; 2:4\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTapered head\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2:3\u003csup\u003e**\u003c/sup\u003e; 2:4\u003csup\u003e**\u003c/sup\u003e;2:5\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElongated head\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9 (10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2:3\u003csup\u003e**\u003c/sup\u003e; 2:4\u003csup\u003e**\u003c/sup\u003e; 2:5\u003csup\u003e**\u003c/sup\u003e;3:4\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLarge head\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1 (9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2:3\u003csup\u003e**\u003c/sup\u003e; 2:4\u003csup\u003e**\u003c/sup\u003e; 2:5\u003csup\u003e**\u003c/sup\u003e;3:4\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmall head\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2:3\u003csup\u003e**\u003c/sup\u003e; 2:4\u003csup\u003e**\u003c/sup\u003e;2:5\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTail anomalies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7 (14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7 (15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7 (16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.6 (16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8 (16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2:4\u003csup\u003e*\u003c/sup\u003e;2:5\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoiled tail\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5 (8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2:4\u003csup\u003e*\u003c/sup\u003e;2:5\u003csup\u003e*\u003c/sup\u003e;3:4\u003csup\u003e*\u003c/sup\u003e;3:5\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShort tail\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2:3\u003csup\u003e**\u003c/sup\u003e; 2:4\u003csup\u003e**\u003c/sup\u003e;2:5\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eERC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2:3\u003csup\u003e**\u003c/sup\u003e; 2:4\u003csup\u003e**\u003c/sup\u003e;2:5\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eValues are presented mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) (median). \u003csup\u003e*\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, \u003csup\u003e**\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001. ERC: Excessive residual cytoplasma. Only morphological anomalies with statistically significant differences among abstinence time groups are given in the table.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eEffects of the age on sperm quality and specific morphological anomalies\u003c/h3\u003e\n\u003cp\u003eSignificant differences were observed in all semen parameters among the age groups (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). All parameters decreased significantly with increasing age groups. Semen volume was found to decrease significantly in the 40\u0026ndash;57 age group compared to other age groups. Sperm concentration, total count, total motility, progressive motility, vitality and normal morphology decreased in age groups over 25, while rapid progressive motility decreased in age groups over 30 (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). There were significantly positive correlations between age and all semen parameters (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Moreover, correlations between age and semen parameters were observed to persist after adjustment for BMI and abstinence time (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of semen parameters and sperm morphological anomalies in the age groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e\u003cp\u003eAge Groups\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup 1\u003c/p\u003e\u003cp\u003e(17\u0026ndash;24)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;1357\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGroup 2\u003c/p\u003e\u003cp\u003e(25\u0026ndash;29)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;1576\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGroup 3\u003c/p\u003e\u003cp\u003e(30\u0026ndash;34)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;1341\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eGroup 4\u003c/p\u003e\u003cp\u003e(35\u0026ndash;39)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;761\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGroup 5 (40\u0026ndash;57)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;456\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSignificant subgroups\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e21.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1 (22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e27.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 (27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e31.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 (32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e36.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3 (36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e43.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5 (42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1:2\u003csup\u003e**\u003c/sup\u003e;1:3\u003csup\u003e**\u003c/sup\u003e;1:4\u003csup\u003e**\u003c/sup\u003e;1:5\u003csup\u003e**\u003c/sup\u003e;2:3\u003csup\u003e**\u003c/sup\u003e;2:4\u003csup\u003e**\u003c/sup\u003e;2:5\u003csup\u003e**\u003c/sup\u003e;3:4\u003csup\u003e**\u003c/sup\u003e;3:5\u003csup\u003e**\u003c/sup\u003e;4:5\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbstinence time (days)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSemen volume (ml)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1:5\u003csup\u003e**\u003c/sup\u003e;2:5\u003csup\u003e*\u003c/sup\u003e;3:5\u003csup\u003e*\u003c/sup\u003e;4:5\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSperm concentration (\u0026times;10\u003csup\u003e6\u003c/sup\u003e / ml)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e37.6\u0026thinsp;\u0026plusmn;\u0026thinsp;34.0 (30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e34.6\u0026thinsp;\u0026plusmn;\u0026thinsp;34.3 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e32.4\u0026thinsp;\u0026plusmn;\u0026thinsp;33.6 (20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e29.8\u0026thinsp;\u0026plusmn;\u0026thinsp;31.7 (20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e31.2\u0026thinsp;\u0026plusmn;\u0026thinsp;31.8 (20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1:2\u003csup\u003e*\u003c/sup\u003e;1:3\u003csup\u003e**\u003c/sup\u003e;1:4\u003csup\u003e**\u003c/sup\u003e;1:5\u003csup\u003e**\u003c/sup\u003e;2:4\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal sperm count (\u0026times;10\u003csup\u003e6\u003c/sup\u003e / ejaculat)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e126.9\u0026thinsp;\u0026plusmn;\u0026thinsp;127.9 (95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e113.1\u0026thinsp;\u0026plusmn;\u0026thinsp;125.6 (72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e103.0\u0026thinsp;\u0026plusmn;\u0026thinsp;118.4 (60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e99.6\u0026thinsp;\u0026plusmn;\u0026thinsp;118.4 (55.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e90.6\u0026thinsp;\u0026plusmn;\u0026thinsp;97.8 (60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1:2\u003csup\u003e**\u003c/sup\u003e;1:3\u003csup\u003e**\u003c/sup\u003e;1:4\u003csup\u003e**\u003c/sup\u003e;1:5\u003csup\u003e**\u003c/sup\u003e;2:4\u003csup\u003e*\u003c/sup\u003e;2:5\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal sperm motility (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e64.4\u0026thinsp;\u0026plusmn;\u0026thinsp;18.4 (68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e60.3\u0026thinsp;\u0026plusmn;\u0026thinsp;22.6 (67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e58.4\u0026thinsp;\u0026plusmn;\u0026thinsp;22.2 (64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e56.5\u0026thinsp;\u0026plusmn;\u0026thinsp;23.1 (63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e54.0\u0026thinsp;\u0026plusmn;\u0026thinsp;23.4 (60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1:2\u003csup\u003e*\u003c/sup\u003e;1:3\u003csup\u003e**\u003c/sup\u003e;1:4\u003csup\u003e**\u003c/sup\u003e;1:5\u003csup\u003e**\u003c/sup\u003e;2:3\u003csup\u003e*\u003c/sup\u003e;2:4\u003csup\u003e**\u003c/sup\u003e;2:5\u003csup\u003e**\u003c/sup\u003e;3:5\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProgressive sperm motility (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e49.5\u0026thinsp;\u0026plusmn;\u0026thinsp;16.6 (52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e45.9\u0026thinsp;\u0026plusmn;\u0026thinsp;19.5 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e44.0\u0026thinsp;\u0026plusmn;\u0026thinsp;19.2 (48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e42.6\u0026thinsp;\u0026plusmn;\u0026thinsp;19.7 (47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e39.8\u0026thinsp;\u0026plusmn;\u0026thinsp;19.6 (43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1:2\u003csup\u003e**\u003c/sup\u003e;1:3\u003csup\u003e**\u003c/sup\u003e;1:4\u003csup\u003e**\u003c/sup\u003e;1:5\u003csup\u003e**\u003c/sup\u003e;2:3\u003csup\u003e*\u003c/sup\u003e;2:4\u003csup\u003e**\u003c/sup\u003e;2:5\u003csup\u003e**\u003c/sup\u003e;4:5\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRapid progressive sperm motility (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e5.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4 (3)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;1330\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e4.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4 (3)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;1548\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e4.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4 (3)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;1320\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e4.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1 (3)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;744\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1 (3)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;448\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1:3\u003csup\u003e**\u003c/sup\u003e;1:4\u003csup\u003e**\u003c/sup\u003e;1:5\u003csup\u003e**\u003c/sup\u003e;2:4\u003csup\u003e*\u003c/sup\u003e;2:5\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSperm vitality (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e50.0\u0026thinsp;\u0026plusmn;\u0026thinsp;29.8 (55)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;282\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e40.7\u0026thinsp;\u0026plusmn;\u0026thinsp;30.5 (45)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;413\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e42.2\u0026thinsp;\u0026plusmn;\u0026thinsp;28.9 (45)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;398\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e36.3\u0026thinsp;\u0026plusmn;\u0026thinsp;27.3 (41)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;241\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e36.9\u0026thinsp;\u0026plusmn;\u0026thinsp;26.5 (41)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1:2\u003csup\u003e*\u003c/sup\u003e;1:3\u003csup\u003e*\u003c/sup\u003e;1:4\u003csup\u003e**\u003c/sup\u003e;1:5\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal sperm morphology (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 (2)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;795\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3 (2)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;857\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 (2)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;686\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 (2)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;385\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 (2)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;220\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1:2\u003csup\u003e*\u003c/sup\u003e;1:3\u003csup\u003e*\u003c/sup\u003e;1:5\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHead Anomaly (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e78.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7 (79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e79.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3 (79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e79.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1 (79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e79.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6 (79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e80.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7 (80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1:5\u003csup\u003e*\u003c/sup\u003e;2:5\u003csup\u003e*\u003c/sup\u003e;3:5\u003csup\u003e*\u003c/sup\u003e;4:5\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElongated head (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e4.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e4.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1:3\u003csup\u003e*\u003c/sup\u003e;1:5\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLarge head (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e5.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e5.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e5.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e5.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1:4\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTail anomaly (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e15.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4 (15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e15.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9 (16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e15.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5 (15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e15.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.0 (15.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e17.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.6 (17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1:5\u003csup\u003e*\u003c/sup\u003e;2:5\u003csup\u003e*\u003c/sup\u003e;3:5\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoiled tail ( %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e7.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e7.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e7.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e8.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e8.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3 (8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1:5\u003csup\u003e**\u003c/sup\u003e;2:5\u003csup\u003e**\u003c/sup\u003e;3:5\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eValues are presented mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) (median). \u003csup\u003e*\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, \u003csup\u003e**\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001. TZI: Teratozoospermia index. Only morphological anomalies with statistically significant differences among age groups are given in the table.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLinear regression analysis of age with semen parameters and sperm morphological anomalies\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSemen Variables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eAge (year)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95% Confidence Intervals\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdjusted \u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVolume (ml)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.040\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.303 / -0.058\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSperm concentration (\u0026times;10\u003csup\u003e6\u003c/sup\u003e / ml)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.052\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.016 / -0.005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal sperm count (\u0026times;10\u003csup\u003e6\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.067\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.005 / -0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal sperm motility (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.044 / -0.028\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProgressive sperm motility (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.053 / -0.034\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRapid progressive sperm motility (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.062\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.110 / -0.042\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSperm vitality (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.036 / -0.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal sperm morphology (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.053\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.467 / -0.094\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHead anomalies (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.007 / 0.099\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.023\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePin head (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.056\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.053 / 0.228\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElongated head (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.001 / 0.137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.048\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTail anomalies (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.054\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.021 / 0.101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoiled tail (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.118 / 0.246\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eP\u003c/em\u003e values were adjusted for BMI and abstinence time. \u003cem\u003eP\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eOnly morphological anomalies with statistically significant differences are given in the table.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe incidence of all five categories of morphological anomalies (head anomalies, elongated and large heads, tail anomalies, and coiled tails) differed significantly among the five age categories. It was noted that the incidence of total head and tail anomalies and coiled tails increased significantly in the 40\u0026ndash;57 age group compared to other age groups. Elongated heads were significantly more frequently in the 30\u0026ndash;34 age group and the 40\u0026ndash;57 age group, and large heads were significantly more frequently in the 35\u0026ndash;39 age group, compared to the 17\u0026ndash;24 age group (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). TZI did not differ significantly among the age groups. In the analysis of correlations of age with specific morphological anomalies, age was positively correlated with total head anomalies, pin heads, large heads, elongated heads, total tail anomalies and coiled tails (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). After adjusting for confounding factors, the correlations between age and specific anomalies, except for large head persisted (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). No significant correlations were observed between other sperm anomalies examined and TZI, and age (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePrevious studies have addressed the role of age and the duration of sexual abstinence on sperm count and motility parameters and the rate of normal morphology. In the present study, we investigated the effects of age and abstinence time on sperm morphology in more detail by considering their associations with specific morphological anomalies. It has been shown that there is a decline in male reproductive functions with aging [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] and that advanced age of the male partner is associated with a decrease in pregnancy rates [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The male age threshold for increased risk for infertility and poor IVF outcomes has not been established, but the risk is believed to increase after age 40 [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Many studies have shown that semen volume, sperm concentration, total sperm motility and progressive motility decrease with the increase of male age [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. However, studies on the role of age on sperm morphology have yielded conflicting results. In addition to evidence that the rate of normal sperm morphology decreases with increasing age [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], it has also been reported that age does not affect normal morphology rate [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The present study showed that increasing age is associated with a significant decrease in all semen parameters, including normal sperm morphology. Different threshold values ​​of male age for the risk of low semen parameters have been reported in the literature. Pino et al. showed that semen volume and sperm concentration significantly decreased in men over 50 years of age, total sperm count over 41 years of age and progressive sperm motility over 31 years of age [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, they did not find any relationship between age and normal morphology rate. Paoli et al. revealed that the most significant risk for decreased total sperm count, progressive motility and morphology occurs after the age of 50 [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Others have suggested a threshold age of 40 for sperm concentration and normal morphology [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and 25 for sperm motility [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. According to our findings, semen volume decreased over age 40, while sperm concentration, total count, total motility, progressive motility, vitality, and normal morphology decreased over age 25, and rapid progressive motility decreased over age 30. Semen volume mainly reflects male accessory gland functions, and thus it is possible that testicular or epididymal functions, which are related to other sperm parameters, may be affected at an earlier age than the accessory gland functions. This discrepancy across the studies may be due to significant racial differences in semen variables. Moreover, it is known that semen parameters can be affected by the duration of abstinence11 and the presence of additional pathological conditions such as obesity and smoking [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Therefore, in our study, the role of age on semen quality was revealed more accurately by controlling the confounding factors that may affect semen parameters. After adjusting for BMI and abstinence time, it was observed that age remained associated with all semen parameters. The present study also showed that the abstinence time was significantly associated with semen parameters, except for progressive motility. Semen volume, sperm concentration, total count, total motility and normal morphology rate increased with the increase of the abstinence time. Rapid progressive motility decreased with the increase of the abstinence time. A previous study showed that the abstinence time was positively correlated with semen volume and sperm concentration and negatively correlated with progressive motility, but morphology parameters were not affected by the abstinence time. However, they did not evaluate rapid progressive motility. They also reported that increasing the abstinence time caused a significant increase in sperm DNA fragmentation index and suggested that DNA damage may be responsible for the motility defect in particular [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAfter their production in the testes through spermatogenesis and spermiogenesis processes, spermatozoa acquire progressive motility and further chromatin condensation during their storage in the ductus epididymis, known as epididimal maturation process [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Sperm production is affected by many factors, including genetic factors, obesity, hormonal changes, and environmental factors such as temperature, radiation, environmental pollutants, reactive oxygen species (ROS), smoking and varicocele [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The decline in semen quality with aging may be explained by decreased testosterone production due to decreased testicular volume and the number of Leydig cells [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Another important mechanism underlying the effect of age on semen quality is the deterioration of sperm DNA integrity due to increased oxidative stress or abnormal sperm apoptosis with aging [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. DNA damage may also arise from defect in the chromatin condensation process. Sperm DNA undergoes epigenetic changes during aging, resulting in abnormal chromatin condensation and increased DNA fragmentation, reducing the stability of the paternal genome [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Sperm DNA damage is also associated with mitochondrial DNA damage and may particularly lead to deterioration of sperm motility parameters [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. However, sperm DNA damage has been associated with different semen parameters such as sperm concentration, motility parameters and normal morphology [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], or with sperm motility and normal morphology [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] in various studies. Therefore, with increasing age and abstinence duration, increased exposure of sperm to ROS levels in the genital tract may be responsible for the alterations in semen parameters by causing sperm DNA damage and abnormal sperm apoptosis. Our results suggest that there may be a widespread increase in ROS with aging, affecting all testicular, epididymal or accessory gland functions, leading to deterioration of all sperm parameters. However, total and progressive sperm motility and sperm vitality were more sensitive to aging than other semen parameters, emphasizing a significant deterioration in epididymal functions with aging. The increase of abstinence time which leads to increased exposure of sperm to epididymal ROS may have a defective epididymal mechanism, resulting in specifically impaired sperm rapid progressive motility.\u003c/p\u003e\u003cp\u003eIt has been shown that morphologically abnormal sperm have a higher rate of DNA damage [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Moreover, DNA fragmentation has been reported to be more closely associated with certain morphological anomalies than with the rate of normal morphology [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Amorphous, round, tapered and elongated heads, bent necks, coiled and short tails, and ERC have been frequently associated with abnormal sperm DNA status such as DNA fragmentation and chromatin condensation defects [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Therefore, it can be predicted that the cumulative effect of aging and negative external factors that can lead to sperm DNA damage, such as obesity, smoking and environmental pollution, may be associated with an increase in the incidence of certain morphological anomalies. In the present study, we observed that aging causes an increase in the incidence of total head and tail anomalies, elongated and large heads and coiled tails, especially in those over 40 years of age. Moreover, after adjusting for confounding factors, age showed weak positive correlations with total head anomalies, elongated heads, pin heads and total tail anomalies, but a relatively stronger positive correlation with coiled tails. Therefore, aging may be associated with defects in sperm morphogenesis, including spermiogenesis and epididymal maturation processes, related to sperm head and especially tail formation. Epididymal structure and function have been shown to be affected by environmental factors and to deteriorate with aging [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Coiled tails may arise from impaired epididymal maturation due to genetics or environmental factors such as varicocele and smoking, resulting in oxidation of the outer dense fibers and fibrous sheath, increased membrane permeability, and hypoosmotic stress [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Coiled tails have been significantly associated with male infertility and unsuccessful IVF outcomes [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Kleshchev et al. have reported increased frequencies of coiled and short tails in men over the age of 40. They also have observed the increased frequency of combinations of coiled tails with amorphous, elongated, or vacuolated heads over the age of 40 [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Sperm head elongation is an important stage of spermiogenesis in which, in addition to head shaping, chromatin rearrangement and tail assembly [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] are carried out. Therefore, any disruption at this stage may result not only in head defects but also in midpiece and tail defects. Abnormal head elongation occurs especially in the presence of infection and varicocele and is generally associated with severe DNA damage, chromosomal abnormalities and impaired chromatin compaction [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Our results indicate that aging is associated with disruption of spermiogenesis and/or epididymal maturation processes, resulting in elongated head and coiled tail defects. Thus, the increase in the incidence of these anomalies may conribute to the decrease in fertilization capacity observed with aging.\u003c/p\u003e\u003cp\u003eThe present study demonstrated for the first time the association of sperm morphological anomalies with the duration of abstinence. We found that as the duration of abstinence increased, there was a significant increase in the incidence of amorphous, tapered and round heads, irregular acrosomal distribution, total tail anomalies, coiled and short tails and ERC. However, there was a decrease in the incidence of elongated, large and pin heads. The results of our unpublished study show that head and tail anomalies were more strongly associated with sperm motility parameters than neck-midpiece anomalies, and that amorphous, tapered and round heads, irregular acrosomal distribution and coiled and short tails were strongly associated with progressive and especially rapid progressive motility, supporting that the duration of abstinence is associated with epididymal dysfunction, probably related to increased epididymal ROS, specifically responsible for the increase of certain morphological anomalies and the decrease of rapid progressive motility, as well as the impairment of spermiogenesis. The fact that head anomalies negatively affected by the duration of abstinence exhibit an abnormal acrosomal structure as a common feature suggests that abstinence duration may be associated with acrosomal deterioration, and this may explain the impairment of rapid progressive motility in particular. Because an intact acrosomal structure and rapid progressive motility are the most important parameters required for sperm to attach to the zona, undergo the acrosome reaction and fertilize the oocyte [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. ERC are the excess cytoplasmic fragments that remain around the midpiece of sperm that does not disappear in the final maturation phase of spermiogenesis. It is also associated with impaired sperm maturation in the epididymis [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. It has been reported that ERC causes DNA damage [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e] and poor semen quality and infertility [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] due to excessive ROS production. It is known that the manchett-transient cytoskeleton structure in spermatids is necessary for the removal of excess cytoplasm and the formation of the tail [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. As the duration of abstinence increases, it is likely that, in addition to the impaired of epididymal maturation, dysfunction of this structure may also occur.\u003c/p\u003e\u003cp\u003eThe main limitation of this study is that computer-assisted semen analysis (CASA) was not employed. Although manual assessment is widely accepted according to WHO guidelines, the absence of CASA data may reduce the precision and objectivity of motility evaluation. Therefore, future research incorporating CASA-based assessments would be valuable to strengthen these findings.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe present study demonstrates the association of age with semen quality and specific morphological anomalies in a large population and after controlling for factors that may affect semen quality. Aging causes significant deterioration in semen quality and an increase in the incidence of certain morphological anomalies including elongated heads and coiled tails, particularly in individuals over 40 years of age. The association between abstinence time and specific morphological anomalies is unknown. The present study shows that with increasing abstinence time, there is a significant increase in the incidence of amorphous, tapered and round heads, irregular acrosomal distribution, total tail defects, coiled and short tails, and ERC, and a significant decrease in rapid progressive sperm motility. It is noteworthy that while age and abstinence time are associated with sperm head and tail anomalies and ERC, there is no association with neck-midpiece anomalies. Therefore, aging and the increase of abstinence may be associated with defects in sperm morphogenesis, which involves spermiogenesis and epididymal maturation processes, especially related to sperm head and tail formation, leading to increased genital ROS levels and sperm DNA damage, possibly with the contribution of external factors. However, sperm formation is a complex process affected by many factors, and the molecular mechanisms underlying the association of specific morphological defects with age and their contribution to male infertility need to be further investigated.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBody mass index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCASA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eComputer-assisted semen analysis\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eERC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eExcessive residual cytoplasm\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIVF\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIn vitro fertilization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eROS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eReactive oxygen species\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTZI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTeratozoospermia index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in compliance with the principles outlined in the Declaration of Helsinki and was approved by the institutional ethics review board of the Ethics Committee of Selcuk University, Faculty of Medicine.\u0026nbsp;All participants were provided with comprehensive information about the study and written informed consent was obtained. Informed consent was obtained from the parents and/or legal guardians of minör participants aged 17 years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll relevant data presented in this study are included in the article. Any other data that support the findings discussed here are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are no conflicts of interest, such as financial or other potential interests, that could undermine the objectivity of the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received to support this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eD.D. was involved in the conceptualization, design, analysis, interpretation and writing of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI would like to thank Rukiye Erdogan and Ozlem Sahin, the staff members of the Andrology Laboratory at Selcuk University Faculty of Medicine Hospital, for their valuable assistance in collecting the study materials.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAgarwal A, Baskaran S, Parekh N, Cho CL, Henkel R, Vij S, et al. Male infertility. Lancet. 2021;397(10271):319\u0026ndash;33. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(20)32667-2\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(20)32667-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2020 Dec 10. PMID: 33308486.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWHO. WHO Laboratory Manual for the Examination and Processing of Human Semen. 5th ed. Geneva: WHO; 2010. pp. 49\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGunes S, Hekim GN, Arslan MA, Asci R. Effects of aging on the male reproductive system. J Assist Reprod Genet. 2016;33(4):441\u0026ndash;54. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10815-016-0663-y\u003c/span\u003e\u003cspan address=\"10.1007/s10815-016-0663-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaufman JM, Lapauw B, Mahmoud A, T'Sjoen G, Huhtaniemi IT. Aging and the Male Reproductive System. Endocr Rev. 2019;40(4):906\u0026ndash;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1210/er.2018-00178\u003c/span\u003e\u003cspan address=\"10.1210/er.2018-00178\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAjayi AF, Onaolapo MC, Omole AI, Adeyemi WJ, Oluwole DT. Mechanism associated with changes in male reproductive functions during ageing process. Exp Gerontol. 2023;179:112232. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.exger.2023.112232\u003c/span\u003e\u003cspan address=\"10.1016/j.exger.2023.112232\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePetersen PM, Seier\u0026oslash;e K, Pakkenberg B. The total number of Leydig and Sertoli cells in the testes of men across various age groups - a stereological study. J Anat. 2015;226(2):175\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/joa.12261\u003c/span\u003e\u003cspan address=\"10.1111/joa.12261\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eColson MH, Cuzin B, Faix A, Grellet L, Huyghes E. Current epidemiology of erectile dysfunction, an update. Sexologies. 2018;27:e7\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMatzkin ME, Calandra RS, Rossi SP, Bartke A, Frungieri MB. Hallmarks of Testicular Aging: The Challenge of Anti-Inflammatory and Antioxidant Therapies Using Natural and/or Pharmacological Compounds to Improve the Physiopathological Status of the Aged Male Gonad. Cells. 2021;10(11):3114. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/cells10113114\u003c/span\u003e\u003cspan address=\"10.3390/cells10113114\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eColasante A, Minasi MG, Scarselli F, Casciani V, Zazzaro V, Ruberti A, et al. The aging male: Relationship between male age, sperm quality and sperm DNA damage in an unselected population of 3124 men attending the fertility centre for the first time. Arch Ital Urol Androl. 2019;90(4):254\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4081/aiua.2018.4.254\u003c/span\u003e\u003cspan address=\"10.4081/aiua.2018.4.254\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePino V, Sanz A, Vald\u0026eacute;s N, Crosby J, Mackenna A. The effects of aging on semen parameters and sperm DNA fragmentation. JBRA Assist Reprod. 2020;24(1):82\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5935/1518-0557.20190058\u003c/span\u003e\u003cspan address=\"10.5935/1518-0557.20190058\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen GX, Li HY, Lin YH, Huang ZQ, Huang PY, Da LC, et al. The effect of age and abstinence time on semen quality: a retrospective study. Asian J Androl. 2022;24(1):73\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/aja202165\u003c/span\u003e\u003cspan address=\"10.4103/aja202165\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCito G, Picone R, Fucci R, Giachini C, Micelli E, Cocci A, et al. Sperm morphology: What implications on the assisted reproductive outcomes? Andrology. 2020;8(6):1867\u0026ndash;74. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/andr.12883\u003c/span\u003e\u003cspan address=\"10.1111/andr.12883\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePaoli D, Pecora G, Pallotti F, Faja F, Pelloni M, Lenzi A, et al. Cytological and molecular aspects of the ageing sperm. Hum Reprod. 2019;34(2):218\u0026ndash;27. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/humrep/dey357\u003c/span\u003e\u003cspan address=\"10.1093/humrep/dey357\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrandt JS, Cruz Ithier MA, Rosen T, Ashkinadze E. Advanced paternal age, infertility, and reproductive risks: A review of the literature. Prenat Diagn. 2019;39(2):81\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/pd.5402\u003c/span\u003e\u003cspan address=\"10.1002/pd.5402\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2019 Jan 10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAuger J, Jouannet P, Eustache F. Another look at human sperm morphology. Hum Reprod. 2016;31(1):10\u0026ndash;23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/humrep/dev251\u003c/span\u003e\u003cspan address=\"10.1093/humrep/dev251\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAgarwal A, Tvrda E, Sharma R. Relationship amongst teratozoospermia, seminal oxidative stress and male infertility. Reprod Biol Endocrinol. 2014;12:45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1477-7827-12-45\u003c/span\u003e\u003cspan address=\"10.1186/1477-7827-12-45\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNguyen HTT, Dang HNT, Nguyen TTT, Nguyen TV, Dang TC, Nguyen QHV, et al. Correlations between abnormalities of morphological details and DNA fragmentation in human sperm. Clin Exp Reprod Med. 2022;49(1):40\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5653/cerm.2021.04777\u003c/span\u003e\u003cspan address=\"10.5653/cerm.2021.04777\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMenkveld R, Stander FS, Kotze TJ, Kruger TF, van Zyl JA. The evaluation of morphological characteristics of human spermatozoa according to stricter criteria. Hum Reprod. 1990;5(5):586\u0026ndash;92. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/oxfordjournals.humrep.a137150\u003c/span\u003e\u003cspan address=\"10.1093/oxfordjournals.humrep.a137150\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDe La Rochebrochard E, McElreavey K, Thonneau P. Paternal age over 40 years: the amber light in the reproductive life of men? J Androl. 2003;24(4):459\u0026ndash;65. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/j.1939-4640.2003.tb02694.x\u003c/span\u003e\u003cspan address=\"10.1002/j.1939-4640.2003.tb02694.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFord WC, North K, Taylor H, Farrow A, Hull MG, Golding J. Increasing paternal age is associated with delayed conception in a large population of fertile couples: evidence for declining fecundity in older men. The ALSPAC Study Team (Avon Longitudinal Study of Pregnancy and Childhood). Hum Reprod. 2000;15(8):1703\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/humrep/15.8.1703\u003c/span\u003e\u003cspan address=\"10.1093/humrep/15.8.1703\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi WN, Jia MM, Peng YQ, Ding R, Fan LQ, Liu G. Semen quality pattern and age threshold: a retrospective cross-sectional study of 71,623 infertile men in China, between 2011 and 2017. Reprod Biol Endocrinol. 2019;17(1):107. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12958-019-0551-2\u003c/span\u003e\u003cspan address=\"10.1186/s12958-019-0551-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKleshchev M, Osadchuk L, Osadchuk A. Age-Related Changes in Sperm Morphology and Analysis of Multiple Sperm Defects. Front Biosci (Schol Ed). 2023;15(3):12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.31083/j.fbs1503012\u003c/span\u003e\u003cspan address=\"10.31083/j.fbs1503012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStone BA, Alex A, Werlin LB, Marrs RP. Age thresholds for changes in semen parameters in men. Fertil Steril. 2013;100(4):952\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.fertnstert.2013.05.046\u003c/span\u003e\u003cspan address=\"10.1016/j.fertnstert.2013.05.046\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLevitas E, Lunenfeld E, Weisz N, Friger M, Potashnik G. Relationship between age and semen parameters in men with normal sperm concentration: analysis of 6022 semen samples. Andrologia. 2007;39(2):45\u0026ndash;50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1439-0272.2007.00761.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1439-0272.2007.00761.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSalas-Huetos A, Maghsoumi-Norouzabad L, James ER, Carrell DT, Aston KI, Jenkins TG, et al. Male adiposity, sperm parameters and reproductive hormones: An updated systematic review and collaborative meta-analysis. Obes Rev. 2021;22(1):e13082. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/obr.13082\u003c/span\u003e\u003cspan address=\"10.1111/obr.13082\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJames ER, Carrell DT, Aston KI, Jenkins TG, Yeste M, Salas-Huetos A. The Role of the Epididymis and the Contribution of Epididymosomes to Mammalian Reproduction. Int J Mol Sci. 2020;21(15):5377. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijms21155377\u003c/span\u003e\u003cspan address=\"10.3390/ijms21155377\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVaughan DA, Tirado E, Garcia D, Datta V, Sakkas D. DNA fragmentation of sperm: a radical examination of the contribution of oxidative stress and age in 16 945 semen samples. Hum Reprod. 2020;35(10):2188\u0026ndash;96. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/humrep/deaa159\u003c/span\u003e\u003cspan address=\"10.1093/humrep/deaa159\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSelvaraju V, Baskaran S, Agarwal A, Henkel R. Environmental contaminants and male infertility: Effects and mechanisms. Andrologia. 2021;53(1):e13646. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/and.13646\u003c/span\u003e\u003cspan address=\"10.1111/and.13646\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAntoniassi MP, Belardin LB, Camargo M, Intasqui P, Carvalho VM, Cardozo KHM, et al. Seminal plasma protein networks and enriched functions in varicocele: Effect of smoking. Andrologia. 2020;52(5):e13562. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/and.13562\u003c/span\u003e\u003cspan address=\"10.1111/and.13562\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLeisegang K, Henkel R, Agarwal A. Obesity and metabolic syndrome associated with systemic inflammation and the impact on the male reproductive system. Am J Reprod Immunol. 2019;82(5):e13178. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/aji.13178\u003c/span\u003e\u003cspan address=\"10.1111/aji.13178\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSharbatoghli M, Valojerdi MR, Amanlou M, Khosravi F, Jafar-abadi MA. Relationship of sperm DNA fragmentation, apoptosis and dysfunction of mitochondrial membrane potential with semen parameters and ART outcome after intracytoplasmic sperm injection. Arch Gynecol Obstet. 2012;286(5):1315\u0026ndash;22. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00404-012-2440-1\u003c/span\u003e\u003cspan address=\"10.1007/s00404-012-2440-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJakubik-Uljasz J, Gill K, Rosiak-Gill A, Piasecka M. Relationship between sperm morphology and sperm DNA dispersion. Transl Androl Urol. 2020;9(2):405\u0026ndash;15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.21037/tau.2020.01.31\u003c/span\u003e\u003cspan address=\"10.21037/tau.2020.01.31\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOkubo T, Onda N, Hayashi T, Kobayashi T, Omi K, Segawa T. Performing a sperm DNA fragmentation test in addition to semen examination based on the WHO criteria can be a more accurate diagnosis of IVF outcomes. BMC Urol. 2023;23(1):78. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12894-023-01257-y\u003c/span\u003e\u003cspan address=\"10.1186/s12894-023-01257-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMa Y, Xie N, Li Y, Zhang B, Xie D, Zhang W, et al. Teratozoospermia with amorphous sperm head associate with abnormal chromatin condensation in a Chinese family. Syst Biol Reprod Med. 2019;65(1):61\u0026ndash;70. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/19396368.2018.1543481\u003c/span\u003e\u003cspan address=\"10.1080/19396368.2018.1543481\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDehghanpour F, Tabibnejad N, Fesahat F, Yazdinejad F, Talebi AR. Evaluation of sperm protamine deficiency and apoptosis in infertile men with idiopathic teratozoospermia. Clin Exp Reprod Med. 2017;44(2):73\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5653/cerm.2017.44.2.73\u003c/span\u003e\u003cspan address=\"10.5653/cerm.2017.44.2.73\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKleshchev M, Osadchuk A, Osadchuk L. Impaired semen quality, an increase of sperm morphological defects and DNA fragmentation associated with environmental pollution in urban population of young men from Western Siberia, Russia. PLoS ONE. 2021;16(10):e0258900. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0258900\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0258900\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAtshan M, Kakavand K, Hosseini SH, Sadighi Gilani MA, Mohseni Meybodi A, Sabbaghian M. Evaluation of sperm DNA fragmentation and chromatin structure in infertile men with immotile short-tail sperm defect. Andrologia. 2020;52(1):e13445. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/and.13445\u003c/span\u003e\u003cspan address=\"10.1111/and.13445\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSerre V, Robaire B. Segment-specific morphological changes in aging Brown Norway rat epididymis. Biol Reprod. 1998;58(2):497\u0026ndash;513. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1095/biolreprod58.2.497\u003c/span\u003e\u003cspan address=\"10.1095/biolreprod58.2.497\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYeung CH, T\u0026uuml;ttelmann F, Bergmann M, Nordhoff V, Vorona E, Cooper TG. Coiled sperm from infertile patients: characteristics, associated factors and biological implication. Hum Reprod. 2009;24(6):1288\u0026ndash;95. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/humrep/dep017\u003c/span\u003e\u003cspan address=\"10.1093/humrep/dep017\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNikolova S, Parvanov D, Georgieva V, Ivanova I, Ganeva R, Stamenov G. Impact of sperm characteristics on time-lapse embryo morphokinetic parameters and clinical outcome of conventional in vitro fertilization. Andrology. 2020;8(5):1107\u0026ndash;16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/andr.12781\u003c/span\u003e\u003cspan address=\"10.1111/andr.12781\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTeves ME, Roldan ERS. Sperm bauplan and function and underlying processes of sperm formation and selection. Physiol Rev. 2022;102(1):7\u0026ndash;60. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1152/physrev.00009.2020\u003c/span\u003e\u003cspan address=\"10.1152/physrev.00009.2020\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eComhaire FH, Vermeulen L, Hinting A, Schoonjans F. Accuracy of sperm characteristics in predicting the in vitro fertilizing capacity of semen. J Vitro Fert Embryo Transf. 1988;5(6):326\u0026ndash;31. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/BF01129567\u003c/span\u003e\u003cspan address=\"10.1007/BF01129567\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMenkveld R, Rhemrev JP, Franken DR, Vermeiden JP, Kruger TF. Acrosomal morphology as a novel criterion for male fertility diagnosis: relation with acrosin activity, morphology (strict criteria), and fertilization in vitro. Fertil Steril. 1996;65(3):637\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/s0015-0282(16)58167-9\u003c/span\u003e\u003cspan address=\"10.1016/s0015-0282(16)58167-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRengan AK, Agarwal A, van der Linde M, du Plessis SS. An investigation of excess residual cytoplasm in human spermatozoa and its distinction from the cytoplasmic droplet. Reprod Biol Endocrinol. 2012;10:92. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1477-7827-10-92\u003c/span\u003e\u003cspan address=\"10.1186/1477-7827-10-92\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLehti MS, Sironen A. Formation and function of the manchette and flagellum during spermatogenesis. Reproduction. 2016;151(4):R43\u0026ndash;54. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1530/REP-15-0310\u003c/span\u003e\u003cspan address=\"10.1530/REP-15-0310\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Male infertility, age, semen quality, sperm morphology, specific sperm morphological anomalies, sperm head anomalies, sperm tail anomalies, coiled tail","lastPublishedDoi":"10.21203/rs.3.rs-7851337/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7851337/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eAging is known to cause a significant decrease in semen quality, but its association with specific sperm morphological anomalies is unclear. The study aimed to investigate the effects of age and abstinence time on semen quality and specific morphological anomalies.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis study is a cross-sectional study including 5491 male participants between the ages of 17\u0026ndash;57. Semen parameters and morphological anomalies analyzed according to the World Health Organization (WHO) criteria were compared in different age and abstinence time groups. Correlations between semen variables and age were analyzed by linear regression analysis after adjusting for body mass index and abstinence time.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eIncreasing age caused a decrease in all semen parameters and an increase in the incidence of total head and tail anomalies, elongated heads and coiled tails. Increasing abstinence time resulted in an increase in semen parameters other than progressive and rapid progressive motility, and amorphous, round, and tapered heads, irregular acrosomal distribution, coiled and short tails, and excessive residual cytoplasma, and a decrease in rapid progressive motility and pin, elongated, large, and small heads decreased.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eSemen variables appear to be affected by abstinence time. Aging is a significant risk factor for poor semen quality and particularly elongated heads and coiled tails in individuals over 40 years of age.\u003c/p\u003e\u003ch2\u003eClinical trial number:\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"The Effect of Age and Abstinence Time on Semen Quality and Specific Sperm Morphological Anomalies","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-20 11:35:32","doi":"10.21203/rs.3.rs-7851337/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-14T09:06:52+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-13T13:18:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-29T09:52:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"338364981999461059792906402743011426407","date":"2026-03-01T05:41:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"226057196888977095696509345622754440742","date":"2026-02-28T15:32:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"237639741770289696011346155240110512310","date":"2026-02-03T22:38:53+00:00","index":"hide","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-19T12:04:41+00:00","index":"","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-11T05:18:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-15T00:06:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-15T00:05:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-10-13T17:10:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5bf6fcf5-0c02-4207-8fec-1d00d78a9508","owner":[],"postedDate":"November 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-06T13:39:49+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-20 11:35:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7851337","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7851337","identity":"rs-7851337","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}