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Abstract

Assisted reproductive technologies (ARTs) are increasingly utilized in Ghana, as treatment options for couples with infertility, including male factor infertility. While extensive research has focused on female determinants of ART success, comparatively fewer studies have systematically examined the contribution of male partner characteristics beyond routine semen analysis to clinical pregnancy outcomes following ART. The paucity in research is more pronounced in Ghana. This was a cross-sectional study, conducted at the Chosen Hospital and Fertility Centre between January 2024 and March 2025. The study population comprised 198 male partners of women seeking ART services at the hospital, aged between 30 and 61 years. Baseline data were collected from the male partners before initiation of the ART procedure. The sociodemographic, anthropometric, and clinical data of the men were collected using a semi-structured questionnaire and medical records. Venous blood samples were then collected before ART and analyzed for fasting lipids, glucose, complete blood count, liver, and renal function tests. Semen samples were also collected after 3 to 7 days of abstinence and analyzed. Following the ART procedure, 126 (63.6%) of the women tested positive for pregnancy. The sociodemographic, anthropometric, hematological, biochemical, and seminal variables were compared between ART outcomes. The mean ± standard deviation of serum chloride level in mmol/L was higher in males whose partners tested negative for post-ART pregnancy compared to those who tested positive (101.3±3.5 vs 99.9±2.6, P=0.026). No significant disparities in the other variables were observed between the groups. The findings suggest that, although chloride is essential for normal spermatogenesis, high levels of serum chloride could be detrimental to sperm quality. Routine electrolyte measurements of male partners of infertile couples should be performed before ART procedure.

Keywords

infertility male factors assisted reproduction technology pregnancy Ghana

Introduction

Infertility remains a major psychosocial and public health concern globally, affecting approximately 10% to 15% of couples of reproductive age (Hawkey, 2023; Liang et al., 2025). In Ghana, just like other sub-Saharan African countries, the burden of infertility is particularly dire due to the strong sociocultural importance placed on lineage continuation, childbearing, and marital stability (Fledderjohann, 2012; Geelhoed et al., 2002). In many African societies, infertility is commonly perceived as a female problem, despite substantial evidence that male factors contribute to approximately 40% to 50% of infertility cases, either alone or in combination with female factors (Chimbatata & Malimba, 2016; Roomaney et al., 2024). This misperception often leads to delayed evaluation of male partners and under-recognition of their role in reproductive outcomes, including assisted reproductive technology (ART).

ARTs, including intra-uterine injection, in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI), are increasingly utilized in sub-Saharan African countries, such as Ghana, as treatment options for couples with infertility, including male factor infertility (Gerrits, 2016; Tenchov & Zhou, 2025). Although ART has improved pregnancy outcomes for many couples in Ghana, success rates remain variable due to clinical, biological, and lifestyle-related factors involving both partners (Damalie et al., 2025). While extensive research has focused on female determinants of ART success, comparatively fewer studies have systematically examined the contribution of male partner characteristics beyond routine semen analysis to clinical pregnancy outcomes following ART (Jewett et al., 2022; Mazzilli et al., 2023). The paucity in research is more pronounced in Ghana and other sub-Saharan African countries.

Male reproductive potential is influenced by several factors, including sociodemographic factors, nutritional and anthropometric status, medical conditions, hematological, biochemical health, and seminal quality (Amoah et al., 2025; Rotimi & Singh, 2024; Tesarik, 2025). Emerging evidence suggests that systemic conditions such as hepatic and renal dysfunction, metabolic abnormalities, oxidative stress, and subclinical inflammation may affect sperm function and fertilization capacity, even when conventional semen parameters appear normal (Fallara et al., 2023; Smith et al., 2025). Most of the emerging evidence originates from high-income settings, and its applicability to African populations is uncertain due to genetic and environmental variabilities.

Data on male reproductive health regarding ART remain limited in Ghana, and few studies have comprehensively evaluated baseline male partner characteristics in relation to ART success. Understanding whether routinely assessed male sociodemographic, biochemical, clinical, hematological, and seminal factors are associated with pregnancy after ART procedure is essential for patient evaluation, counseling couples, and optimizing resource utilization in fertility centers. This is particularly important in low- and middle-income settings where ART is often costly and largely self-funded (Njagi et al., 2023; Whittaker et al., 2024). This cross-sectional study aimed to determine the baseline male factors associated with pregnancy success of their female partners following the ART procedure.

Materials and Methods

Study Design and Setting

This was a cross-sectional study that was conducted at the Chosen Hospital and Fertility Centre, a specialist ART facility located in Accra, Ghana, between January 2024 and March 2025. The study formed part of the baseline assessment of couples undergoing ART procedures. The Chosen Hospital and Fertility Centre has several specialized departments, including a fertility clinic where specialized professionals carry out ART procedures. The hospital also has a well-equipped medical laboratory where baseline and follow-up laboratory assessments are undertaken following standardized protocols and observing laboratory quality management systems.

Study Population

The study population comprised 198 male partners of women seeking ART services at the hospital, aged between 30 and 61 years. The eligible participants included male partners of infertile women who were scheduled to undergo an ART procedure during the study period. Male partners were included if they were aged 18 years or older, were the biological partners of women undergoing ART, and provided informed consent to participate. Male partners with incomplete baseline laboratory or clinical data were excluded from the analysis.

Sample Size Determination

The minimum sample size was determined using the Cochrane formula for cross-sectional studies, using a prevalence of female infertility of 11.8% from a previous study in Ghana (Geelhoed et al., 2002). The study assumed a 95% confidence interval and an alpha value of 5%. The minimum sample size was estimated to be 139.

Data Collection and Laboratory Analyses

Baseline data were collected from both the women and their male partners before initiation of the ART procedure. Data collection was carried out using semi-structured questionnaires, physical measurements, and laboratory investigations conducted according to standard clinical protocols at the fertility center. A fasting venous blood sample was collected from each male and then dispensed into ethylenediaminetetraacetic acid (EDTA) anticoagulant, anti-glycolytic, and gel-separator vacutainer tubes. The blood samples were placed in a cold box with an ice pack and transported to the laboratory for processing and analysis. The EDTA anticoagulated blood samples were analyzed for complete blood count using an automated hematology analyzer within 2 hr after collection. The blood samples in the anti-glycolytic and gel-separator tubes were centrifuged at 3000 rpm for 10 min to obtain plasma or serum. The serum or plasma samples were aliquoted into Eppendorf tubes in duplicates and then stored at −20°C. The plasma or serum samples were later analyzed for fasting blood glucose, lipids, liver, and renal function tests using an automated biochemistry analyzer and following standard protocols and accepted laboratory quality guidelines. Other laboratory tests were performed, including sickling test, G6PD deficiency, hemoglobin electrophoresis, ABO and Rhesus blood groups, and hepatitis B surface antigen tests. Semen samples were collected from male partners following an abstinence period (3–7 days) and analyzed in accordance with standard laboratory guidelines. Analyses were conducted by trained laboratory personnel using established semen analysis protocols routinely applied at the fertility center. Following the ART procedure, women were assessed for clinical pregnancy using standard pregnancy testing protocols and imaging techniques employed by the facility. Based on the pregnancy test results, participants were categorized into male partners of women who tested positive (126 [63.6%]) and those who tested negative for pregnancy following the ART procedure.

Variables

The primary outcome of the study was the clinical pregnancy status of the female partner following the ART procedure, categorized as positive or negative. The independent variables were the sociodemographic information collected from male partners, including age and other relevant background characteristics. Clinical variables assessed included blood pressure measurements and medical screening results such as hepatitis B status, sickling test, hemoglobin phenotype, blood group, and glucose-6-phosphate dehydrogenase (G6PD) deficiency status. Anthropometric measurements included measurement of body weight and height, from which body mass index (BMI) was calculated as weight in kilograms divided by height in meters squared (kg/m²). Biochemical variables included fasting blood glucose, renal function tests (serum urea, creatinine, sodium, potassium, and chloride), liver function tests (liver enzymes, proteins, and bilirubin), and fasting lipid profile (cholesterol and triglycerides). The hematological variables included red blood cell, white blood cell, and platelet count and their indices. Semen analysis included semen volume, sperm count, sperm concentration, motility, and morphology.

Statistical Analysis

Data were collected into an MS Excel Spreadsheet and then analyzed using SPSS version 27.0. Continuous variables were assessed for normality using the Kolmogorov–Smirnov test before being summarized as either mean ± standard deviations or medians and interquartile ranges, as appropriate. Categorical variables were summarized using frequencies and percentages. Bivariate comparisons of male partner variables between the pregnancy-positive and pregnancy-negative groups were performed using Student t-test, for parametric data and the Mann–Whitney U test for nonparametric variables. Association tests were performed using the chi-square or Fisher’s exact test as appropriate. All statistical analyses were two-tailed, and significance was set at a p value <.050.

Ethical Approval

The study was approved by the institutional review board of the University for Development Studies (ref# UDS/RB/0019/25). The study followed the guidelines recommended by the 1964 Declaration of Helsinki, its later amendments for human subject studies, and national and local guidelines. The data were de-identified or anonymized to ensure confidentiality.

Results

Participants

There were 206 male partners of infertile women who were potentially eligible for the study. However, 203 were examined for eligibility, and 200 were confirmed eligible. A total of 198 men were finally included in this study because two men declined participation. There was no follow-up in this study, and all 198 were included in the final analysis.

Sociodemographic, Anthropometric, and Clinical Variables

The sociodemographic, anthropometric, and clinical variables were compared between male partners of infertile women who tested positive or negative following the ART procedure (Table 1). The results showed that there were no significant differences between the groups in sociodemographic, anthropometric, and clinical attributes.

Table 1.

Sociodemographic, Anthropometric, and Clinical Attributes of the Study Population.

Variable	Category	Post-ART Pregnancy		p value
Variable	Category	Positive	Negative	p value
Age (years)	—	46.6 ± 7.4	45.3 ± 7.5	.415
Weight (kg)	—	81.6 ± 11.6	82.5 ± 10.4	.702
Height (m)	—	1.7 ± 0.1	1.7 ± 0.1	.904
BMI (kg/m²)	—	28.9 ± 6.0	29.0 ± 5.1	.938
SBP (mm Hg)	—	120.7 ± 22.7	124.3 ± 20.4	.436
DBP (mm Hg)	—	83.0 ± 10.5	86.9 ± 11.6	.082
HBV	Negative	116 (92.1)	70 (97.2)	.412
	Positive	10 (7.9)	2 (2.8)
Sickling test	Negative	120 (95.2)	64 (88.9)	.253
	Positive	6 (4.8)	8 (11.1)
HB electrophoresis	AA	100 (79.4)	56 (77.8)	.432
	AC	20 (15.9)	8 (11.1)
	AS	6 (4.8)	8 (11.1)
ABO	O	52 (41.3)	28 (38.9)	.728
	A	36 (28.6)	26 (36.1)
	B	34 (27.0)	14 (19.4)
	AB	4 (3.2)	8 (5.6)
Rh” D”	Negative	4 (3.2)	2 (2.8)	>.999
	Positive	122 (96.8)	70 (97.2)
G6PD	No defect	116 (92.1)	76 (94.4)	.737
	Partial defect	2 (1.6)	0 (0.0)
	Full defect	8 (6.3)	4 (5.6)

Note. Continuous variables are summarized as mean ± standard deviation, whereas the categorical variables are summarized as frequency (%).

Differences in Male Partner Biochemical Variables

The fasting lipids, liver, and renal function variables, as well as the fasting blood glucose of male partners of infertile women with or without success following ART, were compared (Table 2). Although there were disparities in hepatic, renal, fasting lipids, and fasting blood glucose levels between the groups, none achieved statistical significance, except serum chloride level which was higher in the post-ART negative pregnancy group than the positive group (P=0.026).

Table 2.

Differences in Male Partner Biochemical Variables Stratified by ART Success.

Variables	Post-ART Pregnancy		p value
Variables	Positive	Negative	p value
Total bilirubin (mmol/L)	12.2 ± 4.3	12.2 ± 3.9	.965
Direct bilirubin (mmol/L)	5.6 ± 2.2	5.8 ± 2.0	.724
Total protein (g/L)	63.3 ± 12.5	62.7 ± 11.3	.820
Albumin (g/L)	36.8 ± 3.3	36.7 ± 3.1	.875
Aspartate aminotransferase (IU/L)	21.6 ± 7.0	23.7 ± 6.4	.149
Alanine aminotransferase (IU/L)	22.3 ± 8.3	23.6 ± 8.8	.476
Alkaline phosphatase (IU/L)	66.5 ± 18.6	65.7 ± 15.9	.829
Gamma-glutamyl transferase (IU/L)	33.2 ± 13.4	36.0 ± 13.0	.303
Urea (mmol/L)	4.7 ± 1.3	4.3 ± 1.0	.132
Creatinine (µmol/L)	82.1 ± 24.6	79.2 ± 24.2	.571
Potassium (mmol/L)	4.0 ± 0.2	4.0 ± 0.2	.572
Sodium (mmol/L)	140.1 ± 1.8	139.8 ± 1.6	.351
Chloride (mmol/L)	99.9 ± 2.6	101.3 ± 3.5	.026
Total cholesterol (mmol/L)	4.7 ± 1.0	4.7 ± 1.0	.778
Triglycerides (mmol/L)	1.3 ± 0.4	1.1 ± 0.5	.195
HDL-cholesterol (mmol/L)	1.2 ± 0.5	1.1 ± 0.4	.413
LDL-cholesterol (mmol/L)	2.6 ± 0.8	2.6 ± 0.9	.987
Fasting blood glucose (mmol/L)	6.5 ± 1.0	6.2 ± 1.3	.228

Note. Results are summarized as mean ± standard deviation.

Differences in Male Partner Hematological Variables

The red blood cell, white blood cell, platelet counts, and their indices were compared between male partners of infertile women’s ART outcome (Table 3). Despite observed disparities between the groups, the differences did not achieve statistical significance.

Table 3.

Differences in Male Partner Hematological Variables Stratified by ART Success.

Variables	Post-ART Pregnancy		p value
Variables	Positive	Negative	p value
WBC (× 10⁹/L)	5.6 ± 1.1	5.8 ± 1.4	.461
Lymphocytes (%)	41.7 ± 12.4	39.4 ± 12.7	.368
Monocytes (%)	9.3 ± 2.5	8.8 ± 2.9	.385
Neutrophils (%)	45.3 ± 12.0	46.5 ± 12.0	.628
Eosinophils (%)	3.1 ± 2.1	3.1 ± 1.9	.942
Basophil (%)	0.08 ± 0.05	0.09 ± 0.07	.941
RBC (× 10⁶/µL)	4.6 ± 0.5	4.7 ± 0.5	.733
Hemoglobin (g/dL)	14.9 ± 1.8	14.6 ± 1.6	.316
HCT (%)	36.7 ± 5.9	34.8 ± 8.6	.210
MCV (fL)	78.4 ± 16.8	77.3 ± 15.6	.740
MCH (pg)	32.4 ± 3.9	31.5 ± 4.4	.338
MCHC (g/dL)	41.4 ± 10.4	41.1 ± 9.4	.888
RDW-CV (%)	14.0 ± 1.2	14.4 ± 1.4	.112
RDW-SD (fL)	46.1 ± 8.1	43.2 ± 11.1	.136
Platelet (× 10³/µL)	206.7 ± 57.9	222.5 ± 56.2	.189
MPV (fL)	9.2 ± 1.4	9.2 ± 1.6	.953
PDW (%)	11.6 ± 2.4	11.6 ± 2.5	.989
PCT (%)	0.2 ± 0.0	0.2 ± 0.1	.696
P-LCR (%)	25.1 ± 9.5	24.9 ± 11.6	.957
P-LCC (× 10³/µL)	50.8 ± 20.1	54.4 ± 23.5	.420

Note. Results are summarized as mean ± standard deviation.

Differences in Male Partner Seminal Variables

Seminal variables were compared between ART outcome groups (Table 4). Although there were disparities in appearance, viscosity, volume, concentration, count, motility, and morphology, the differences did not attain statistical significance.

Table 4.

Differences in Male Partner Seminal Variables Stratified by ART Success.

Variables	Category	Post-ART Pregnancy		p value
Variables	Category	Positive	Negative	p value
Appearance	Grayish	116 (92.1)	60 (83.3)	.409
	Whitish	8 (6.3)	10 (13.9)
	Brownish	2 (1.6)	2 (2.8)
Viscosity	Normal	124 (98.4)	68 (94.4)	.128
	Semi-viscous	0 (0.0)	4 (5.6)
	Viscous	2 (1.6)	0 (0.0)
Semen collection	Masturbation	84 (66.7)	54 (75.0)	.496
	Coitus interruptus	42 (33.3)	18 (25.0)
PH	—	8.0 (7.7–8.0)	7.9 (7.5–8.0)	.107
Volume (mL)	—	2.0 (1.5–3.0)	2.0 (1.6–4.0)	.521
Conc (sperm/mL)	—	38.0 (12.0–64.0)	33.0 (8.0–59.0)	.791
count	—	74.4 (21.0–129.0)	57.0 (17.5–157.5)	.937
Motile %	—	60.0 (40.0–75.0)	60.0 (38.0–67.0)	.591
Immotile %	—	40.0 (25.0–56.0)	40.0 (33.0–62.0)	.454
Grade A	—	0.0 (0.0–5.0)	0.0 (0.0–5.0)	.525
Grade B	—	30.0 (17.5–39.0)	31.0 (14.3–30.0)	.726
Grade C	—	22.5 (15.0–34.3)	20.0 (14.5–30.0)	.441
Grade D	—	40.0 (30.0–60.5)	40.5 (34.5–63.5)	.568
Morphology %	—	10.0 (8.0–14.0)	10 (8.0–14.0)	.796
EC/hpf	—	1.0 (0.0–2.0)	1.0 (0.0–1.8)	.198
PC/hpf	—	1.0 (0.0–2.0)	1.0 (0.0–2.0)	.493
Round cells/hpf	—	2.0 (0.8–2.0)	1.5 (0.0–2.0)	.497
Abstinence (days)	—	4.0 (3.0–5.0)	4.0 (3.0–5.0)	.681

Note. Results are summarized as frequency (%) for categorical and median (IQR) for continuous variables.

Discussion

This cross-sectional study aimed to investigate male partner-related factors associated with success following ART procedures among infertile couples attending a fertility center. The findings showed no statistically significant differences in sociodemographic, anthropometric, clinical, hematological, or seminal parameters between male partners of women who achieved pregnancy and those who did not following ART. However, the serum chloride level was significantly higher in males whose partners tested negative for post-ART pregnancy.

The absence of an association between male age and BMI and ART outcomes is contrary to previous findings. Studies showed that advanced paternal age has been linked to reduced sperm quality, increased DNA fragmentation, and adverse reproductive outcomes (Donatti et al., 2023; Kadoch et al., 2024). The observed lack of association in this study may be due to the relatively narrow age distribution in this study and the use of ART techniques that may mitigate age-related sperm dysfunction (Tenchov & Zhou, 2025). Careful selection of quality sperm is undertaken in ART procedures such as IVF, ICSI, and intrauterine insemination (IUI), unlike the traditional method for conception. Similarly, obesity has been associated with hormonal disturbances and impaired spermatogenesis (Leisegang et al., 2021; Palmer et al., 2012). The findings of this study suggest that BMI alone may not significantly influence ART success once couples are selected and managed within specialized fertility programs.

The study showed that clinical variables, including hepatitis B status, hemoglobin phenotype, blood pressure, blood group, sickling status, and G6PD deficiency, were not associated with pregnancy outcomes. This is particularly relevant in Ghana and many African populations, where hemoglobinopathies, hepatitis B infection, and G6PD deficiency are relatively prevalent (Hemoglobinopathies et al., 2025; Sticher et al., 2025). While these conditions are important for general health and reproductive counseling, the present findings suggest that, when clinically stable and appropriately managed, they may not independently compromise ART success. This aligns with emerging evidence that systemic health conditions may have a limited direct effect on fertilization and implantation once ART bypasses several natural reproductive barriers (Tenchov & Zhou, 2025).

Chloride is an essential electrolyte that helps maintain cellular homeostasis and osmotic balance. However, high chloride levels may hurt male reproductive function. Excess chloride can disrupt the ionic microenvironment of the seminiferous tubules, impairing the function of Sertoli cells and the maturation of germ cells necessary for normal spermatogenesis (Raut et al., 2024). Increased chloride concentrations may also promote oxidative stress within testicular tissue, leading to DNA damage, lipid peroxidation and apoptosis of developing sperm cells (Aitken & Roman, 2008). In addition, electrolyte imbalance associated with hyperchloremia may indirectly affect the hypothalamic-pituitary-gonadal axis, potentially altering testosterone production and further compromising spermatogenic activity (Rohrbasser et al., 2016). Collectively, these mechanisms may contribute to reduced sperm quality and impaired male fertility.

Hematological indices, including hemoglobin concentration, white blood cell count, and platelet count, did not differ between groups. Although systemic inflammation and anemia have been hypothesized to affect male fertility through oxidative stress and impaired oxygen delivery to the testes, these effects may be subtle and not adequately captured by routine full blood count parameters (Naelitz et al., 2024; Potiris et al., 2025). Moreover, the clinical relevance of mild hematological variations for ART outcomes remains uncertain, particularly in populations where physiological ranges may differ from Western reference standards.

Conventional semen parameters, including sperm count, concentration, motility, morphology, and volume, were not associated with clinical pregnancy following ART. This finding is consistent with growing evidence that standard semen analysis has limited predictive value for ART success, especially in the era of ART (Tomlinson, 2016; Wang & Swerdloff, 2014). While semen analysis remains central to the diagnosis of male factor infertility, it may not adequately reflect functional sperm competence, including DNA integrity, chromatin packaging, and epigenetic quality (Tomlinson, 2016). These advanced sperm characteristics, which were not assessed in this study, may be more relevant determinants of fertilization, embryo development, and implantation.

This study contributes valuable data from a Ghanaian fertility center, addressing a critical gap in African reproductive health research. Assessing ART in sub-Saharan Africa, including Ghana, is challenged by weak data systems, including the absence of national ART registries and standardized reporting, which limits reliable estimation of service use and outcomes (Archary et al., 2023). ART access is largely restricted by lack of public insurance coverage, high costs and urban concentration of services, resulting in selection bias and poor representation of rural and lower-income populations in research (Damalie et al., 2025). Variability in laboratory standards, clinical infrastructure, and the availability of trained personnel further affect the quality and comparability of data. Sociocultural stigma surrounding infertility, especially for women, reduces care-seeking and study participation, while inconsistent ethical and regulatory frameworks complicate multicenter assessments. These bottlenecks, combined with limited research capacity and funding, contribute to a sparse and fragmented evidence base on ART effectiveness, safety, and equity in the region (Whittaker et al., 2024). The study is a cross-sectional design. A key limitation of the cross-sectional study design is its inability to establish temporal or causal relationships, as exposure and outcome are measured simultaneously, making it unclear whether the exposure preceded the outcome (Savitz & Wellenius, 2023). Such studies are also prone to prevalence-incidence or survivor bias, since they capture only existing cases and may underrepresent short-duration or severe outcomes. Confounding is difficult to control, particularly for unmeasured or unknown variables, which can distort observed associations. Cross-sectional designs are sensitive to measurement and recall bias, especially when relying on self-reported data, and they provide only a snapshot in time, limiting their usefulness for assessing changes, trends, or long-term effects (Wang & Cheng, 2020). Some semen samples were collected using coitus interruptus. Obtaining semen samples for analysis via coitus interruptus is not the best because it introduces several sources of systematic error and bias that compromise the validity of semen analysis (Organization, 2021). Some limitations of coitus interruptus include the loss of the first ejaculatory fraction, which is the most sperm-rich, containing the highest sperm concentration and motility, contamination with vaginal secretions, which can alter semen pH, viscosity, and volume; interfere with sperm motility; and introduce cells or microorganisms that confound microscopic and biochemical assessments. Collecting semen samples by coitus interruptus may lead to inaccurate semen volume measurement due to loss of semen, thereby affecting semen parameters such as total sperm number. Increased risk of sample variability may also arise because the timing and completeness of ejaculation are difficult to control, increasing intra-individual variability and reducing reproducibility. Anxiety or interruption may affect ejaculation quality, potentially altering sperm motility and liquefaction characteristics (Björndahl & Brown, 2022).

Conclusion

The findings suggest that, although chloride is essential for normal spermatogenesis, high levels of serum chloride could be detrimental to sperm quality. Routine electrolyte measurements of male partners of infertile couples should be performed before ART procedure.

Footnotes

Acknowledgements

The staff of The God Chosen Hospital and Fertility Centre are acknowledged for their support during participant recruitment and data collection for the study

ORCID iDs

Moses Banyeh

Issah Zabsonre Alhassan

Consent to Participate

All participants offered written informed consent before enrollment in the study. The study was voluntary, and a participant could withdraw at any stage.

Consent for Publication

Participants gave their consent for the publication of the study findings

Author Contributions

I.K.A., M.B., N.A.—conceptualization and methodology. N.A., M.B.—supervision, administration, and validation. I.K.A., V.B.O., E.K.A., G.N.A.A., E.K.A., I.Z.A.—experimentation, data collection, data curation, statistical analysis, and writing draft. All the authors reviewed the draft manuscript and approved its content.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The data supporting the findings of this study are available through a responsible request from the corresponding author

Code Availability

Not applicable

Declaration of AI and AI-Assisted Technologies in the Writing Process

AI-assisted technologies such as ChatGPT and Grammarly were used for the English language and searching for relevant literature.

References

Aitken

R. J.

Roman

S. D.

(2008). Antioxidant systems and oxidative stress in the testes. Oxid Med Cell Longev, 1(1), 15-24. https://doi.org/10.4161/oxim.1.1.6843

Amoah

B. Y.

Yao Bayamina

Gborsong

Owusu

Asare

G. A.

Yeboah

E. K.

Ablakwa

Hammond

(2025). Modifiable life style factors and male reproductive health: A cross-sectional study in IVF clinic attendees in Ghana. Frontiers in Reproductive Health, 7, Article 1520938.

Archary

Potgieter

Elgindy

Adageba

R. K.

Mboloko

Iketubosin

Serour

Dyer

Network

(2023). Assisted reproductive technologies in Africa: The African Network and Registry for ART, 2018 and 2019. Reproductive BioMedicine Online, 46(5), 835–845.

Avcı

A. E.

Çakıroğlu

Uyanık

B. S.

Kendirci

Başar

M. M.

(2025). Role of metabolic syndrome in male fertility: Is it a risk factor? Archivos Españoles de Urología, 78(5), 541–546. https://doi.org/10.56434/j.arch.esp.urol.20257805.73

Björndahl

Brown

J. K.

(2022). The sixth edition of the WHO laboratory manual for the examination and processing of human semen: Ensuring quality and standardization in basic examination of human ejaculates. Fertility and Sterility, 117(2), 246–251.

Carrageta

D. F.

Pereira

S. C.

Ferreira

Monteiro

M. P.

Oliveira

P. F.

Alves

M. G.

(2024). Signatures of metabolic diseases on spermatogenesis and testicular metabolism. Nature Reviews Urology, 21(8), 477–494. https://doi.org/10.1038/s41585-024-00866-y

Chimbatata

N. B.

Malimba

(2016). Infertility in sub-Saharan Africa: A woman’s issue for how long? A qualitative review of literature. Open Journal of Social Sciences, 4(8), 69–102.

Damalie

F. J. M. K.

Senaya

C. M.

Damalie

E. A.

Dankluvi

H. E.

Osaah

Yeboah

Annan

J. J.

Djoleto

E. F.

Adageba

R. K.

Odoi

A. T.

(2025). Barriers to assisted reproductive technology (ART) services in Ghana: A countrywide cross-sectional quantitative survey of fertility health workers and women with infertility. BMC Health Services Research, 25(1), 1228. https://doi.org/10.1186/s12913-025-13457-3

Donatti

L. M.

Martello

C. L.

Andrade

G. M.

Oliveira

N. P.

Frantz

(2023). Advanced paternal age affects the sperm DNA fragmentation index and may lead to lower good-quality blastocysts. Reproductive Sciences, 30(8), 2489–2494. https://doi.org/10.1007/s43032-023-01209-9

10.

Fallara

Capogrosso

Pozzi

Belladelli

Cilio

Corsini

Candela

Raffo

Boeri

Ventimiglia

Pontillo

Cotellessa

d’Arma

Alfano

Montorsi

Salonia

(2023). Kidney function impairment in men with primary infertility: A case-control analysis. Andrology, 11(7), 1377–1385. https://doi.org/10.1111/andr.13425

11.

Fledderjohann

J. J.

(2012). ‘Zero is not good for me’: Implications of infertility in Ghana. Human Reproduction, 27(5), 1383–1390. https://doi.org/10.1093/humrep/des035

12.

Geelhoed

Nayembil

Asare

Van Leeuwen

J. S.

Van Roosmalen

(2002). Infertility in rural Ghana. International Journal of Gynecology & Obstetrics, 79(2), 137–142.

13.

Gerrits

(2016). Assisted reproductive technologies in Ghana: Transnational undertakings, local practices and “more affordable” IVF. Reproductive Biomedicine & Society Online, 2, 32.

14.

Hawkey

(2023). Infertility as a social and public health issue. In Liamputtong

(Ed.), Handbook of social sciences and global public health (pp. 1–19). Springer. https://doi.org/10.1007/978-3-030-96778-9_102-1

15.

Hemoglobinopathies

Collaborators

H. A.

Ojo

T. T.

Amegbor

P. M.

Islam

Gyamfi

Mai

Malburg

C. M.

Adenikinju

D. B.

Kassebaum

N. J.

Abebe

S. T.

(2025). Burden of hemoglobinopathies and hemolytic anemias in the World Health Organization African region, 2000–2021: Findings from the Global Burden of Disease 2021 study. PLOS Global Public Health, 5(9), Article e0005197.

16.

Jewett

Warner

Kawwass

J. F.

Mehta

Eisenberg

M. L.

Nangia

A. K.

Dupree

J. M.

Honig

Hotaling

J. M.

Kissin

D. M.

(2022). Assisted reproductive technology cycles involving male factor infertility in the United States, 2017-2018: Data from the National Assisted Reproductive Technology Surveillance System. F & S Reports, 3(2), 124–130. https://doi.org/10.1016/j.xfre.2022.03.004

17.

Kadoch

Benguigui

Chow-Shi-Yee

Tadevosyan

Bissonnette

Phillips

Zini

Kadoch

I.-J.

(2024). The paternal clock: Uncovering the consequences of advanced paternal age on sperm DNA fragmentation. Reproductive Biology, 24(4), 100931.

18.

Latif Khan

Boothroyd

Chang

Novero

Chan

Chen

Chung

Ezoe

Liow

Malhotra

. (2023). ASPIRE guidelines for assisted Reproductive Technology (ART) laboratory practice in low and medium resource settings. Fertility & Reproduction, 5(3), 115–133.

19.

Leisegang

Sengupta

Agarwal

Henkel

(2021). Obesity and male infertility: Mechanisms and management. Andrologia, 53(1), Article e13617. https://doi.org/10.1111/and.13617

20.

Liang

Huang

Zhao

Feng

Ruan

(2025). Global, regional, and national prevalence and trends of infertility among individuals of reproductive age (15-49 years) from 1990 to 2021, with projections to 2040. Human Reproduction, 40(3), 529–544. https://doi.org/10.1093/humrep/deae292

21.

Mazzilli

Rucci

Vaiarelli

Cimadomo

Ubaldi

F. M.

Foresta

Ferlin

(2023). Male factor infertility and assisted reproductive technologies: Indications, minimum access criteria and outcomes. Journal of Endocrinological Investigation, 46(6), 1079–1085. https://doi.org/10.1007/s40618-022-02000-4

22.

Naelitz

B. D.

Khooblall

P. S.

Parekh

N. V.

Vij

S. C.

Rotz

S. J.

Lundy

S. D.

(2024). The effect of red blood cell disorders on male fertility and reproductive health. Nature Reviews Urology, 21(5), 303–316. https://doi.org/10.1038/s41585-023-00838-8

23.

Njagi

Groot

Arsenijevic

Dyer

Mburu

Kiarie

(2023). Financial costs of assisted reproductive technology for patients in low- and middle-income countries: A systematic review. Human Reproduction Open, 2023(2), hoad007. https://doi.org/10.1093/hropen/hoad007

24.

Organization

W. H.

(2021). WHO laboratory manual for the examination and processing of human semen. World Health Organization.

25.

Palmer

N. O.

Bakos

H. W.

Fullston

Lane

(2012). Impact of obesity on male fertility, sperm function and molecular composition. Spermatogenesis, 2(4), 253–263. https://doi.org/10.4161/spmg.21362

26.

Potiris

Moustakli

Trismpioti

Drakaki

Mavrogianni

Matsas

Zikopoulos

Sfakianakis

Tsakiridis

Dagklis

Zachariou

Christopoulos

Domali

Drakakis

Stavros

(2025). From inflammation to infertility: How oxidative stress and infections disrupt male reproductive health. Metabolites, 15(4), 267. https://www.mdpi.com/2218-1989/15/4/267

27.

Raut

S. K.

Singh

Sanghvi

Loyo-Celis

Varghese

Singh

E. R.

Gururaja Rao

Singh

(2024). Chloride ions in health and disease. Biosci Rep, 44(5). https://doi.org/10.1042/bsr20240029

28.

Rohrbasser

L. J.

Alsaffar

Blair

(2016). The Hypothalamus–Pituitary Axis. In Belfiore

LeRoith

(Eds.), Principles of Endocrinology and Hormone Action (pp. 1-35). Springer International Publishing. https://doi.org/10.1007/978-3-319-27318-1_12-1

29.

Roomaney

Salie

Jenkins

Eder

Mutumba-Nakalembe

M. J.

Volks

Holland

Silingile

(2024). A scoping review of the psychosocial aspects of infertility in African countries. Reproductive Health, 21(1), 123. https://doi.org/10.1186/s12978-024-01858-2

30.

Rotimi

D. E.

Singh

S. K.

(2024). Implications of lifestyle factors on male reproductive health. JBRA Assisted Reproduction, 28(2), 320–330. https://doi.org/10.5935/1518-0557.20240007

31.

Savitz

D. A.

Wellenius

G. A.

(2023). Can cross-sectional studies contribute to causal inference? It depends. American Journal of Epidemiology, 192(4), 514–516. https://doi.org/10.1093/aje/kwac037

32.

Smith

P. A.

Sarris

Clark

Wiles

Bramham

(2025). Kidney disease and reproductive health. Nature Reviews Nephrology, 21(2), 127–143. https://doi.org/10.1038/s41581-024-00901-6

33.

Sticher

J. S.

Csermak

K. R.

Otsyula

Turkson

Aubrun

Oshagbemi

O. A.

(2025). Prevalence of viral hepatitis in sub-Saharan Africa among the general population: An umbrella review of systematic reviews and meta-analyses. BMJ Open, 15(9), Article e101029.

34.

Technology, P. C. o. t. S. f. A. R., & Medicine, P. C. o. t. A. S. f. R. (2006). Revised minimum standards for practices offering assisted reproductive technologies. Fertility and Sterility, 86(5), S53–S56.

35.

Tenchov

Zhou

Q. A.

(2025). Assisted reproductive technology: A ray of hope for infertility. ACS Omega, 10(22), 22347–22365. https://doi.org/10.1021/acsomega.5c01643

36.

Tesarik

(2025). Lifestyle and environmental factors affecting male fertility, individual predisposition, prevention, and intervention. International Journal of Molecular Sciences, 26(6), 2797. https://www.mdpi.com/1422-0067/26/6/2797

37.

Tomlinson

M. J.

(2016). Uncertainty of measurement and clinical value of semen analysis: Has standardisation through professional guidelines helped or hindered progress? Andrology, 4(5), 763–770. https://doi.org/10.1111/andr.12209

38.

Wang

Swerdloff

R. S.

(2014). Limitations of semen analysis as a test of male fertility and anticipated needs from newer tests. Fertility and Sterility, 102(6), 1502–1507. https://doi.org/10.1016/j.fertnstert.2014.10.021

39.

Wang

Cheng

(2020). Cross-sectional studies: Strengths, weaknesses, and recommendations. Chest, 158(1), S65–S71.

40.

Whittaker

Gerrits

Hammarberg

Manderson

(2024). Access to assisted reproductive technologies in sub-Saharan Africa: Fertility professionals’ views. Sexual and Reproductive Health Matters, 32(1), 2355790. https://doi.org/10.1080/26410397.2024.2355790

Male Factors Associated With Success Following Assisted Reproduction Technology Among Infertile Couples in Ghana

Abstract

Keywords

Introduction

Materials and Methods

Study Design and Setting

Study Population

Sample Size Determination

Data Collection and Laboratory Analyses

Variables

Statistical Analysis

Ethical Approval

Results

Participants

Sociodemographic, Anthropometric, and Clinical Variables

Differences in Male Partner Biochemical Variables

Differences in Male Partner Hematological Variables

Differences in Male Partner Seminal Variables

Discussion

Conclusion

Footnotes

Acknowledgements

ORCID iDs

Consent to Participate

Consent for Publication

Author Contributions

Funding

Declaration of Conflicting Interests

Data Availability Statement

Code Availability

Declaration of AI and AI-Assisted Technologies in the Writing Process

References