One in three Ugandan men seeking fertility care shows abnormal semen parameters

Approximately one in three men seeking fertility services in Eastern and Central Uganda has at least one abnormal semen parameter, according to a multicentre cross-sectional study published in Basic and Clinical Andrology. Among 155 men recruited from three health facilities between September 2025 and January 2026, 52 had at least one semen value outside the World Health Organization reference range, giving a prevalence of 33.5 percent with a 95 percent confidence interval of 26.5 to 41.4 percent. The figure was strikingly consistent across the three participating sites, with no statistically significant difference in prevalence between them (p = 0.841).

The research team conducted a hospital-based, cross-sectional analytical study at Jinja Regional Referral Hospital, Kayunga Regional Referral Hospital, and Healingway Diagnostic and Fertility Centre. Recruitment ran from 17 September 2025 to 17 January 2026, and eligible participants were men attending the facilities for fertility evaluation who provided written informed consent. Men unable to provide a semen sample, or with conditions that made participation impossible, were excluded. Enrollment was consecutive, and each participant completed a structured interviewer-administered questionnaire covering sociodemographic characteristics, lifestyle factors, medical history, sexual and reproductive history, and occupational or environmental exposures. The questionnaire was pretested at a similar, non-participating health facility before data collection began, and trained research assistants administered it using standardized procedures.

Semen analysis followed the WHO Laboratory Manual for the Examination and Processing of Human Semen. Participants were instructed to abstain from ejaculation for two to seven days before collection, in line with WHO recommendations, and samples were obtained by masturbation into sterile, wide-mouthed containers in a private room within each facility. Specimens were delivered immediately to the laboratory, allowed to liquefy at room temperature, and assessed for semen volume, sperm concentration, total sperm count, motility, morphology, vitality, and pH. Values falling outside WHO reference limits were classified as abnormal; by those limits, hypospermia was defined as an ejaculate volume below 1.5 millilitres, oligozoospermia as a sperm concentration below 15 million per millilitre, asthenozoospermia as progressive motility below 32 percent, and teratozoospermia as fewer than 4 percent normal forms. All laboratory analyses were performed by trained personnel using standardized procedures, with unique identification numbers used to protect confidentiality.

The sample size was calculated using the Kish–Leslie formula for a single population proportion, anchored to a prevalence of 26.41 percent drawn from a previous study in Sudan. In the end, 155 eligible men consented and entered the final analysis. The cohort was predominantly aged 31 to 40 years (40.0 percent), had attained tertiary education (49.0 percent), and was formally employed (58.7 percent). Most reported never smoking (70.3 percent) and no alcohol intake (65.2 percent), while 54.8 percent were physically active. Nearly half had a normal body mass index (45.8 percent), 32.3 percent were overweight, 16.1 percent were obese, and 5.8 percent were underweight. The large majority had no history of hypertension (90.3 percent), diabetes mellitus (79.4 percent), or mumps infection (90.3 percent), 80.0 percent were not using any medication, 55.5 percent had never fathered a child, and 39.4 percent reported occupational hazard exposure.

Among the 52 men with abnormal semen findings, teratozoospermia was the most common abnormality at 42.3 percent, followed closely by asthenozoospermia at 38.5 percent. Hypospermia accounted for 26.9 percent, necrozoospermia for 25.0 percent, and oligozoospermia and azoospermia for 23.1 percent each. These percentages were calculated among participants with abnormal results, meaning several abnormalities co-occurred within individuals. The authors note that defects in sperm morphology and motility were the dominant patterns in this population, and they point out that both parameters are sensitive to infection, inflammation, oxidative stress, metabolic disease, and environmental exposures. The prominence of motility-related abnormalities is consistent with findings from Kenya, Ethiopia, Bangladesh, and India, where asthenozoospermia was also frequently reported as a leading abnormality, suggesting that impaired motility may be a common expression of male reproductive dysfunction across different infertility settings.

The 33.5 percent prevalence sits lower than estimates reported from several other African countries, including Kenya, Ethiopia, Nigeria, Cameroon, and Ghana, where figures ranged from 69.1 to 84.3 percent, and from Sudan, where 86.8 percent was reported. It is closer to findings from less selective or mixed clinical populations, including 38.2 percent in Nigeria, 33.0 percent in Indonesia, and reports from Sri Lanka. The authors urge caution in such comparisons, noting differences in study populations, referral settings, the number of semen samples analyzed, laboratory procedures, and the definitions used to classify abnormal findings. Many of the higher estimates came from tertiary or specialist infertility centres that may receive men with longer-standing or more complex fertility problems, and one Nigerian study that performed two semen analyses per participant reported a prevalence of 66.5 percent, while older Nigerian data using earlier WHO criteria reported 27.3 percent. Methodological variation in morphology assessment, one of the most observer-dependent semen parameters, may also explain why the relative frequency of teratozoospermia differs across studies.

Using bivariable and multivariable logistic regression, the researchers identified five factors independently associated with abnormal semen parameters. History of mumps infection was the strongest, with an adjusted odds ratio of 5.29 (95 percent CI: 1.25–22.31), followed by hypertension at 5.23 (95 percent CI: 1.10–24.93), diabetes mellitus at 4.82 (95 percent CI: 1.85–12.57), occupational hazard exposure at 4.23 (95 percent CI: 1.60–11.13), and current medication use at 2.73 (95 percent CI: 1.11–6.71). The associations with hypertension and diabetes are biologically plausible, the authors write, because cardiometabolic disease may impair semen quality through oxidative stress, hormonal dysregulation, endothelial dysfunction, and reduced testicular microcirculation. Medication use, defined as self-reported use of prescribed medications within the preceding three months, is likely a marker of underlying chronic illness rather than an isolated exposure, an interpretation consistent with the importance of hypertension and diabetes in the same model. A history of mumps aligns with established evidence that post-pubertal mumps can damage the testes through orchitis and lead to long-term impairment of sperm production, a finding the authors say highlights the continuing reproductive consequences of preventable infections.

Occupational hazard exposure in the study was a broad, self-reported category encompassing heat, pesticides, industrial chemicals, fuels, radiation, dust, prolonged sitting, and other workplace conditions considered potentially harmful to reproductive health. Because these exposures are biologically distinct and may not affect semen quality in the same way, the authors interpret the association as a general indicator of workplace-related risk rather than the effect of any single exposure. Evidence from Cameroon and other settings has previously linked occupational and environmental exposures to poor semen quality, particularly abnormalities in motility, morphology, and viability. Notably, age, body mass index, and smoking showed crude associations but did not remain significant after adjustment, which the authors suggest may indicate that their effects are mediated through other factors such as cardiometabolic disease or occupational exposure. The authors also note that emerging evidence on dietary quality, including associations between Mediterranean-style diets and better semen profiles, points to a role for future studies in this setting that assess diet alongside medical and occupational risk factors.

The study’s limitations are substantial and are laid out plainly by the authors. The cross-sectional design does not allow causal or temporal interpretation, and the associations should be read as exploratory correlates rather than definitive independent determinants of impaired semen quality. Semen analysis was based on a single specimen, even though semen quality varies over time, and the composite outcome grouped heterogeneous abnormalities, so the reported prevalence reflects the overall burden of impaired semen quality rather than a single clinical entity. Important factors such as varicocele, hormonal profile, genital infections, diet, stress, genetic abnormalities, and sperm DNA fragmentation were not assessed, leaving room for residual confounding, and some adjusted estimates carried wide confidence intervals. Because participants were recruited from fertility clinics, the findings may not generalize beyond similar clinical settings. Even so, the authors conclude that the results support routine semen analysis and careful assessment of medical history, previous infections, medication use, and occupational exposures during male infertility evaluation in comparable settings, where delayed recognition of male factors may prolong couple distress and delay appropriate management.

Subject of Research: Prevalence and associated factors of abnormal semen parameters among men seeking fertility services in Eastern and Central Uganda

Article Title: Semen abnormalities and associated factors among men seeking fertility services in Eastern and Central Uganda: a multicentre cross-sectional study

Article References: Hafsa, A. A., Ishimwe, M. P. S., Kasujja, M., Okello, M., Nteziyaremye, T., Anyanwu, C. N., Namutebi, S., Liban, S., Musinguzi, R., Mugisha, D., Ahmed, A. A., Mire, A. M., Mumim, B. A., Muhumuza, A., Olabisi, A. S., & Hakizimana, T. (2026). Semen abnormalities and associated factors among men seeking fertility services in Eastern and Central Uganda: a multicentre cross-sectional study. Basic and Clinical Andrology, 36(1), Article 23. https://doi.org/10.1186/s12610-026-00322-4

Image Credits: AI Generated

DOI: 10.1186/s12610-026-00322-4

Keywords: male infertility, semen analysis, semen abnormalities, Uganda, cross-sectional study, teratozoospermia, asthenozoospermia, hypertension, diabetes mellitus, mumps, occupational hazard exposure, fertility services