Users Online: 541
Home Print this page Email this page
Home About us Editorial board Search Browse articles Submit article Ahead of Print Instructions Subscribe Contacts Login 


 
Previous article Browse articles Next article 
ORIGINAL ARTICLE
Adv Biomed Res 2013,  2:55

Lithium carbonate inducing disorders in three parameters of rat sperm


1 Department of Biology, Islamic Azad University, Tehran Science and Research University, Isfahan, Iran
2 Department of Anatomical Sciences and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3 Department of Biology, Islamic Azad University, Falavarjan University, Isfahan, Iran

Date of Submission15-Aug-2012
Date of Acceptance22-Oct-2012
Date of Web Publication30-Jul-2013

Correspondence Address:
Gholam R Dashti
Department of Anatomical Sciences and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan
Iran
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-9175.115793

Rights and Permissions
  Abstract 

Background: Lithium has a significant impact in reducing the symptoms of bipolar mania but in long periods of use with therapeutic doses can cause several disorders in various organs including the reproductive system. In this study, the effect of lithium on the sperm concentration and motility and forms of abnormal cells has been examined.
Materials and Methods: Male Wistar rats under the 48-day treatment with lithium carbonate at doses of 10, 20, and 30 mg/kg bw/day were kept in standard conditions. At the end of this period, sperm cells isolated from the cauda epididymis were counted, motility was estimated, and stained with smear papanicolaou stain.
Results: In lithium-treated groups, the rate of spermatogenesis and sperm quality were reduced and was seen in a dose-dependent manner.
Discussion: Lithium alters intracellular signaling pathways such as inositol phosphate metabolic cycle and cyclic adenosine mono phosphate (cAMP) system and adenosine triphosphate (ATP) synthesis. It also interferes in the division of sex cells to produce mature sperm and showed changes in the sperm cell membrane, function, and structure.

Keywords: Lithium carbonate, morphology, motility, sperm concentration


How to cite this article:
Toghyani S, Dashti GR, Roudbari NH, Rouzbehani S, Monajemi R. Lithium carbonate inducing disorders in three parameters of rat sperm. Adv Biomed Res 2013;2:55

How to cite this URL:
Toghyani S, Dashti GR, Roudbari NH, Rouzbehani S, Monajemi R. Lithium carbonate inducing disorders in three parameters of rat sperm. Adv Biomed Res [serial online] 2013 [cited 2019 Jul 18];2:55. Available from: http://www.advbiores.net/text.asp?2013/2/1/55/115793


  Introduction Top


Infertility is one of the essential health problems and of which 30% is due to male factors. [1] Diagnosis of reproductive system abnormalities and assessment of male fertility potential are of special importance, and common methods for determining male fertility potential include analysis of semen factors such as determination of sperm concentration, percentage of viable sperm, and percentage of sperm with normal motility and morphology using Papanicolaou staining. [2]

Among male infertility factors are primary factors like disorder in sperm transport from testicles to tubes and secondary factors such as side effects of drugs, hormones and their metabolites, toxins, urinary tract infections, and some diseases like diabetes, inflammation, and some surgical operations. In the twenty-first century, environmental pollution, radioactive radiation, inappropriate nutrition, noise pollution, addiction to tobacco, alcohol, coffee, and drugs are main factors of progressive disorder in reproductive processes. [3]

Over the last 50 years, researchers evaluating male fertility have paid attention to a branch of medicine named "Andrology" and its discipline "Seminology." This discipline concerns about study of sperm content of patients on the basis of factors related to a normal fertile man who has adequate sperms with normal motility and morphology (ability to reach the ovule and fertilize it). [4] Sperm maturation in humans is the result of intracellular processes and their interaction with epithelium of epididymis while passing through it. During this passage, special glycoproteins are replaced in the sperm membrane that supplies its immunological protection and stability of plasma membrane. In the female genital tract, removal of those glycoproteins causes a process known as capacitation that enables fertilization of ovules. [5] As mentioned before, spermatozoa that are present in epididymis spend their developmental stages and will change significantly as compared to those existing in testicles that have no progressive motility and their flagellar movements are minor fluctuations. At the beginning of epididymis, flagella gain active motility from the point joining the head. The first 15-16 μm has more motility than other parts. In this mode, sperm is seen with progressive developmental and irregular movements. At the end of epididymis, flagellar movements, especially the first 18-19 μm, is developed to forward progressive and regular movements. [6]

Besides epididymis and normal developmental process of sexual cells taking place in testes, changes such as an increase in osmolarity, reduction of pH, activity of mitochondrial plates in the middle of flagellum, structure of outer mitochondrial membrane, compact fibers of oxonium, an increase in concentration of calcium ions, and cAMP in sperm cell are involved in motility of sperm. [7] According to the previous studies, motility is known as one of the important parameters of qualitative evaluation of sperm cell as an impaired motility extremely affects male fertility negatively and reduces fertilization of ovules. [8] Apart from sperm motility, morphology of sperm is influenced by cytotoxic agents that target testicular tissue. An increase in abnormal forms of sperm reduces chances of fertility. [9]

In this study, the focus is on the lithium ion (+Li) among the factors affecting sperm parameters negatively and reducing male fertility. The lithium ion is the effective substance of drugs known for treating manic depression that is often used as carbonate and chloride salts and long-term use of its therapeutic doses causes certain structural and functional disorders in different body organs despite its strong effect on reduction of disease's symptoms. [10],[11] In this study, sperm concentration of the liquid extracted from the end of epididymis and percentage of motility and morphology of spermatozoa were examined under the influence of lithium carbonate.


  Materials and Methods Top


Animal house and the course of treatment

Wistar adult male rats with a mean weight of 230 g were divided into three experimental groups and one control group, each with six rats. They were kept and treated at temperature of 23-25°C and a humidity of 60-75% for 48 days under 12h/12h light/dark cycles.

Lithium carbonate solution and used doses

The experimental groups were treated with 10, 20, and 30 mg/kg bw/day doses of lithium carbonate lithium provided by Tehran Darou Co. (with serial no. 8808), which was taken orally for a 48 day of spermatogenesis process. In each gavage, 0.5 mL of lithium carbonate solution (prepared out of sterile distilled water in order to balance daily normal water consumption) was given to the rats.

Sampling and evaluation of sperm parameters

The rats were anesthetized with 10% ketamine solution, 24 h after termination of treatment course. Their testicles and genital ducts were exposed by dissecting the skin of the lower abdomen in order to remove the distal part of epididymis. The removed epididymal tissue was cut into small pieces in 1 cc of Ham's F-10+ albumin solution with a ratio of 1 to 9 (provided from Isfahan's Royan Research Institute). The resulted sperm solution obtained was used to study sperm parameters including percentage of sperm motility, total sperm count, and determining percentage of normal and abnormal sperms, and diagnosing the type of abnormality. The sperms in the solution maintain their normal motility for 6 h and survive up to 12 h.

Total sperm count obtained from the cauda epididymis

The sperm motility was inhibited by adding 50 μL of 10% formalin to the sperm solution, and then, total number of sperm cells was estimated in 1 mL of the sperm solution prepared on a neubauer slide with a magnification of ×10.

Determining the percentage of motile sperms

After several times of sampling, the solution containing epididymal pieces was placed in the laboratory environment and shaken gently for 20 minutes in order to extract the sperms. One drop of the sperm solution was placed on the slide, and the percentage of sperm motility with progressive movement was estimated using a light microscope with a magnification of ×10, then with ×40 in 10 fields, and the percentage of sperms with normal and abnormal morphology in the fields was recorded.

Papanicolaou staining for morphological analysis of sperm cells

In this method, the sperm fluid was fixated by adding 100 μL of 10% formalin, and then, a smear was made on the slide and Papanicolaou staining was carried out sequentially. The slide was immersed in 70% methanol for 15 min and rinsed by running tap water and then dipped in acid alcohol for 1 s and again rinsed in running tap water. After staining with OG-6 (orange) for 2-4 min, the slide was dipped in distilled water for 1 s and immersed in alcohol 1 for 1 s and then put in alcohol 2 for 2 s. Then, it was stained with EA-50 for 2-4 min. Once again, the slide was dipped in distilled water for 1 s and immersed in alcohol 1 for 1 s and then put in alcohol 2 for 2 s and air dried. Finally, the slide was immersed in xylene for 10 min and again air dried.

Morphology of the sperms in terms of normal and abnormal shape of the head and tail was analyzed in the prepared slides and mean data were recorded. [12]

Statistical analysis

Finally, the results of cell count were statistically analyzed by one-way ANOVA and Duncan post hoc tests using SPSS software and are shown in [Table 1] and [Figure 1],[Figure 2] and [Figure 3].
Figure 1: Percentage of sperm cell motility in groups receiving lithium shows a dose-dependent reduction

Click here to view
Figure 2: Percentage of normal sperm cells obtained from cauda epididymis is reduced in treatment with lithium

Click here to view
Figure 3: Number of sperm cells in the cauda epididymis is reduced in experimental groups treated with lithium

Click here to view
Table 1: Comparison of mean percentage of motility, number, and percentage of normal and abnormal sperm cells in cauda epididymis

Click here to view



  Results Top


The analysis by one-way ANOVA test showed that mean percentage of motility, number, and percentage of normal and abnormal sperm cells were not equal in different groups. The status of experimental groups and the control group to each other was determined using the Duncan post hoc test as shown in [Table 1] and [Figure 1],[Figure 2] and [Figure 3].


  Discussions Top


Studies have shown that men using lithium for a long time suffer from complications such as reduced steroidogenic activity and reduced efficiency of spermatogenesis process. [13] In a study on a species of Viscacha (Lagostomus maximus maximus), a 35-day injection of therapeutic doses of lithium showed destruction of Leydig cells followed by reduction of plasma testosterone level and remarkable reduction of sperm motility and viability in sperm solution. [14] Lithium reduces the activity of hypothalamus-pituitary-gonad axis, and spermatogenesis-stimulating hormones. It also affects testicles directly that may result in profound complications. Since the lithium ion can pass through the blood-testis barrier, it affects developing sexual cells and disrupts maturation and release of spermatozoa out of seminiferous epithelium by stopping cell differentiation and growth cycle and consequently reduces the number of the total sperm count. [11],[13] The results of this study also confirm the role of lithium in reduction of the produced sperm, number of motile sperms, and motility of sperm's tail and production of abnormal sperms. Papanicolaou staining showed sperms with abnormal tail. These results agree with the results of the previous studies on the effect of lithium on the function of male reproductive system. Some probable reasons for verifying results of this study will be mentioned in the following parts [Figure 4],[Figure 5],[Figure 6] and [Figure 7].
Figure 4: Papanicolaou staining of sperm cells of the control group that are seen to have normal head and tail, under a light microscope with magnification of ×100

Click here to view
Figure 5: Papanicolaou staining of sperm cells of the group treated with 10 mg lithium carbonate showed some sperms with abnormal tails (curl-like shape) under a light microscope with magnification of ×100

Click here to view
Figure 6: Papanicolaou staining of sperm cells of the group treated with 20 mg lithium carbonate under a light microscope with magnification of ×100 showed more frequent abnormal tails and total sperm density was reduced

Click here to view
Figure 7: Papanicolaou staining of sperm cells of the group treated with 30 mg lithium carbonate under a light microscope with magnification of ×40 showed abnormal curling tails with abnormal sperms, which was more than that of 10 mg and 20 mg doses, and the least sperm density was observed using 30 mg dose

Click here to view


Lithium and Cyclic adenosine mono phosphate

Cyclic adenosine mono phosphate (cAMP) molecule binds to cAMP-dependent protein kinase enzyme, stimulates dynein protein phosphorylation and slippage of microtubules of flagellum, [15],[16] and increases flagellar beat frequency. [17],[18] More evidence show that the lithium ion reduces sperm motility through inhibiting the activity of cAMP second messenger system, disrupting activity of adenylate cyclase enzyme, and reducing cAMP's concentration. [19]

Lithium and cytoplasmic calcium

Adhesion of cortical exocytotic vesicle membranes, hyperactivation induction, capacitation, acrosome reaction, several chemotaxic and thermotaxic pathways that are activated in aggregation, orientation, and increased motility of sperms toward the fertilization area and also the onset of sperm motility dependent on calcium and its release from intracellular reservoirs enhance these processes. [20] Moreover, reduction of cytoplasmic free calcium in developing sexual cells stops transfer of membrane exocytotic vesicles added to the cytokinetic area that causes meiosis to slow down or stop. [21] In this study, percentage of sperm cells with normal motility at all three doses of lithium, especially at the highest doses, showed a significant reduction revealing interference of lithium in normal motility of sperms that may be due to reduced cAMP signaling and low release of calcium into cytoplasm.

Lithium and production of inositol

The most important therapeutic effects of lithium in neurons, i.e., inhibiting activity of inositol monophosphatase (IMpase) enzymes and inositol polyphosphate 1-phosphatase (IPPase) and prevention of inositol reproduction in its retrieval cycle (the main source of these lipids) may slow down or stop cytokinesis of sexual cells. Phosphatidylinositols in sex cells are the main molecules adjusting cytoskeleton, cytokinetic membrane, and direct signaling of aggregation of many types of essential molecules in cells. Induction of actin polymerization in cells and production of meiosis spindle and absorption of cleavage-activating proteins like septin to the cytokinetic area along with calcium are necessary for stability of cleave furrow and actomyosin contractile ring. [22] In this study, reduction of total produced sperm at three doses of lithium carbonate was obvious and the previous studies also showed the same disorder in cell division.

Lithium and nitric oxide

Endogenous NO is produced under normal conditions to cause and support sperm normal motility, and exogenous NO results in hyperactivation of sperm motility, which is commonly observed when sperm penetrates ovula. High concentrations of NO in sperm may reduce or inhibit viability and motility of sperms. Increasing expression of the NO pathway in sex epithelium in urinary-genital tract infections and intense immunological reactions in order to create cytotoxicity against microbes can make the surrounding tissues and sperm cells toxic, that is the main cause of infertility arising from genital tract abnormalities and infections. [23] At higher doses of lithium, high concentrations of NO are produced in the sperm cell that set out an oxidative stress reaction and membrane lipid peroxidation and consequently reduce sperm viability and

motility. [24],[25] Therefore, besides previous reasons, remarkable reduction of motile sperms and total produced sperm may be due to the effect of nitric oxide.

Lithium, adenosine triphosphate level of sperm, and Glycogen Synthase Kinase-3 enzyme

Factors, like lithium, which change the normal shape of mitochondrial membrane disrupt mitochondrial ATP formation. [26] Furthermore, lithium is considered as a strong ATP production blocker by inhibiting GSK3 enzyme in the glycolysis pathway (main pathway for ATP production). The strong GSK3 kinase adjusts phosphorylation of glucose metabolism enzymes and its inhibitory effect on severe reduction of flagellar movements is remarkable. [27],[28] In this study, it was observed that there was a significant difference between the motility speed and interval of consequent beats of the normal sperms and sperms of rats receiving lithium. This finding confirms to the mentioned reasons. In addition to the above-mentioned reasons, lithium reduces the activity of hypothalamus, pituitary gland, gonad, and level of gonadotropins and subsequent reduction of intratesticular testosterone that is directly effective in development of sex cells [13],[29] and also an excessive increase in expression of the signaling pathway of WNT/CTNNB1 in Sertoli and Leydig cells and aggregation of stable structure of the molecule CTNNB1 along with changes in gene expression of cell toward stopping cell cycle in M/G2 and apoptotic induction reduce the number of sex cells and testicular somatic cells. [30]

When lithium induces cholesterol aggregation in cell [31] and increases membrane cholesterol in a long period, it reduces fluidity of cell and disrupts the membrane-dependent functions including reduction of acrosome reaction index, reduction of sperm capacity, and an increase in abnormal sperms and due to the high cholesterol, cells in the physiologic solution get hypo-osmotic stress and the normal shape of their membrane changes that is visible at the sperm's tail. [32] On the basis of these information and results of this study, treatment with lithium severely reduces active progressive motility with linear acceleration in a straight direction, especially at the highest concentration, and the flagellar movements change into slow vibrations with intervals. [33] Moreover, abnormal sperm's tail and curled membrane in this area were observed in this study.


  Conclusion Top


The results presented here support that lithium carbonate exposure can considerably reduce the sperm motility, normal sperms, and total sperm count during a spermatogenesis cycle in Wistar rats. This may justify for reduced fertility, while taking this drug for a long time. This study indicated the detrimental effect of lithium drug on fertility and thereby suggested the importance of monitoring patients' health undergoing this treatment.


  Acknowledgment Top


The authors would like to thank Dr. Nader Pestehchian and Dr. Noushin Afshar Moghaddam for their help in performing this study.

 
  References Top

1.Isidori AM, Pozza C, Gianfrilli D, Isidori A. Medical treatment to improve sperm quality. Reprod Biomed 2006;12:704-14.  Back to cited text no. 1
    
2.Joffe M. Semen quality analysis and the idea of normal fertility. Asian JAndrol 2010;12:79-82.  Back to cited text no. 2
    
3.Yanagimachi R. Mechanism of fertilization. International symposium of male factor in human infertility Surseine. France: 1994. p. 21-2.  Back to cited text no. 3
    
4.Macleod J. Human male infertility. NEJM 1956;225:1140-6.  Back to cited text no. 4
    
5.Mann T, Lutwak-Mann C. Male reproductive function and semen. J R Soc Med 1982;75:289-98.  Back to cited text no. 5
    
6.Mohri H. Epididymal maturation and motility of mammalian spermatozoa. In: Serino M, editor. Prespective in andrology. Vol. 53. NewYork: Raven Press; 1989. p. 291-2.  Back to cited text no. 6
    
7.Majumder GC, Dey CS, Haldar S, Barua M. Biochemical parameters of initiation and regulation of sperm motility. Arch Androl 1990;24:287-303.  Back to cited text no. 7
[PUBMED]    
8.Ferrel J, Jeffay S, Suare ZJ, Robert N, Kline Felter ER, Laskey JW, et al. The Ethane di-methane sulphonate-induced decrease in the fertilizing ability of cauda epididymal, sperm is independent of the testis. J Androl 1994;15:318-27.  Back to cited text no. 8
    
9.Plassman S, Urwyler H. Improved risk assessment by screening sperm parameters. Toxicol Lett 2001;119:157-71.  Back to cited text no. 9
    
10.Zarnescu O, Zamfirescu G. Effect of Lithium carbonate on rat seminiferous tubules an ultra structural study. Int J Androl 2006;29:576-82.  Back to cited text no. 10
[PUBMED]    
11.Banerji TK, Maitra SK, Dey M, Hawkins HK. Gametogenic responses of the testis in spotted munia (Lonchurapunctulata, Aves) to oral administration of lithium chloride. Endocr Res 2001;27:345-56.  Back to cited text no. 11
[PUBMED]    
12.Marshall PN. Papanicolaou staining-a review. Microsc Acta 1983;87:233-43.  Back to cited text no. 12
[PUBMED]    
13.Thakur SC, Thakur SS, Chaube SK, Singh SP. Subchronic supplementation of Lithium carbonate induces reproductive system toxicity in male rat. Reprod Toxicol 2003;17:683-90.  Back to cited text no. 13
[PUBMED]    
14.Garacia Aseff S, Fuentes LB. Lithium effect on testicular tissue of adult male and female viscacha. Acta Physiol Pharmacol 1995;45:87-95.  Back to cited text no. 14
    
15.Bouchard P, Penningroth SM, Cheung A, Eagnon C, Bardin CW. Erythro-9-[3(2-Hydroxynonyl)] adenine is an inhibitor of sperm motility that blocks dyneine ATP ase and protein carboxyl methylase activities. Natl Acad Sci USA 1981;89:1303-36.  Back to cited text no. 15
    
16.Lawson CH, Goupil S, Leclerc P. Increased activity of the Human sperm Tyrosine Kinase by the CAMP-Dependent pathway in the presence of calcium. Biol Reprod 2008;79:657-66.  Back to cited text no. 16
    
17.Luconi M, Marroo F, Gandidni L, Filimberti E, Lenzi A, Froti G, et al. Phospatidylinositol3-kinase: Inhabitation enhances human sperm motility. Hum Reprod 2001;16:1931-7.  Back to cited text no. 17
    
18.Carlson AE, Hille B, Babcock DF. External Ca2 acts upstream of adenyltlcyclase in the bicarbonate signaled of sperm motility. Dev Biol 2007;312:183-92.  Back to cited text no. 18
[PUBMED]    
19.Henderson NA, Robaire B. Effects of a dual 5-alpha-reductase inhibitor on rat epididymal sperm maturation and fertility. Biol Reprod 2005;72:436-43.  Back to cited text no. 19
[PUBMED]    
20.Bahat A, Eisenbach M. Human sperm Termotaxis is mediated by phospolipase C and Inositol Triphosphate receptor Ca2+channel. Biol Reprod 2010;82:606-16.  Back to cited text no. 20
[PUBMED]    
21.King J, Regina T, Ryves J, Hawood A. The mood stabilizer Lithium suppresses PIP3 signaling in dictiostelium and human cells. Biochem Soc Trans 2009;2:306-12.  Back to cited text no. 21
    
22.Carla DB, Fernand Z. Lithium blocks cell cycle transition in the first cell cycle of sea urchin embryos an effect rescued by myo-inositol. Development 1997;124:1099-107.  Back to cited text no. 22
    
23.Rosselli M, Dubey RK, Imthurn B, Macas E, Keller PJ. Effects of nitric oxide on human spermatozoa: Evidence that nitric oxide decreases sperm motility and induces sperm toxicity. Hum Reprod 1995;10:1786-90.  Back to cited text no. 23
[PUBMED]    
24.Miraglia E, De Angelis F, Gazzano E, Hassanpour H, Bertagna A, Aldieri E, et al. Nitric oxide stimulates human sperm motility via activation of the cyclic GMP/protein kinase G signaling pathway. Reproduction 2011;141:47-54.  Back to cited text no. 24
[PUBMED]    
25.Bagetta G, Corasaniti MT, Melino G, Paoletti AM, Finazziagro A, Nistico G. Lithium and Tacrne increase the expression of Nitric Oxide synthase Mrna in the Hippocampus of Rat. Biochem Biophys Res Commun 1993;197:1132-9.  Back to cited text no. 25
    
26.Marchetti C, Obert G, Deffosez A, Formstecher P, Marcheti P. Study of mitochondrial membrane potential reactive oxygen species, DNA fragmentation and cell viability by flow cytometry in human sperm. Hum Reprod 2002;17:1257-65.  Back to cited text no. 26
    
27.Vijayaraghavan S, Mohan J, Gray H, Khata B, Carr DW. A role for Phosphorylation of Glycogen synthase kinase-3 alpha in bovine sperm motility regulation. Biol Reprod 2000;62:1646-54.  Back to cited text no. 27
    
28.Stambolic V, Ruel L, Woodgett JR. Lithium inhibits glycogen synthase kinase-3 activity and mimics wingless signalling in intact cells. Curr Biol 1996;6:1664-8.  Back to cited text no. 28
[PUBMED]    
29.Gosh PK, Biswase NM, Gosh D. Effect of Lithium chloride on spermatogenesis and testicular steroidogenesis in mature albino rats: Duration dependent responses. Life Sci 1999;48:649-57.  Back to cited text no. 29
    
30.Boyer A, Hermo L, Paquet M, Robaire B, Boerboom D. Seminiferous tubule degeneration and infertility in mice with sustained activation of WNT/CTNNB1 signaling in sertoli cells. Biol Reprod 2008;79:475-85.  Back to cited text no. 30
[PUBMED]    
31.Fleischman A, Lenz P, Bierenbaum M. Effect of lithium upon lipid metabolism in rats. J Nutr 1974;104:1242-5.  Back to cited text no. 31
    
32.Sharma S, Prasanthi RP, Schommer E, Feist G, Ghribi O. Hypercholesterolemia-induced Aβ accumulation in rabbit brain is associated with alteration in IGF-1 signaling. Neurobiol Dis 2008;32:426-32.  Back to cited text no. 32
    
33.Raof NT, Pearson RM, Turner P. Lithium inhibits human sperm motility in vitro. Br J Clin Pharmacol 1989;28:715-7.  Back to cited text no. 33
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
    Tables

  [Table 1]


This article has been cited by
1 The Association Between Psychotropic Drug Use and Fertility Problems Among Male Subjects
RONNIE SOLOMON,RACHEL SHVARTSUR,ABED N. AZAB
Journal of Psychiatric Practice. 2019; 25(1): 22
[Pubmed] | [DOI]
2 The impact of drugs on male fertility: a review
M. Semet,M. Paci,J. Saļas-Magnan,C. Metzler-Guillemain,R. Boissier,H. Lejeune,J. Perrin
Andrology. 2017;
[Pubmed] | [DOI]
3 Is lithium essential for epididymal sperm maturation?
Tanmoy Halder,Uttam Datta,Siddhartha Basu,Prasenjit Mukherjee
Medical Hypotheses. 2016;
[Pubmed] | [DOI]
4 Adverse effects of common medications on male fertility
Mary K. Samplaski,Ajay K. Nangia
Nature Reviews Urology. 2015; 12(7): 401
[Pubmed] | [DOI]



 

Top
Previous article  Next article
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussions
Conclusion
Acknowledgment
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed5535    
    Printed40    
    Emailed0    
    PDF Downloaded383    
    Comments [Add]    
    Cited by others 4    

Recommend this journal