Andrology最新文献

{"title":"Aggregate Ratings Do Not Establish Response-Level Clinical Acceptability in ChatGPT Penile Prosthesis Counseling.","authors":"Tong Wang, Ran Tong, Zhixiang Huang","doi":"10.1111/andr.70413","DOIUrl":"https://doi.org/10.1111/andr.70413","url":null,"abstract":"","PeriodicalId":7898,"journal":{"name":"Andrology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Caffeinated Beverage Intake and Semen Quality in a Preconception Cohort.","authors":"Sachelly Julián-Serrano, Ruth J Geller, Martha R Koenig, Krystal E Kuan, Eliza P Pentz, Greg Sommer, Michael L Eisenberg, Kenneth J Rothman, Elizabeth E Hatch, Amelia K Wesselink, Lauren A Wise","doi":"10.1111/andr.70415","DOIUrl":"https://doi.org/10.1111/andr.70415","url":null,"abstract":"<p><strong>Background: </strong>Few studies have examined the association between caffeine intake and semen quality among couples attempting conception.</p><p><strong>Objectives: </strong>To examine the effect of caffeinated beverage intake on semen quality.</p><p><strong>Materials and methods: </strong>We analyzed cross-sectional data from Pregnancy Study Online (PRESTO), a preconception cohort study. We invited US residents aged ≥ 21 years to perform at-home semen testing (n = 929 participants; 1668 samples). The outcomes included semen volume, sperm concentration, total sperm count (TSC), percent motility, and total motile sperm count (TMSC). Participants reported their past-month intakes of caffeinated coffee, tea, soda, and energy drinks, from which we calculated caffeine intake. We used multivariable linear regression to estimate mean percentage differences (%D) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Median caffeine intake was 138 mg/day (interquartile range = 51-270 mg/day). No monotonic associations were observed for intakes of coffee, tea, soda, or energy drinks. Comparing caffeine intakes of ≥ 200 versus < 100 mg/day, we found no consistent associations with semen volume (%D [95% CI]: 0.2 [-8.2, 8.6]), sperm concentration (-9.1 [-23.2, 7.5]), TSC (-10.1 [-23.7, 6.0]), % motility (2.4 [-3.5, 8.3]), or TMSC (-7.9 [-23.5, 11.0]).</p><p><strong>Discussion: </strong>Caffeinated beverage intake was not consistently associated with semen parameters in this preconception cohort.</p><p><strong>Conclusion: </strong>Moderate caffeine intake has little effect on semen quality.</p>","PeriodicalId":7898,"journal":{"name":"Andrology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Ejaculatory Prolactin Elevation Resolves Within 2 Hours: Implications for Blood Sampling in Male Infertility Evaluation.","authors":"Shuai Li, Junjie Tian, Li Zhao, Yaoting Xu, Bo Zhu, Lejun Li","doi":"10.1111/andr.70411","DOIUrl":"https://doi.org/10.1111/andr.70411","url":null,"abstract":"<p><strong>Background: </strong>The acute post-ejaculatory prolactin (PRL) elevation is well recognized, but its magnitude and recovery kinetics remain poorly defined.</p><p><strong>Objectives: </strong>To delineate the post-ejaculatory PRL kinetics, define its recovery window, and assess the clinical impact of improper sampling timing on hyperprolactinemia misclassification.</p><p><strong>Materials and methods: </strong>This single-center retrospective cohort study included 22,590 infertile men (aged 20-45 years). Participants were classified into pre-ejaculatory (n = 8804) and post-ejaculatory (n = 13,786) groups, with the latter subdivided into 17 subgroups by sequential post-ejaculatory time intervals. Serum PRL, testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol were measured. The proportion of participants with PRL exceeding the local upper reference limit (17 ng/mL) was calculated. Interaction effects of ejaculation, sampling time of day, and age were evaluated using three-way ANOVA.</p><p><strong>Results: </strong>Ejaculation induced a rapid and pronounced elevation in serum PRL, peaking within the ≤ 0.1 h interval (median 17.9 ng/mL, 58.4% increase from baseline, p < 0.01) and returning to baseline by the ≤ 2 h interval. Other sex hormones showed only minimal changes. PRL exhibited significant diurnal variation and age-related decline, but no significant interactions were observed between ejaculation and sampling time of day (p = 0.111) or age (p = 0.330). Notably, the percentage of participants with PRL >17 ng/mL increased from 15.8% at baseline to > 50% within the first 0.2 h, and remained significantly elevated through the ≤ 1.5 h interval. At the ≤ 2 h interval, the proportion (17.4%) was no longer significantly different from baseline.</p><p><strong>Conclusions: </strong>Post-ejaculatory prolactin elevation resolves within 2 h. This effect is independent of diurnal variation and age. Blood for PRL measurement should be collected either before ejaculation or at least 2 h after ejaculation to avoid misdiagnosis.</p>","PeriodicalId":7898,"journal":{"name":"Andrology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidimensional Determinants of Quality of Life in Men With Klinefelter Syndrome: A Narrative Review of Workshop Evidence.","authors":"Francesca Allosso, Lucia Digitale Selvaggio, Daniela Pasquali","doi":"10.1111/andr.70409","DOIUrl":"https://doi.org/10.1111/andr.70409","url":null,"abstract":"<p><strong>Background: </strong>Klinefelter syndrome (KS), typically characterized by a 47, XXY karyotype, is the most common sex chromosomal aneuploidy in males, with a prevalence of approximately one in 600-660 individuals. Despite its frequency, the syndrome remains significantly underdiagnosed, with 50%-75% of affected individuals never receiving a clinical diagnosis. While the classic phenotype includes hypergonadotropic hypogonadism and infertility, recent evidence highlights a lifelong burden of neurocognitive, psychological, and socioeconomic challenges.</p><p><strong>Objectives: </strong>This study synthesizes current evidence regarding the determinants of quality of life (QoL) in men with KS, specifically contextualizing the registry data and clinical trajectories discussed during the fourth International Workshop on Klinefelter Syndrome.</p><p><strong>Materials and methods: </strong>To perform a narrative review, a literature search was conducted across major electronic databases, including PubMed/MEDLINE, Scopus, and the Cochrane Library. The search focused on peer-reviewed articles published up to March 2026, utilizing primary keywords such as \"Klinefelter Syndrome,\" \"47, XXY, \" \"Quality of Life, \" \"Socioeconomic Status, \" and \"Testosterone Replacement Therapy.\"</p><p><strong>Results: </strong>Affected individuals consistently report lower QoL across physical, psychological, and social domains compared to healthy controls, with social relationship scores often reaching levels observed in psychiatric reference populations. Key drivers of reduced well-being include lower educational achievement, precarious employment, chronic health comorbidities, and experienced discrimination.</p><p><strong>Discussion: </strong>While testosterone replacement therapy is essential for physical virilization, it is frequently insufficient to normalize QoL or alleviate deep-seated psychological distress, highlighting the impact of unmitigated developmental hurdles, metabolic burdens, and infertility-related psychological trauma.</p><p><strong>Conclusion: </strong>A multidisciplinary approach-integrating endocrinology with specialized psychological, fertility, and educational support-is strictly required to address the complex, multidimensional needs of this population across the lifespan.</p>","PeriodicalId":7898,"journal":{"name":"Andrology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author's Response: Can Hormonal Therapy Improve the Outcomes of mTESE in Patients with Nonobstructive Azoospermia?","authors":"M Anfosso, M Schubert, J F Cremers, S Kliesch, M Zitzmann, S Bier","doi":"10.1111/andr.70408","DOIUrl":"https://doi.org/10.1111/andr.70408","url":null,"abstract":"","PeriodicalId":7898,"journal":{"name":"Andrology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lower Systolic Blood Pressure in 67 Boys With Klinefelter Syndrome Compared to 1842 Healthy Danish Boys.","authors":"Andrés Felipe Ø Fritzbøger, Riccardo Battiston, Cecilie N Larsen, Anna Sophie L Kjaer, Klaus Juul, Ida M Schmidt, Jørgen H Petersen, Katharina M Main, Anders Juul, Lise Aksglaede","doi":"10.1111/andr.70410","DOIUrl":"https://doi.org/10.1111/andr.70410","url":null,"abstract":"<p><strong>Objective: </strong>Our objective was to develop age- and height-specific reference ranges for blood pressure, pulse pressure and mean arterial pressure in healthy boys and to compare these to measurements in patients with Klinefelter syndrome followed longitudinally through childhood and adolescence.</p><p><strong>Design: </strong>Cohort study consisting of a population-based reference cohort including 1842 healthy non-obese boys aged 0-20 years and 67 patients with Klinefelter syndrome aged 7-20 years, followed at a single tertiary center.</p><p><strong>Methods: </strong>Height, weight, and blood pressure were measured, and references were developed as a function of age, height, and their combined effect in healthy boys. In patients with Klinefelter syndrome standard deviation scores were calculated for systolic and diastolic blood pressure, pulse pressure and mean arterial pressure. These were adjusted for age and height independently, as well as combined age and height. A subgroup analysis in patients with Klinefelter syndrome assessed whether testosterone replacement therapy influenced blood pressure.</p><p><strong>Results: </strong>Systolic and diastolic blood pressure increased with increasing age in healthy boys. Patients with Klinefelter syndrome had significantly lower systolic blood pressure compared to the healthy, non-obese reference population, with a mean standard deviation score of -0.65, -0.90, -0.91 when adjusted for age, height, and both, respectively. Diastolic blood pressure did not differ from controls. Pulse pressure showed a mean standard deviation score of -0.74, -0.99, and -0.94 when adjusting for age, height or both, respectively. Mean arterial pressure showed a mean standard deviation score of -0.27, -0.33, and -0.41 adjusted for age, height or both, respectively. Testosterone replacement therapy had no significant effect on blood pressure.</p><p><strong>Conclusions: </strong>Our study showed that patients with Klinefelter syndrome have lower systolic but similar diastolic blood pressure compared to our new blood pressure reference ranges. Pulse pressure and mean arterial pressure were both significantly lower after any adjustment compared to healthy controls.</p>","PeriodicalId":7898,"journal":{"name":"Andrology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vasoepididymostomy-First Versus Primary ICSI for Epididymal Obstructive Azoospermia: Real-World Reproductive Outcomes for Treatment Selection.","authors":"Hong Xiao, Yilang Ding, Yonghuai Hu, Jianfeng Chen, Shan Zhou, Peng Yang, Qiang Chen, Hailin Huang, Xi Chen, Maoyuan Wang, Guoda Song, Li'e Zheng, Yilu Zou, Qicai Liu, Huiliang Zhou, Songxi Tang","doi":"10.1111/andr.70412","DOIUrl":"https://doi.org/10.1111/andr.70412","url":null,"abstract":"<p><strong>Background: </strong>In couples with epididymal obstructive azoospermia (EOA), choosing between microsurgical vasoepididymostomy (MVE)-first and primary intracytoplasmic sperm injection (ICSI) remains a practical treatment-selection challenge. Conventional endpoints such as patency and pregnancy rates provide an incomplete assessment of the real-world consequences of an MVE-first strategy, including transition to assisted reproduction, subsequent ICSI outcomes, and time to live birth. It remains uncertain whether MVE-first preserves natural-conception potential without compromising subsequent ICSI live-birth outcomes. How this time trade-off should inform couple-level treatment selection is also unclear.</p><p><strong>Methods: </strong>This retrospective cohort study included 397 couples (270 MVE‑first, 127 primary ICSI). Treatment trajectories after MVE, including postoperative patency, natural conception, transition to assisted reproductive technology, and subsequent ICSI, were evaluated. The primary comparative outcome among ICSI-treated couples was cumulative live birth rate (CLBR) after all embryo-transfer cycles derived from the first oocyte retrieval. Post-MVE ICSI included ICSI using ejaculated sperm after MVE patency and ICSI using surgically retrieved sperm after persistent azoospermia.</p><p><strong>Results: </strong>Among the 241 men who remained evaluable after MVE, postoperative patency was achieved in 177 (73.4%). After additional follow-up losses, 236 couples comprised the final post-MVE follow-up cohort; 84 couples achieved natural conception (35.6%), resulting in 80 live births. A female age ≤ 28 years and an AMH concentration >2.91 ng/mL were associated with a higher probability of natural conception. Among couples who subsequently underwent ICSI, CLBR was 45.9% after MVE versus 43.8% after primary ICSI (difference, +2.1 percentage points; one-sided 95% CI lower bound, -8.3%), which met the non-inferiority criterion. Major pregnancy, birth, and neonatal safety outcomes were comparable among the ICSI groups. Among ICSI-treated couples, post-MVE ICSI was associated with a lower live-birth hazard than primary ICSI (adjusted hazard ratio [aHR] 0.22, 95% CI 0.15-0.35; p < 0.001), whereas higher baseline AMH was associated with a higher live-birth hazard (aHR 1.13, 95% CI 1.03-1.25; p = 0.010).</p><p><strong>Conclusion: </strong>An MVE-first strategy enabled natural conception in over one-third of the post-MVE follow-up cohort. Among couples who ultimately required ICSI, cumulative live-birth outcomes were not compromised by the MVE-first pathway, although time to live birth was longer than with primary ICSI. In this cohort, MVE-first may be favored for couples with a female partner aged ≤ 28 years and an AMH level > 2.91 ng/mL. Primary ICSI may be more appropriate when minimizing time to live birth is the main priority.</p>","PeriodicalId":7898,"journal":{"name":"Andrology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seminal Microbiota and Pregnancy Outcomes: Mechanistic Insights, Clinical Implications, and Future Directions.","authors":"Yang Chai, Guangyu Ma, Wei Zhao, Jiayue Song, Zhongsheng Chen, Huijuan Luo, Xiaomin Xiao, Xiaomei Tang","doi":"10.1111/andr.70401","DOIUrl":"https://doi.org/10.1111/andr.70401","url":null,"abstract":"<p><strong>Background: </strong>Seminal fluid contains a low-biomass microbial community that may influence male reproductive health and pregnancy outcomes, but its biological and clinical significance remains uncertain.</p><p><strong>Objectives: </strong>To critically synthesise evidence linking seminal microbiota with sperm quality, reproductive tract inflammation, natural conception, and assisted reproductive technology outcomes, and to evaluate proposed mechanisms and clinical implications.</p><p><strong>Materials and methods: </strong>This review integrates human observational studies with relevant in vitro, animal, and female reproductive tract evidence, with particular attention to 16S rRNA gene sequencing, low-biomass contamination, and methodological heterogeneity.</p><p><strong>Results: </strong>Genus-enriched and compositionally distinct seminal profiles have been reported, but no reproducible community types have been established across populations. Lactobacillus-enriched profiles are associated with favourable semen parameters in some cohorts, whereas infection-associated or opportunistic taxa are more often linked to impaired semen characteristics. Proposed pathways include immune activation, oxidative stress, spermmicrobe interactions, and guttestis signalling.</p><p><strong>Discussion: </strong>Evidence remains predominantly observational and heterogeneous, with limited direct mechanistic validation and sparse longitudinal data.</p><p><strong>Conclusion: </strong>Standardised, contamination-aware studies with independent validation are needed. Current evidence does not support routine seminal microbiome testing or microbiota-directed interventions in infertility care.</p>","PeriodicalId":7898,"journal":{"name":"Andrology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypogonadism in Cisgender Men Living With HIV: Prevalence, Clinical and Metabolic Features.","authors":"Felipe Augusto Azevedo Leao, Gabriel Cabreira Nunes, Manuela Almeida Ribeiro, Luiza Costa da Fonseca, Aline Cristina Miranda Marinho Costa, Mateus Rodrigues Westin, Unai Tupinambas, Milena Maria Moreira Guimaraes, Leticia Ferreira Gontijo Silveira","doi":"10.1111/andr.70400","DOIUrl":"https://doi.org/10.1111/andr.70400","url":null,"abstract":"<p><strong>Background: </strong>Hypogonadism is frequently observed in men living with  human immunodeficiency virus (HIV), although its prevalence, etiology, and predictors remain incompletely understood.</p><p><strong>Objective: </strong>To evaluate the prevalence of hypogonadism and its association with metabolic factors in men living with HIV (MLWH), on stable antiretroviral therapy.</p><p><strong>Materials and methods: </strong>Total testosterone (TT), sex hormone-binding globulin (SHBG), calculated free testosterone (cFT), metabolic parameters, and ADAM questionnaire responses were assessed in 136 MLWH (19-73 years), classified as hypogonadal or eugonadal.</p><p><strong>Results: </strong>Subnormal cFT or TT levels were detected in 35.3% of the participants; 52.1% had isolated low cFT and 78.4% were hypogonadotropic. ADAM showed 75.6% sensitivity and 44.7% specificity.</p><p><strong>Discussion: </strong>Hypertension, dysglycemia, higher triglycerides levels, higher BMI, increased waist circumference, older age, longer time of infection, and insulin resistance indexes were positively associated with hypogonadism in univariate analysis. Serum estradiol levels were similar between groups. After multivariate analysis, age and dysglycemia remained independently associated with testosterone deficiency.</p><p><strong>Conclusion: </strong>One-third of MLWH had hypogonadism, mostly of central origin. cFT assessment was essential to avoid underdiagnosis. Hypogonadism in MLWH seems to be associated with metabolic impairment, however only age and dysglycemia remained independently associated after adjustment.</p>","PeriodicalId":7898,"journal":{"name":"Andrology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Smokeless Tobacco on Semen Quality: A Systematic Review and Meta-Analysis.","authors":"Rayan Alqarni, Ebtesam Almajed, Mohammed Alahmari, Nawaf A Althobait, Sultan A Alkathami, Noura Nawar AlQurashi, Omar M Althobaiti, Abdullah Almarzouki, Abdullah D Alotaibi, Ahmed S Zugail","doi":"10.1111/andr.70394","DOIUrl":"https://doi.org/10.1111/andr.70394","url":null,"abstract":"<p><strong>Background: </strong>Smokeless tobacco products are widely regarded as a safer alternative to smoking. However, a growing body of evidence points to harmful effects on male reproductive health. The aim of this systematic review and meta-analysis was to assess the association between smokeless tobacco use and the principal indicators of male infertility.</p><p><strong>Methods: </strong>This review was conducted in accordance with PRISMA 2020 guidelines and registered with PROSPERO (CRD420251056391). A systematic search of PubMed, Medline, Web of Science, and Google Scholar was performed from January 1993 to December 2025. Observational and interventional studies that examined smokeless tobacco exposure in adult men were eligible. Risk of bias was assessed with ROBINS-I and the certainty of evidence with GRADE.</p><p><strong>Results: </strong>Sixteen studies with a total of 3401 participants met the inclusion criteria. Smokeless tobacco use was associated with lower sperm motility (mean difference, MD: -9.56; 95% confidence interval, CI: -14.85 to -4.28), lower sperm concentration (MD: -14.90; 95% CI: -21.43 to -8.37), lower sperm vitality (MD: -12.86; 95% CI: -19.86 to -5.86), and a higher proportion of abnormally shaped sperm (MD: +3.58; 95% CI: 0.34 to 6.82). Semen pH was slightly but significantly lower in users (MD: -0.03; 95% CI: -0.04 to -0.02). Semen volume was also lower, but the difference did not reach statistical significance (MD: -0.36; 95% CI: -0.76 to 0.04; p = 0.078). Heterogeneity was high for several outcomes (I² > 90%), but sensitivity analyses did not change the direction of effect. The GRADE certainty of evidence was moderate for all pooled outcomes except semen volume, for which it was low.</p><p><strong>Conclusion: </strong>Smokeless tobacco use was associated with poorer semen quality, particularly in sperm motility, concentration, vitality, and morphology. These findings are consistent with smokeless tobacco being an important and frequently overlooked risk factor for male infertility, although the evidence is observational and derived largely from South Asian populations. Clinicians should consider asking about smokeless tobacco use during infertility evaluations, and targeted public health measures appear warranted to address its reproductive effects.</p>","PeriodicalId":7898,"journal":{"name":"Andrology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}