الفهرس 
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Abstract
Intracytoplasmic sperm injection (ICSI) is a specialized form of in vitro fertilization (IVF) that is often utilized to overcome severe male infertility by injecting a single sperm directly into an oocyte. Despite the advancements in assisted reproductive technologies (ARTs), the success rate of ICSI is not universally high, with many cycles failing to result in pregnancy. Emerging research suggests that environmental factors, specifically the exposure to heavy metals like lead and cadmium, may significantly impact reproductive health and the outcomes of ARTs such as ICSI.
Lead (Pb) and cadmium (Cd) are two heavy metals known for their toxicity and widespread environmental distribution. Both metals can enter the human body through various routes, such as ingestion, inhalation, or absorption through the skin. Once inside the body, they can accumulate and exert toxic effects on multiple organs and systems. Notably, these metals have been associated with detrimental effects on male reproductive health. They can impact semen quality through several mechanisms, including hormonal disruptions, oxidative stress, and direct damage to the sperm’s DNA.
Seminal plasma, the fluid portion of semen, plays a crucial role in the transport, nutrition, and protection of sperm. The concentration of heavy metals in seminal plasma can reflect the exposure levels and potential toxicity to spermatozoa. Studies have shown that elevated levels of lead and cadmium in seminal plasma can adversely affect sperm parameters such as motility, morphology, and count—all of which are critical for the success of ICSI.
The hypothesis that seminal plasma levels of lead and cadmium might influence ICSI success is supported by several lines of inquiry. Firstly, the integrity of sperm DNA is paramount for successful fertilization and subsequent embryo development. Heavy metals have been shown to induce DNA damage and oxidative stress, which could compromise the genetic quality of spermatozoa. Secondly, the capacitation and acrosome reaction—key processes that sperm undergo to fertilize an oocyte—could be adversely affected by the toxic effects of these metals.
Understanding the correlation between seminal plasma metal concentrations and ICSI outcomes could lead to improved screening and therapeutic strategies, potentially including chelation therapy or lifestyle changes prior to treatment. This study aims to elucidate the mechanisms by which lead and cadmium affect sperm functions essential for successful ICSI, thereby contributing to a broader understanding of environmental impacts on reproductive success in the context of ARTs.
This was a prospective cohort study involved 50 infertile couples undergone Intracytoplasmic Sperm Injection (ICSI).
Participants were selected based on specific inclusion and exclusion criteria focused on unexplained infertility and idiopathic male infertility with normal female reproductive health. Men were required to undergo a detailed medical evaluation including history, physical examination, semen analysis according to WHO standards, and measurement of Pb and Cd levels using atomic absorption spectrophotometry. Women underwent ovarian stimulation using either a long or short protocol and followed a series of procedures including oocyte retrieval, sperm preparation, and embryo assessment.
The embryos were graded based on quality and fragmentation, and pregnancy was confirmed via serum beta-hCG testing and ultrasound then followed up until delivery to assess live birth rate.