CHAPTER ONE

1.0 INTRODUCTION

1.1 Preamble

Infertility has been a major medical and social predicament, and until recently, most

of the blame for infertility was placed on the female. However, male factor infertility

is now gaining considerable attention. Infertility is defined as the inability to conceive

after one year of regular and unprotected intercourse by couples of reproductive age.

In males it is inability to impregnate a fertile female in a year after unprotected

intercourse. In cases of females, it is inability to conceive in a year after unprotected

intercourse with a fertile male (Agarwal et al., 2007; Badade and Samant, 2011).

Infertility affects approximately 15% of all couples trying to conceive, and male

factor is the sole or contributing factor in roughly half of these cases. It is estimated

that the male factor in couple infertility is between 25% to 50% (Safarinejad, 2008;

Bablok et al., 2011). This occurs when an ―alteration in sperm concentration, motility,

and/or morphology is present in at least one sample of two sperm analyses, collected 1

to 4 weeks apart‖ (Agarwal and Sekhon, 2011). This problem becomes further

compounded when no identifiable reason can be found (Agarwal et al., 2014).

Aside the well documented conventional risk factors of male fertility (male accessory

gland infection, mumps, orchitis, varicocele, and cryptorchidism, etc), poor lifestyle

choices, including prolonged exposure to xenobiotics and other chemical substances

can adversely affect male reproductive system, thereby causing impaired fertility.

Mechanisms of impaired fertility include direct disruption of sperm production and

quality; effects on the delicately balanced hypothalamo-pituitary-testicular axis;

effects on erectile or ejaculatory function, and effects on libido (Sharpe and Irvine,

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2004; Ten et al., 2008). Moreover, oxidative stress mediated by reactive oxygen

species (ROS) is being recognized more commonly as a causative factor in male

infertility (Meeker et al., 2007). This is because mature spermatozoa, encased in a

polyunsaturated lipid membrane, are vulnerable to the effects of ROS, which at high

doses can impair spermatogenesis and decrease sperm quality (Saleh and Agarwal

2002; Mahfouz et al., 2009; Agarwal and Sekhon, 2011).

Malaria is caused by infection of red blood cells with protozoan parasite of the genus

Plasmodium. The parasites are inoculated into the human host by a feeding female

anopheline mosquito. The four Plasmodium species that infect humans are P.

falciparum, P. vivax, P. ovale and P. malariae (WHO, 2010a). Malaria illness

imposes great burden on the society as it has adverse effects on the physical, mental

and social wellbeing of the people as well as on the economic development of the

nation (Peter, 2013). Malaria control requires an integrated approach, including

prevention (primarily vector control) and prompt treatment with effective

antimalarials (WHO, 2010a).

The constant emergence of drug-resistant plamodium parasites to monotherapies have

shored up the use of artemisinin-based combination therapies (ACTs) as the malaria

therapy of choice. Artemether-Lumefantrine is one of the ACTs recommended by the