Malaysian Journal of Public Health Medicine 2018, Special Volume (1): 33-40 ORIGINAL ARTICLE EFFECT OF WORKSTRESS AND SMOKING TOWARDS SPERM QUALITY AMONG INFERTILE MALE Khairul Osman 2 , Rafeah Pakri Mohamed 1 , Mohd Hashim Omar 1 , Siti Fatimah Ibrahim 1 and Norhamizan Hashim 3 1 Faculty of Medicine, National University of Malaysia (UKM), 56000 Kuala Lumpur 2 Faculty of Health Sciences, National University of Malaysia (UKM), 50300 Kuala Lumpur 3 National Population and Family Development Board (NPFDB), 50350 Kuala Lumpur Malaysia Corresponding Author: Rafeah Pakri Mohamed Email: tasha_raf87@yahoo.com, gabysolis56@gmail.com ABSTRACT Male infertility is a relatively common condition affecting approximately 1 in 20 of the male population. DNA fragmentation is an important factor in the etiology of male infertility. Men with high DNA fragmentation levels have significantly lower odds of conceiving, naturally or through procedures such as intrauterine insemination and IVF. The most common contributing factor of male infertility is smoking. Studies have shown that smoking intensity is positively associated with job demands and stress. Therefore, we believe that work stress increases the nicotine-dependent thus causing lower male fertility rate. As proper protamine to histone ratio is essential to produce viable sperm, smoking is strongly suspected to reduce sperm viability through histone-to-protamine transition abnormalities. These abnormalities, results in sperm with high DNA damage when exposed to excessive free radical. This present study was undertaken to evaluate the relationship of work stress, smoking and sperm quality. A total of 210 infertile patients attending Medical Assisted Contraceptive Clinic (MAC), UKMMC were selected for the study. Smoking status and stress level of patients were collected after obtaining relevant consent. Histone-to-protamine ratio was acquired using Aniline Blue staining and Chromomycin A3 staining respectively. Sperm DNA fragmentation was estimated using Comet Assay. Result revealed that smokers tend to be more stressful (r = .446, p <. 001). The result showed a significantly increased level of histone (r = .385, p <. 001) and incomplete protamination (r = .492, p <. 001) in smokers. The imbalance of histone-to-protamine ratio lead to increase of DNA damage. All the data were analyzed using SPSS version 20.0. Result revealed that patients who smoke are more stressful at work. Higher proportion of abnormal sperm histone to protamine ratio were found among smokers suggesting that cigarette smoking may inversely affect male fertility. Keywords: male, stress, smoking, sperm quality INTRODUCTION In recent decade, infertility affects 10% - 15% of couples worldwide and it is recognized as a public health problem 1 . From the afore mentioned prevalence, male infertility accounts for half of the problem 2 . Drilling deeper into the subject, numerous studies have reported that cigarette smoking plays a major role in sperm quality and consequently male infertility. 3,4,5 . Cigarette smoking is well known to be a leading source of preventable morbidity and morbidity 6 . There are many reason one can pick up the habit of smoking 7 . One of which is job stress. Stress present physiological and psychological challenges to the body and mind and can be a result of real or perceived challenge to homeostasis 8 . In response to stress, individuals try to maintain homeostasis through a number of mechanism, one potential mechanism is self-medication by smoking 9 . Many smoking studies have been carried out for the past three decades among adolescents who belongs in the working age group population 10 . Job-related stress might affect smoking behavior because smoking may relieve stress and stress can make individuals more focused 11 . Some studies have showed that heavy smoking is associated with high job demands 12 low job control 13 or peer influence at work 14 . This evidence suggest that job stress could causally related to smoking. Smoking can be detrimental to human sperm due to high concentration of free radicals in the smoke and can potentially induce the production of cellular reactive oxygen species in the human body 15 . Due to high concentration of polysaturated fatty acids on human sperm plasma membrane, spermatozoa are especially prone to oxidative damage caused by smoking 16 . The exact pathophysiology underlying cigarette smoking and sperm deterioting is still unclear 17 . However, it has been reported that cigarette smoking may affect sperm DNA integrity 18 .