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Objectives <p>This paper examined how the level of serum zinc, selenium, and cadmium relates to semen quality and testicular functions in infertile men, in a conceptual model of strategic patience that focuses on a gradual process of micronutrient optimization.</p> Methods <p>The case-control study was a hospital-based study that was carried out in the Fertility Center of Al-Sadr Medical City, Najaf, Iraq, in the period between February and October 2025. The participants in the study were 172 infertile men and 75 fertile controls. Semen analysis was done in accordance with the guidelines of the World Health Organization. The colorimetric assay, inductively coupled plasma mass spectrometry (ICP-MS), and graphite furnace atomic absorption spectrophotometry (GFAAS) were used to measure serum zinc, selenium, and cadmium levels, respectively. The statistical test was independent t-tests, one-way ANOVA, and Pearson correlation.</p> Results <p>Infertile men showed significantly lower zinc (17.1–69.5&#xa0;µg/dL) and selenium (20.4–69.5&#xa0;µg/L) levels compared with controls (70.8–105.7&#xa0;µg/dL and 75.3–143.7&#xa0;µg/L, respectively; <i>p</i> &lt; 0.05). Cadmium levels were significantly higher in infertile men (0.71–4.28&#xa0;µg/L) than controls (0.10–0.90&#xa0;µg/L; <i>p</i> &lt; 0.05). The correlation between zinc and selenium and semen abnormalities was found to be negative (<i>r</i> = -0.48 to -0.62, <i>p</i> &lt; 0.001), whereas cadmium had positive correlations (<i>r</i> = 0.57 to 0.61, <i>p</i> &lt; 0.001).</p> Conclusions <p>The imbalance of trace elements with a decrease in the level of zinc and selenium and an increase in the level of cadmium is strongly linked to the damage of semen quality and testicular dysfunction. The idea of strategic patience can be used as an interpretative framework that focuses on constant monitoring, gradual micronutrient correction and minimizing toxic exposure in the management of male infertility.</p>

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Strategic patience approach to male infertility: trace element imbalance and the critical role of zinc, selenium, and cadmium in testicular dysfunction and semen quality

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  • 发表日期：

    2026年5月28日

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  • Baqer Khudair Al-Hadrawi,
  • Kais Khudhair Al-hadrawi,
  • Hanan Khaled Aldhalmi

摘要

Objectives

This paper examined how the level of serum zinc, selenium, and cadmium relates to semen quality and testicular functions in infertile men, in a conceptual model of strategic patience that focuses on a gradual process of micronutrient optimization.

Methods

The case-control study was a hospital-based study that was carried out in the Fertility Center of Al-Sadr Medical City, Najaf, Iraq, in the period between February and October 2025. The participants in the study were 172 infertile men and 75 fertile controls. Semen analysis was done in accordance with the guidelines of the World Health Organization. The colorimetric assay, inductively coupled plasma mass spectrometry (ICP-MS), and graphite furnace atomic absorption spectrophotometry (GFAAS) were used to measure serum zinc, selenium, and cadmium levels, respectively. The statistical test was independent t-tests, one-way ANOVA, and Pearson correlation.

Results

Infertile men showed significantly lower zinc (17.1–69.5 µg/dL) and selenium (20.4–69.5 µg/L) levels compared with controls (70.8–105.7 µg/dL and 75.3–143.7 µg/L, respectively; p < 0.05). Cadmium levels were significantly higher in infertile men (0.71–4.28 µg/L) than controls (0.10–0.90 µg/L; p < 0.05). The correlation between zinc and selenium and semen abnormalities was found to be negative (r = -0.48 to -0.62, p < 0.001), whereas cadmium had positive correlations (r = 0.57 to 0.61, p < 0.001).

Conclusions

The imbalance of trace elements with a decrease in the level of zinc and selenium and an increase in the level of cadmium is strongly linked to the damage of semen quality and testicular dysfunction. The idea of strategic patience can be used as an interpretative framework that focuses on constant monitoring, gradual micronutrient correction and minimizing toxic exposure in the management of male infertility.