Smoking is a major lifestyle factor associated with impaired male reproductive health, affecting both active smokers and individuals exposed to secondhand smoke. It also represents a significant source of cadmium (Cd) exposure, a toxic metal associated with altered sperm quality. This study aimed to evaluate the association between active and passive smoking and semen parameters, sperm DNA fragmentation, and chromatin decondensation, as well as cadmium (Cd) and zinc (Zn) levels in seminal plasma. A total of 280 men from infertile couples were included and categorized into three groups: 104 non-smokers (control), 90 active smokers, and 86 passive smokers. Semen samples were analyzed according to the WHO 2021 guidelines. Cadmium and zinc concentrations in seminal plasma were determined using inductively coupled plasma atomic emission spectroscopy (ICP-AES), and sperm DNA fragmentation and chromatin decondensation were evaluated. The findings indicated that both active and passive smoking were associated with impaired semen parameters, increased sperm DNA fragmentation and chromatin decondensation, decreased zinc levels, and elevated cadmium concentrations in seminal plasma.

Objective: The objectives of this study were to characterize the clinical, hormonal, and extended biomarker profile of infertile men in a Moroccan context, based on a retrospective single-center study, and to assess the relevance of selected markers for initial andrological assessment. Methods: This descriptive, retrospective, single-center study included 1399 men consulting for infertility between January and December 2024 in a specialized center. Collected data encompassed lifestyle habits, medical history, semen parameters (WHO 2021 criteria), sperm DNA fragmentation (TUNEL assay), nuclear decondensation, and hormonal assays (FSH, testosterone, and inhibin B) available in a subset of 156, 56, and 26 patients (for FSH, testosterone, and inhibin B, respectively). Associations with oligozoospermia were explored using univariate logistic regression analysis. Results: The mean age was 39.0 ± 8.0 years; 57% presented with primary infertility, and 82.8% were active smokers. A sperm concentration <16 M/mL was observed in 31.6% of patients. Among the 156 patients analyzed, high FSH levels were observed in 24% of cases. As for inhibin B, among the 26 patients evaluated, a decrease in levels was observed in 38% of cases. Pathological DNA fragmentation was found in 9.6%. In univariate analysis, oligozoospermia was significantly associated with elevated FSH (OR = 7.25; 95% CI: 3.15–16.70), varicocele (OR = 1.81), and smoking (OR = 0.66). Conclusion: This is the first large-scale Moroccan study integrating advanced biomarkers into the assessment of male infertility. The observed associations between elevated FSH, sperm DNA fragmentation, and varicocele support the development of a simplified andrological triage strategy, particularly relevant in resource-limited settings.