Male Factors Associated With Success Following Assisted Reproduction Technology Among Infertile Couples in Ghana

In 198 Ghanaian ART patients, only serum chloride differed between pregnancy and non-pregnancy groups — a marginal gap within normal range

Journal: American Journal of Men's Health | Published: 2026-03-19 | Type: Cross-sectional study | PMID: 41857700 Authors: Adu IK et al. — University for Development Studies, Tamale & The Chosen Hospital and Fertility Centre, Accra, Ghana Funding/COI: No funding listed; authors declared no conflicts of interest

Summary

A cross-sectional study of 198 Ghanaian men whose female partners underwent ART found that virtually nothing about the male partner — age, BMI, semen parameters, blood counts, liver function, lipids, hepatitis B status, hemoglobin phenotype — predicted whether his partner would conceive. The one exception: serum chloride was modestly higher in men whose partners did not achieve pregnancy (101.3 vs. 99.9 mmol/L). The authors conclude that routine electrolyte screening should precede ART. That conclusion is not well supported by the data.

Claims

• 126 of 198 couples (63.6%) achieved clinical pregnancy following ART
• Serum chloride was the only variable that differed significantly between ART success and failure groups: 101.3 ± 3.5 mmol/L (negative) vs. 99.9 ± 2.6 mmol/L (positive), P = 0.026
• No statistically significant differences were found in sperm concentration, motility, morphology, count, or volume between groups
• No significant differences in age, BMI, blood pressure, hepatitis B status, sickle cell status, G6PD deficiency, fasting glucose, lipids, liver or renal function

Study Quality

This is a single-center cross-sectional study with a modest sample of 198 men recruited at one private fertility clinic in Accra. The design is adequate for generating hypotheses but cannot establish causation or generalize beyond this population. The authors measured a large panel of variables — sociodemographic, anthropometric, clinical, hematological, biochemical, and seminal — and ran comparisons on all of them. With that many tests at α = 0.05, finding one significant result is expected by chance; the study performs no correction for multiple comparisons (no Bonferroni, no false discovery rate adjustment). That omission is the central methodological problem here.

The chloride difference itself is clinically trivial: 101.3 vs. 99.9 mmol/L are both well within the standard reference range of 98–106 mmol/L. The practical significance of a 1.4 mmol/L difference — even if real — is unclear. No mechanism linking serum chloride to ART outcomes is established in this study; the discussion borrows from basic science about spermatogenesis but this study does not measure testicular chloride, sperm chloride channels, or anything that would connect the finding to the proposed mechanism.

Red Flags

• Multiple comparisons, no correction: Dozens of variables tested; one reaches P = 0.026. Without adjustment, this is consistent with a false positive.
• Effect size is clinically negligible: A 1.4 mmol/L difference, with both means inside the normal range, has no established clinical meaning.
• Single center, single country: The Chosen Hospital and Fertility Centre, Accra — results may not replicate at other centers or in other populations.
• Conclusion overreaches the data: "Routine electrolyte measurements should be performed before ART" is a clinical recommendation resting on one marginally significant, uncorrected finding. This crosses from reporting data to prescribing practice.
• No mechanism tested: Sertoli cell disruption and oxidative stress are invoked from external literature, but no testicular or seminal chloride measurements were taken.
• Outcome is the partner's pregnancy, not sperm quality directly: Pregnancy depends on many female factors the male comparison can't isolate.
• Funding not disclosed: Unknown whether institutional resources introduced any selection bias in this specialist private clinic population.

Strengths

• Comprehensive baseline panel (lipids, renal, hepatic, hematological, seminal) in a population rarely studied in ART research
• Addresses a genuine gap: male partner data from sub-Saharan African ART programs is sparse
• Reasonable pregnancy rate (63.6%) suggests competent clinical practice at the study site
• No industry funding or declared conflicts

Verdict

This paper's headline finding — that serum chloride predicts ART failure — should be treated with skepticism. It is one significant result pulled from a large battery of tests, the difference is within the normal physiological range, and no multiple-comparisons correction was applied. The recommendation to add routine electrolyte screening to pre-ART workups is not supported by a single observational study of this design. The paper's real contribution is baseline descriptive data on male ART patients in Ghana, where such data are scarce. File it as hypothesis-generating; it would need a larger, prospective, appropriately powered replication before chloride earns a place in ART pre-screening.