{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T12:26:00Z","timestamp":1784031960977,"version":"3.55.0"},"reference-count":18,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T00:00:00Z","timestamp":1768435200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background<\/jats:title>\n Male infertility constitutes a notable health burden in Sub-Saharan Africa, contributing to approximately 40\u201350% of all infertility cases, compounded by cultural stigma and a grave knowledge issue. The study aimed to apply the updated World Health Organisation (WHO) 6th Edition (2021) criteria to a Ghanaian cohort, generating contemporary prevalence data on semen abnormalities.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective cohort study design was employed, analysing the medical and laboratory records of 221 men who underwent semen analysis as part of an infertility investigation at Oak Specialist Hospital, Kumasi, Ghana. A consecutive sampling method was used to include all eligible patient records from September 1, 2022, to August 31, 2024. Key variables included semen parameters (volume, concentration, motility, morphology, leukocytes) analysed per WHO 2021 guidelines, and associated lifestyle and demographic factors. Data were analysed using descriptive statistics, prevalence rates, and regression analysis.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The study identified high prevalence rates of oligozoospermia (38.91%) and teratozoospermia (38.46%). A critically high prevalence of leukocytospermia was the most striking finding, affecting 80.54% of the cohort. Regression analysis revealed significant negative associations between sugary drink consumption and sperm motility (p\u2009=\u20090.038) and a positive association between caffeine intake and sperm morphology (p\u2009=\u20090.011). Paradoxically, the cohort\u2019s median values for semen volume, concentration, and motility were significantly above the WHO 2021 lower reference limits.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Using current international standards, this study provides updated baseline data on male infertility patterns in urban Ghana. The findings reveal a high burden of specific abnormalities, particularly in sperm morphology and leukocyte concentration, which may be more clinically relevant than simple concentration or motility deficits in this population. Modifiable lifestyle factors, such as diet, represent viable targets for public health intervention. These results are vital for clinical benchmarking, guiding targeted health strategies, and establishing a foundation for future comparative studies in similar resource-constrained settings.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0340902","type":"journal-article","created":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T18:21:23Z","timestamp":1768501283000},"page":"e0340902","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Lifestyle factors and prevalence of semen abnormalities among men undergoing infertility evaluation at oak specialist hospital: A retrospective cohort study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-5586-2428","authenticated-orcid":true,"given":"Rex Mawuli Kwadjo","family":"Djokoto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor Boachie","family":"Owusu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward Anabila","family":"Agana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kingsley Afreh","family":"Nduroh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johnny","family":"Arthur-Komeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Opei","family":"Adarkwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew Panyin","family":"Vormawor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony Amanfo","family":"Ofori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac Kofi","family":"Adu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,1,15]]},"reference":[{"key":"pone.0340902.ref001","first-page":"43","article-title":"Infertility: Prevalence and consequences","volume":"10","author":"EI Obeagu","year":"2023","journal-title":"Int J Curr Res Chem Pharm Sci"},{"issue":"1","key":"pone.0340902.ref002","doi-asserted-by":"crossref","first-page":"2195","DOI":"10.1186\/s12889-023-16793-3","article-title":"Global, regional and national burden of male infertility in 204 countries and territories between 1990 and 2019: an analysis of global burden of disease study","volume":"23","author":"B Huang","year":"2023","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0340902.ref003","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4103\/ajiac.ajiac_3_18","article-title":"The pattern of male infertility in Kumasi, Ghana","volume":"2","author":"P Manu Maison","year":"2017","journal-title":"Afr J Infertil Assist Concept"},{"key":"pone.0340902.ref004","doi-asserted-by":"crossref","first-page":"219","DOI":"10.4054\/DemRes.2025.53.8","article-title":"Education, religion, and male fertility in sub-Saharan Africa: A descriptive analysis","volume":"53","author":"A Durowaa-Boateng","year":"2025","journal-title":"Demogr Res"},{"issue":"8","key":"pone.0340902.ref005","doi-asserted-by":"crossref","first-page":"825","DOI":"10.3109\/01443615.2015.1009876","article-title":"Level of male infertility in the Ghanaian city of Tema","volume":"35","author":"A Martin-Odoom","year":"2015","journal-title":"J Obstet Gynaecol"},{"key":"pone.0340902.ref006","author":"M Sunder","year":"2025"},{"key":"pone.0340902.ref007","volume-title":"WHO Laboratory Manual for the Examination and Processing of Human Semen","author":"WHO","year":"2021","edition":"6"},{"key":"pone.0340902.ref008","doi-asserted-by":"crossref","first-page":"21","DOI":"10.22514\/jomh.2024.086","article-title":"The impact of the new 2021 reference limits of the World Health Organization criteria for semen analyses","volume":"20","author":"ME Ayd\u0131n","year":"2024","journal-title":"J Mens Health"},{"issue":"12","key":"pone.0340902.ref009","first-page":"1368","article-title":"The Sixth Edition of the WHO Manual for Human Semen Analysis: A Critical Review and SWOT Analysis","volume":"11","author":"F Boitrelle","year":"2021","journal-title":"Life (Basel)"},{"key":"pone.0340902.ref010","doi-asserted-by":"crossref","first-page":"1520938","DOI":"10.3389\/frph.2025.1520938","article-title":"Modifiable life style factors and male reproductive health: a cross-sectional study in IVF clinic attendees in Ghana","volume":"7","author":"BY Amoah","year":"2025","journal-title":"Front Reprod Health"},{"key":"pone.0340902.ref011","author":"J Simkus","year":"2022"},{"issue":"1","key":"pone.0340902.ref012","doi-asserted-by":"crossref","DOI":"10.33470\/2379-9536.1468","article-title":"Retrospective chart reviews: a practical approach to designing, collecting data, and writing the manuscript","volume":"11","author":"O Hart","year":"2025","journal-title":"Marshall Journal of Medicine"},{"key":"pone.0340902.ref013","author":"Oak Specialist Hospital","year":"2025"},{"key":"pone.0340902.ref014","author":"KMA","year":"2020"},{"key":"pone.0340902.ref015","first-page":"87","article-title":"Application of consecutive sampling technique in a clinical survey for an ordered population: does it generate accurate statistics","volume":"71","author":"MA Bujang","year":"2016","journal-title":"Philipp Stat"},{"issue":"11","key":"pone.0340902.ref016","doi-asserted-by":"crossref","first-page":"1948","DOI":"10.1017\/S1368980019004014","article-title":"Dietary behaviours in the context of nutrition transition: a systematic review and meta-analyses in two African countries","volume":"23","author":"EK Rousham","year":"2020","journal-title":"Public Health Nutr"},{"issue":"3","key":"pone.0340902.ref017","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1080\/20905998.2024.2381957","article-title":"Do mobile phones and laptop computers really impact sperm?","volume":"23","author":"PK Kavoussi","year":"2024","journal-title":"Arab J Urol"},{"issue":"2","key":"pone.0340902.ref018","doi-asserted-by":"crossref","first-page":"191","DOI":"10.5534\/wjmh.210063","article-title":"Relevance of Leukocytospermia and Semen Culture and Its True Place in Diagnosing and Treating Male Infertility","volume":"40","author":"R Sharma","year":"2022","journal-title":"World J Mens Health"}],"container-title":["PLOS 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