The Effects of Snuff (Toombak) on Semen Parameters among Sudanese Patients 2022

Background: Men’s tobacco usage may be a contributing factor in up to 12% of cases of infertility in couples
due to decreased semen parameters. It is the reality that Sudan is home to the greatest number of nicotine snuffers (toombaks)
worldwide. Unlike snuff, the detrimental effects of cigarette smoking on sperm parameters are well-documented, even though
they apply to other smokeless nicotine products. Aim: to research the influence on semen variables related to toombak snuffing.
Methods: A comparative study analysed 120 subjects, out of which 50 were toombak snuffers (cases), (mean age = 33.9±6.4
years), and 70 were non-snuffers (control), (mean age= 33.5±6.9 years) attended Hawa Fertility Centre in the period from
November 2021 to November 2022. Data regarding demographics, duration of tobacco snuffing, frequency of snuffing per day,
diagnosis, and seminal analysis parameters were compared between groups. Results: Among patients in the snuffer group, the
majority of them had snuffing duration from 10–20 years (n = 20; 40%) and had snuffing frequency >20 times per day (n =
27; 54%). Compared to the control group, snuffing was a significant predictor of low count. (oligiospermia and azoospermia)
(OR = 3.8; 95% CI: 1.6–9.1; P = 0.002), low motility <42% (OR = 3.6; 95% CI: 1.7–7.9; P = 0.001), low progressive motility
<30% (OR = 2.0; 95%CI: 1.3-4.2; P = 0.018) and normal morphs <4% (OR = 2.7; 95%CI: 1.2-5.7; P = 0.009). The snuffing
duration above 20 years was a significant risk factor for a low count. (oligiospermia and azoospermia) (OR = 16.8; 95% CI:
2.6-46.3; P = 0.003), low motility <42% (OR = 11.0; 95% CI: 2.0–60.0; P = 0.006), low progressive motility <30% (OR = 10.8;
95%CI: 1.9-59.8; P = 0.007) and normal morphs <4% (OR = 10.6; 95%CI: 2.1-60.0; P= 0.007). The snuffing frequency above
20 times per day was a significant risk factor for low count (oligiospermia and azoospermia) (OR = 7.9; 95% CI: 1.8–34.5; P
= 0.008), low motility <42% (OR = 3.4; 95% CI: 1.7–12.1; P = 0.041), low progressive motility <30% (OR = 4.1; 95% CI:
1.1–14.9; P = 0.033), but not normal morphs <4% (P = 0.083). Conclusion: Toombak snuffing had a major detrimental impact
on spermatogenesis, which in turn affected sperm motility, measure, and shape. Furthermore, longer duration (>20 years) and
intensive toombak snuffing use (>20 times per day) were significantly correlated with low motility, shape, and quantity of
sperm.