A Cross-Sectional Study on the Effect of Smoking
on the Semen Analysis of 21 year old males and
older in Barangay Cembo, Makati City
from May – June 2009
A Research Paper Submitted in Partial Fulfilment of the Requirements
Of Community Medicine
At
Makati Medical Center
Baraan, Amadeus
Capco, Diorella Anne
Manotok, Ma. Veronica
Mata, Cecille
Moderes, Vincent
Nova, Isabelle
Ortiz Luis, Guinevere
Osias, Jerny
Pabalan, Jorja
Palis, Alexandra Jean
Pallera, Julius
Peñaflorida, Andrea
May – June 2009
PROJECT PAPER
ABSTRACT
A cross-sectional study was performed to investigate the effect of
cigarette smoking on semen parameters of semen volume, sperm
morphology, sperm motility, and sperm count among males residing at
Barangay Cembo, Makati City. Previous studies that tackled various factors
that affect the semen analysis among male subjects of various ethnicities and
health groups was recognized in this study, which aimed to investigate the
effect of cigarette smoking on the semen volume, sperm morphology, sperm
motility, and sperm count among the selected subjects. A routine sperm
analysis was performed on the 30 subjects with their consent. From the
statistical analysis, it was seen that smoking is protective for semen volume
(0.4), sperm motility (0.71), sperm morphology (0.45), sperm count
(0.2272) suggested by the resultant value of the odds ratio, however the
relationships are not significant and these could be explained by chance due
to a small sample size .
Chapter I
INTRODUCTION
Community Dimensions Secondarily Related to Health
Barangay Profile
The first batch of enlisted men from the Philippine Ground Force was given a settling area
in 1949, adjacent to the North Gate of what was then Fort William McKinley. It was known as the
Central Enlisted Men’s Barrio, and now that big rolling open tract of land which was the housing
area of these enlisted personnel is now known as Cembo. Other similar housing areas came about to
be the adjacent communities of West Rembo, East Rembo, Comembo, and Pembo to provide
housing for the increasing population of the enlisted forces.
Geography
Currently, Barangay Cembo has a population of 25,815 with a population growth rate of
2.9%, a population density of 1201 persons per hectare. The number of households is 5,887. The
land is situated over a moderately undulating and rolling land sloping in many directions in a
tuffaceous plain. Flood is not a problem in the community, and earthquakes are a rare occurrence.
The bodies of water near the community are the Pasig River and San Jose Creek. The Barangay is
bounded by the Pasig River (Mandaluyong City) in the north; South Cembo to the south, West
Rembo in the East and Guadalupe Nuevo in the West.
Government Offices
Government offices and edifices in the Barangay are: Barangay Hall; Solid Waste
Management Division – District II; Makati Plant Nursery; Veterans’ Center/Cembo Multi-Purpose
Hall; Cembo Elementary School; Bantay Bayan/MAPSA Headquarters; Bantay Bayan Outpost (2);
Daycare Center; Cembo Talipapa Market; National Teachers Center; and Comelec District 2 Field
Office.
Transportation and Communication
Transportation in the community was possible with jeepneys and taxi cabs at Kalayaan
Avenue, and tricycles that course through the interior streets of the Barangay. There are structures
for phone lines and electricity that contribute to the means of communication within the
community. Wireless landline phones and cellular phones provide alternatives for the populace.
Leadership Pattern and Structure
Leadership of the Barangay is headed by Barangay Captain Leonardo Magpantay, with
seven Barangay Councilors, a Barangay Secreteary, Barangay Treasurer, and members of the
Sangguniang Kabataan, headed by Ruben Talosig, with seven councillors.
Community Dimensions Directly Related to Health
Table 1 Barangay Cembo Age Disribution 2007
Age distribution
M
F
Both
<1 yo
367
367
734
1-4 yo
1449
1406
2855
5-9 yo
1557
1535
3092
10-14 yo
1362
1298
2660
15-19 yo
1059
1146
2205
20-24 yo
856
1017
1903
25-29 yo
778
909
1687
30-34 yo
670
693
1363
35-39 yo
540
562
1102
40-44 yo
432
454
886
50-54 yo
281
367
648
55-59 yo
238
346
584
60-64 yo
195
281
476
65-69 yo
130
195
325
> 70 yo
151
216
367
TOTAL POPULATION:
10,419
11,204
21623
Table 1 shows that Barangay Cembo has a total population of 21,623 in the year 2007. It
had a relatively young population composed mostly of school aged children, adolescents and young
adults. The majority of the population consisted of children between 5-9 years old while the
individuals between 65-69 years comprised the minority.
Age Distribution (Males)
1800
1600
1400
1200
1000
800
600
400
200
0
<1
1 - 4 5 - 9 10 - 15.
. 14
19
.
2024
2529
3034
3539
4044
5054
5559
6064
65- > 70
69
Age group
Figure 1 Barangay Cembo Male Age Distribution 2007
Figure 1 shows the age distribution of citizens in Barangay Cembo with the majority
between ages 5-9 years old (1,557)and the minority between 65-69 years old (130).
Age distribution (Females)
1800
1600
1400
1200
1000
800
600
400
200
0
<1
1 - 4 5 - 9 10 - 15.
. 14
19
.
2024
2529
3034
3539
4044
5054
5559
6064
Age group
Figure 2 Barangay Cembo Female Age Distribution 2007
65- > 70
69
In 2008, the total population of Bry Cembo is 27, 098. There is almost equal male to female
sex distribution in the community (48.2 % females and 51.8 % males). Compared to 2007 data, The
majority of population is still between 5-9 yrs old.
Table 2. MAKATI HEALTH DEPARTMENT VITAL HEALTH STATISTICS
Total live births
Male
246
Female
270
516
Distribution of maternal deliveries
Home
71
lying-in
155
govt hosp
143
Private hosp
147
Assisted deliveries
Physician
304
Nurse
28
Midwife
177
Hilot
7
Table shows the number of total live births in Barangay Cembo in the year 2007 and the
specific gender distribution with more female infants than male infants. Most maternal deliveries
were done in a lying-in clinic with the least deliveries done at home. Assisted deliveries were done
mostly by physicians with the least number of deliveries assisted by “hilot”.
Morbidity in All Ages
In the year 2007 and 2008, acute upper respiratory tract infection remained the leading
cause of morbidity in all ages. This is followed by Pneumonia, diarrhea and UTI in 2007. Pneumonia
still ranked second as the most common cause of morbidity, while diarrhea was replaced with acute
lower respiratory tract infection in 2008.
Ten leading causes of morbidity on all ages in barangay
Cembo, Makati, 2007
4497
79
65
55
Br
D
H
ia
be
te
s
er
m
D
77
m
el
on
lit
us
ch
ia
la
st
hm
a
156
at
it i
s
yp
er
te
ns
io
n
U
AU
194
PT
B
239
TI
R
TI
Pn
eu
m
on
ia
D
ia
rrh
ea
258
TI
359
LR
5000
4500
4000
3500
3000
2500
2000
1500
1000
500
0
Disease
Figure 3. Ten Leading Causes of Morbidity, All Ages in Brgy Cembo, 2007
In 2007, majority of the morbidity cases in all ages is caused by acute upper respiratory
tract infection.
Ten leadin causes of morbidity on all ages
in barangay Cembo, Makati, 2008
6000
5000
4950
189
120
113
70
53
HPN
Bronchial
Asthma
diabetes
mellitus
Non
specific
197
Arthritis
201
Dermatitis
395
UTI
518
ALRI
AURI
1000
0
Pneumonia
4000
3000
2000
Disease
Figure 4. Ten Leading Causes of Morbidity, All Ages in Brgy Cembo, 2008
In 2008, still the leading cause of morbidity is acute upper respiratory tract infection.
Infant Morbidity
There has no abrupt change on the 10 causes of infant morbidity in 2007 and 2008. Acute
Respiratory tract infection is the leading cause of infant morbidity, followed by Pneumonia,
Diarrhea and Dermatitis.
Ten leading causes of infant morbidity in
barangay Cembo, Makati, 2007
530
27
25
20
8
O
t it
is
a
in
fa
nt
um
30
m
ed
Co
ia
nj
un
ct
Vi
iv
itis
ra
le
xa
nt
he
m
Ca
rb
un
cle
32
AL
RT
I
De
rm
39
Ro
se
ol
57
rrh
ea
Di
a
on
ia
Pn
eu
m
AU
RI
94
at
itis
600
500
400
300
200
100
0
Disease
Figure 5. Ten Leading Causes of Infant Morbidity in Brgy Cembo, 2007
In 2007,majority of the total infant morbidity was cause by acute upper respiratory tract
infection(530 cases). This is followed by pneumonia (94 cases), diarrhea (57 cases), and dermatitis
(39 cases).
Ten leading causes of infant morbidity in barngay
Cembo, Makati, 2008
52
Dermatitis
Otitis Media
Non specific
Diarrhea
Conjunctivitis
48
39
35
27
Systemic
Viral Illness
61
Roseola
Infantum
85
ALRI
94
Impetigo
128
Pneumonia
1237
AURI
1400
1200
1000
800
600
400
200
0
Disease
Figure 6. Ten Leading Causes of Infant Morbidity in Brgy Cembo, 2008
In 2008, acute respiratory infection (1237 cases) tops the list that causes morbidity among
infants, followed by pneumonia (128 cases), dermatitis (dermatitis) and otitis media (85 cases).
Communicable Diseases
The top 10 leading cause of Communicable Diseases mostly involved the respiratory tract.
Pneumonia remains the leading communicable disease in 2007 and 2008. This is followed by PTB,
acute lower respiratory tract infection, mumps and varicella.
ten leading communicable disease in barangay
Cembo, Makati, 2007
359
28
10
German
measles
35
Scabies
42
Acute viral
illness
57
Conjunctivitis
64
Varicella
70
Mumps
PTB
URTI
77
Herpes
zoster
194
Pneumonia
400
350
300
250
200
150
100
50
0
Disease
Figure 7. Ten Leading Communicable Diseases, 2007
About 359 cases was cause by pneumonia. Thus followed by upper respiratory tract
infection (194 cases), pulmonary tuberculosis (77 cases) and mumps (70 cases)
Ten leading communicable diseases in barangay
Cembo, Makati, 2008
600
500
400
300
200
100
0
518
151
15
sl
es
an
er
m
G
H
er
8
M
ea
Z
os
te
r
ie
s
45
pe
s
en
za
flu
In
ju
n
ic
el
la
48
C
on
V
ar
53
S
ca
b
59
ct
iv
iti
s
62
um
ps
B
M
P
T
A
LR
I
P
ne
um
on
ia
66
Dise ase
Figure 8. Ten Leading Communicable Diseases in Brgy Cembo, 2008
Pneumonia (518 cases) is the most common communicable disease in Brgy Cembo in 2008.
Followed by acute lower respiratory infection (151 cases), PTB (66 cases) and mumps (62 cases).
Mortality
Table 9 shows the 10 leading causes of death/mortality in barangay Cembo in the year
2007. The top 3 diseases include: 1) heart disease (928 cases), 2)Cancer (15 cases) and Pneumonia
(14 cases).
Ten leading causes of mortality in barangay
Cembo, Makati
28
14
2
Disease
Figure 9. Ten Leading Causes of Death in Barangay Cembo, 2007
2
Sepsis
3
Acute
pancreatitis
3
Asphyxia
3
Diabetes
mellitus
5
Kidney
failure
Hypertension
Pneumonia
Cancer
6
CVA
15
Heart
disease
30
25
20
15
10
5
0
Figure 11 shows the 10 leading causes of death in Barangay Cembo in the year 2007
with the greatest number of cases who suffered from heart diseases.
Background of the Study
Males produce semen in the process of intercourse as their contribution in conception,
which contains the male sex cell. Semen is composed of four fractions that are contributed by the
testes and epididymis, the seminal vesicles, the prostate, and the bulbourethral glands. The
integration of all four fractions during ejaculation is essential for the production of a normal semen
specimen. Spermatozoa, the male sex cells, are produced in the seminiferous tubules, then mature
and are stored in the epididymis. This contributes to about 5% of the semen volume. Majority of
the fluid comes from the seminal vessels. Spermatozoa become motile only upon exposure to the
fluid from the seminal vessels, which has high fructose content. About 20-30% of the semen
volume is acidic fluid from the prostate gland. It has high concentrations of acid phosphatase, citric
acid, zinc and proteolytic enzymes which are responsible for both coagulation and liquefaction of
the semen. The bulbourethral glands contribute about 5%. It is thick, alkaline mucus that helps
neutralize the acidity from the prostate and the vaginal acidity as well.
Environmental studies on potential hazards to health have been elaborating in the past
decade or so. Studies have revealed the presence of pollutants and their hazardous effects to health.
Many degenerative diseases are largely due to exposures from environmental pollutants. Among
the most common of these pollutants is cigarette smoke, which is not only a largely growing health
hazard, but likewise a social phenomenon. Smoking is the act of consuming tobacco products such
as cigars, cigarettes and the like. A multitude of the population is engaged in this habit, and as a
result, experiences the long term effects of smoking. There are degenerative diseases that are
precipitated or aggravated by smoking such as lung cancer, hypertension, and diabetes. The act of
smoking has also been a reflection of behavior mostly amongst the young people of today. Though
smoking is manifested because of peer pressure, stress, and status quo, the lifestyle of the smoker
and recipients of second-hand smoke has been affected. Clearly smoking is a threat to the integrity
of health.
It has been known that nicotine affects the body in a variety of ways. Nicotine has an
addicting effect, seen in people who abuse cigarette smoking. However, the effect of nicotine has
not been properly documented. Men who smoke should be aware of the possibility that nicotine
can damage a man’s fertility. We know that pregnant women who smoke can harm their fetuses
but men are oblivious to the potential damage of smoking to their offspring long before they meet
their future partners. If this study can target men’s innate drive to properly reproduce, we may
have given them one more reason to quit smoking. This study may then serve to be a contribution
to the continuing awareness of people regarding the hazards presented by cigarette smoke and a
possible effect on the male reproductive system.
CHAPTER II
Objectives
General: This study aims to investigate the effect of cigarette smoking on the semen analysis of
males, particularly on the parameters of semen volume, sperm motility, sperm morphology, and
sperm count.
Specific: The specific objectives of the study are to:
1. Provide baseline information on the effect of cigarette smoking and sperm characteristics of
males residing at Cembo, Makati
2. Describe the participants of the study as to the socio-demographic characteristics; and
3. Determine the association between cigarette smoking of males to the following parameters:
a. semen volume
b. sperm motility
c. sperm morphology
d. sperm count
Significance of the Study
Smoking has been a growing problem especially as it directly influences health. It has been
known that cigarette smoking largely contributes to the development or elaboration of
degenerative diseases including cancers, hypertension, heart disease, and diabetes among a few.
This study shall deal with the effect of smoking on any of the three parameters of a routine sperm
analysis: semen volume, sperm morphology, sperm motility, and sperm count. The resultant effect
can be a basis for inference of a larger scale effect as well as a contribution for an existing baseline
knowledge of a study such as this locally. This shall investigate and document the effect of smoking
on the sperm analysis particularly to this area of interest and population of interest.
Scope and Limitations
This study shall be applicable to males aged 21 and above, as is the legal age for males in our
country. A legal age for participants is also considered to avoid sensitive issues regarding the sexual
aspect of our study. This study shall be performed at the area assigned for this purpose, Barangay
Cembo, Makati City. All legal aged male residents of this barangay is eligible to be a participant.
Cases of TB, DM, mumps, genetic factors, trauma, and undescended testis are known to affect the
sperm analysis, hence respondents with these conditions may not be eligible to participate.
However, only three aspects of sperm analysis is included in this study, which are morphology,
motility, and count. These three main aspects would be the basis of concluding a normal or
abnormal sperm analysis. The individual influence on each parameter may be described
subsequently in the study and may serve to contribute to baseline knowledge for this and as well
for future recommendations on latter studies.
REVIEW OF RELATED LITERATURE
Despite worldwide anti-smoking campaigns, cigarette smoking is still common. The highest
prevalence of smoking is observed in young adult males during their reproductive period at 46%
smokers between 20 and 39 years (Langgassner, 1999). In this regard, there has been number of
studies that have evaluated the effect of smoking and cigarette smoking. However, the results of
recent studies have either been contrary or similar to past studies. There has been no clear cut
relationship between the two.
According to Lewin et al, Cigarette smoking may be associated with sub-fertility in males
and may result in decreased sperm concentration, lower sperm motility, and a reduced percentage
of morphologically normal sperm respectively. In a recent meta-analysis (Vine, 1996 ), including
27 studies on the association between cigarette smoking and semen quality, a mean reduction in
sperm concentration of 13%, a mean reduction of sperm motility of 10%, and a mean reduction of
morphologically normal sperm of 3% was reported in smokers.
A cross sectional study was conducted by Chia, et al (1998) to determine the semen
parameters (volume, concentration, motility, viability and normal morphology) of proven fertile
males in Singapore and compare it with World Health Organization recommended normal values
and to examine some factors that may affect spermatogenesis. A total of 243 men in the younger
age group (19-47 years old), whose wives were pregnant at the time of collection of semen,
provided semen sample each after sexual abstinence of 3 days. A questionnaire was used to elicit
occupational exposure, alcoholic consumption, smoking history, and past significant medical
history. Most subjects had normal sperm volume (56.4%), concentration (79.8%), motility (69.5%),
and viability (53.5%) based on WHO criteria. However, fertile men had a low mean percentage of
normal sperm morphology (20%), although they were normally distributed. Cigarette smoking was
associated with significantly lower semen volumes even after adjusting for alcohol consumption.
The sperm parameters (volume, density, motility, viability and normal morphology), were not
significantly associated with ethnic differences. Social alcohol consumption, cigarette smoking, and
“recent fever” (history of fever 3 months prior to semen collection) did not appear to affect sperm
quality in this group of fertile men.
Hellstrom and Overstreet et al (2006) mentioned that initial standards were set out since
1950 to cater for the growing needs of research and clinical practice for standardized procedures
for these analyses. Their research aimed to determine semen and sperm reference ranges for an
older population, 45 years old and older. The participants in their study were either affected with
mild or no erectile dysfunction with four particular sperm parameters of semen volume, sperm
concentration, sperm motility, and sperm morphology. The total sperm count was mentioned to be
a derived parameter. It was determined that median semen volume, sperm motility, and sperm
morphology parameters declined significantly with age. There were associations between sperm
parameters and semen with smoking status, alcohol use, and serum hormone concentrations.
In relation to age, there was a decline in semen volume, sperm concentration, sperm
progressive motility and sperm morphology among individuals over 45 years of age. Semen volume
and sperm concentration increased according to how many days of sexual abstinence there were.
However, in patients with 5 or more days of abstinence, a reduction in progressive motility was
found. No modification of sperm normal morphology percentage with increased length of
abstinence was found.
In a cross sectional study by Eskenazi, Wyrobek et al (2003) sought to characterize the
association between age and semen quality. There was noted age related decreases in semen
quality, most notably for semen volume and sperm motility. A sample of 97 men aged 22 – 80
without known fertility problems were recruited. The men provided semen samples and
information relating to lifestyle, diet medical and occupational details. Parameters that were
measured were semen volume, sperm concentration, total sperm count, motility, progressive
motility and total progressively motile sperm count. The data suggest that men may become
progressively les fertile as they age, however, unlike women, there appears to be no evidence of an
age threshold for men. Some broad modes of action have explained the age dependent changes
observed in semen quality. There may be cellular or physiological changes in the genitourinary
tract with ageing, some of these are the age related narrowing and sclerosis of the testicular tubular
lumen, and decreased numbers and function of Leydig cell. Decreased semen volume with age may
be caused by seminal vesicle insufficiency, since seminal fluid contributes most of the ejaculate
volume. Age also provides increased opportunities to suffer reproductive damage from exogenous
exposures or diseases. Older men are more likely have smoked for a longer period than younger
men, or to have illnesses including genitourinary infections.
Another srudy by Sloter and Schmid et al (2006) acknowledged the limited amount of
information regarding quantitative measures of factors that may affect semen quality. Their study
investigated the effects of age on sperm, quantitatively, using computer-assisted semen analysis.
Their population comprised of 97 healthy male volunteers, aged 22–80 years and were screened by
current or prior fertility or reproductive problems; smoked cigarettes in the last 6 months;
vasectomy; reported history of undescended testicle or prostate cancer; chemotherapy or radiation
treatments for cancer; or a previous semen analysis with zero sperm count. Mainly, a reduction on
sperm motility was noted in this study.
In studies made by Sofikitis et al (1995), and Zinaman et al (2000), reductions in sperm
concentration, motility and normal morphology percentage among infertile patients who smoke
have been observed. In a meta-analysis covering 27 studies on sperm quality among smokers, an
average reduction of 13% in sperm concentration, 10% in motility and 3% in normal morphology
percentage were observed (Vine, 1996).
The aim of this study by Colagar et al (2007) is to evaluate the relationship between
cigarette smoking and sperm quality in male partners of fertile and infertile couples undergoing
infertility evaluation. Study population included fertile non-smokers, fertile smokers, infertile
nonsmokers and fertile male smoker. Semen samples were collected by masturbation into a sterile
container after sexual abstinence for 2-3 days and were analyzed for appearance, volume,
consistency and pH and evaluated according to the World Health Organization criteria and Kruger’s
criteria. Results show that sperm parameters (sperm counts, motility and morphology) in smoker
men were approximately lower than nonsmoker men. Ejaculate volume was not different between
fertile smoker-non smoker men. Statistical analysis in infertile smoker-non smoker showed that
sperm quality in infertile smoker is lower than infertile non-smoker.
This study by C.H. Ramlau-Hansen et al (2006) focused on the association between current
smoking and semen characteristics and hormonal levels in a large group of healthy men. The aim of
this study is accordingly to investigate the dose–response relationship between current cigarette
smoking and conventional semen characteristics and hormonal levels in a large group of healthy
men. There were seven separate occupational or environmental semen quality studies from 1987 to
2004 that were considered in this study. A total of 2562 men participated, each providing semen
and blood sample and answering a questionnaire about lifestyle and factors related to health.
Appropriate semen and smoking data were available for 2542 men. From the data obtained, there
was an inverse dose–response relation between smoking and semen volume, total sperm count and
percentage motile sperm. Heavy smokers had a 19% lower sperm concentration than non-smokers.
In conclusion, current smoking in adult life moderately impairs the semen quality. It is well known
that semen quality is associated to fecundity. Therefore, it would be sensible to advise men to
abstain from smoking to avoid decreased fecundity.
A study conducted by Sobreiro et al (2005), revealed that there were no differences in
semen parameters related to smoking. In the prospective study, 500 fertile candidates for voluntary
sterilization by vasectomy between September 999 and August 2002 at the Urology Division,
Hospital dos Clinicos, Universidade de Sao Paulo, Brazil were included. Subjects were grouped into
non-smokers and smokers (1-10 cigarettes/day, 11-20 cigarettes/day; and >20 cigarettes/day).
Results showed that there were no statistically significant differences in semen parameters
observed between smokers and non-smokers, or between the groups of smokers. However, one
possible explanation for these results is that only fertile subjects were studies, and cases of
infertility associated with smoking were excluded from the sample population.
A case-control study was done by Okonofua, F., et al (2005) to evaluate the association
between selected potential socio-demographic and behavioral risk factors and infertility in Nigerian
men. The cases were 150 men found to have abnormal semen parameters when their wives
presented for investigation and treatment of infertility in the clinic. The controls were 150 men
with normal semen parameters and their spouses were pregnant at the time of the study. Both
groups were matched for age, place of residence and key socio-demographic variables. Infertile
men were significantly more likely than fertile men to report having experienced penile discharge,
painful micturition and genital ulcers, less likely to seek treatment for these symptoms and more
likely to seek treatment with informal sector providers. Multivariate analysis showed that male
infertility was significantly associated with bacteria in semen cultures, self-reporting of previous
use of traditional medications and moderate to heavy alcohol intake. There were no significant
differences between them in the proportions reporting that they had ever smoked; however,
infertile men were more likely to report longer duration of smoking. The types of smoking
(cigarettes or marijuana) and the frequency of smoking did not differ between the two groups.
Although this study showed that a higher proportion of infertile men reported having ever smoked
and that infertile men had longer duration of smoking, the results of the association between
smoking and male infertility were not significant in the multivariate analysis. It was contrary to
published findings in other populations which consistently showed a strong association between
cigarette smoking and male infertility.
From experimental studies done by Mehrannia, T. (2007), they evaluated the effects of
cigarette on the sperm quality of men attending the infertility center. Two hundred fourteen
infertile men who had been smoking cigarette and 130 infertile non-smokers were employed in the
study. It included men aged 25-45 years who were able to provide an ejaculate. None of the
subjects had any urogenital or serious systemic disease. They never used any contraceptive.
Smokers were categorized as mild (≤10 cigarettes per day), moderate (>10 and ≤20 cigarettes per
day), and heavy smokers (>20 cigarettes per day). The smokers according to the duration of
smoking were divided into short term (1-10 years) and long term (11-20 years). Samples were
collected by masturbation after a sexual abstinence of 3-6 days.
Specimens were evaluated
according to the WHO guidelines. The ejaculate volume, pH, count, viability and time to liquefaction
were measured. From the data, it was found that the semen volume, acidity, sperm concentration,
viability and forward progression were much lower in the smokers than in the nonsmokers. The
semen parameters were much lower in the nonsmokers of infertile men than in fertile men. There
was no significant difference in results of semen quality seen between mild, moderate and short
term smokers and nonsmokers. Those parameters in the heavy and long term smokers were
significantly lower than their corresponding values in nonsmokers.
Another study by Chen, Z., et al (2004) evaluated the relationship of human semen
parameters, particularly sperm concentration, motility and morphology, to season, age and
smoking status. Studies on the seasonal variations in semen parameters revealed that there was a
significant seasonal variation in sperm count. The sperm counts were highest in late winter & early
spring, and was lowest in late summer. Age, on the other hand, was said to have an inverse
relationship with the total sperm count. With regards to the association of smoking, data found
were said to be less clear. From the data obtained, it was found that the mean sperm concentration
in spring was significantly higher than in the winter, summer and fall. Median sperm concentration
by month was higher in March, April, May, and June than all other months. Mean sperm motility
was also higher in the spring than in the summer, fall and winter. Seasonal variations in sperm
morphology parameters were noted. The mean percent normal morphology in spring was greater
than in summer, fall or winter, although it was not statistically significant. There was no statistically
significant relationship between age with semen volume, sperm concentration, percent motility and
percent normal morphology. In the study, only 22 men were current smokers and 57 ex-smokers.
It was found that there was no statistically significant relationship between semen quality and
smoking status, though current smokers tended to have lower mean sperm concentration (83
million/ml) than never smokers (104 million/ml). There were seasonal variations in sperm
concentration and suggestive evidence of seasonal variation in sperm motility and percent sperm
with normal morphology. Although smoking status was not a significant predictor of semen
parameters, this may have been due to the small number of current smokers in the study.
A prospective study done by Harald Trummer et al (2002), semen parameters and hormone
concentrations of infertile smokers were compared with infertile non- and ex-smokers. Work-up for
infertility included a medical history, physical examination, as well as the assessment of hormone
and semen parameters. Medical history and particularly any history of previous genital disease was
assessed using a questionnaire including the number of cigarettes per day and the duration of
smoking as well as the smoking status of the female partner. Men who had stopped smoking
6
months prior to the examination for infertility were classified as ex-smokers and men who had
never smoked as non-smokers. Every man who had smoked cigarettes for >6 months and was still
smoking was classified as a smoker. Smokers were categorized as mild ( 10 cigarettes per day),
moderate (>10 and 20 cigarettes per day) and heavy smokers (>20 cigarettes per day). After the
primary evaluation for infertility, all men without a history of, or current, genital disease as well as
men who had neither azoospermia nor severe oligozoospermia were invited for a second semen
analysis 3 months later. The reason to exclude these men was that men with non-idiopathic
infertility received causative treatment as soon as possible, and men with a high grade
oligozoospermia or azoospermia were offered assisted reproductive techniques, if appropriate. In
conclusion, in their large study with a total of 1104 infertile men including 571 non-smokers, 109
ex-smokers and 478 smokers, no significant differences in conventional ejaculate parameters
(sperm concentration, morphology and motility) between non-smokers, ex-smokers and smokers
were observed, although azoospermia was more prevalent among ex-smokers than the other two
groups.
Chapter III
METHODOLOGY
Inclusion Criteria
Males aged 21 and older who are residents of Barangay Cembo are to be included in this
study. Smokers and non-smokers may be able to participate in the study. Questionnaires are to be
handed out to participants, containing information pertinent to health information of the subjects.
Collection of Samples
The researchers recruited study subjects from Barangay Cembo, Makati City. The
proponents surveyed the said area for the candidates for the study. Random names from the list of
voters were selected and house visits were done where the participants were provided with
sufficient information about the research and were asked to accomplish a questionnaire after they
consented to participate in the study. Due to unforeseen circumstances that the selected
participants were not able to submit specimens, the researchers set another two days wherein
walk-in participants were entertained.
Specimens were obtained following a period of sexual abstinence of at least 3 days and not
longer than 5 days. Specimens were collected in plastic containers kept at room temperature.
Collection of semen sample was done by masturbation. The specimen labelled with the time of
specimen collection as well as the patient general data (name, age, gender and contact number)
were submitted in the barangay health center within 1 hour of collection where a temporary
laboratory and a licensed medical technologist immediately tested the samples. Other samples were
picked-up by the researchers from the houses of the participants per request.
Data Analysis
Odds ratio (OR) is used in cross-sectional studies as a measure of relationship between a
disease entity and an exposure factor. In this case, this will be used to measure a relationship
between cigarette smoking and an abnormal result for semen volume, sperm morphology, sperm
motility, and sperm count. EpiInfo StatCalc® was used in the computation.
Sample size determination
The sample size was determined using the standard formula of
n= t² x p(1-p)
m²
Where n is the required sample size, t is the confidence level at 95% (standard value of
1.96), p is the estimated prevalence of malnutrition in the project area, and m is the margin of error
at 5% (standard value of 0.05). A prevalence was stated at 33% from a study by Sobeiro et al.
(2005). A local prevalence was stated at 60% of men in the Philippines by WHO Western Pacific
(2002).
The
resultant
sample
size
at
computation
was
estimated
at
369.
Operational Definition of Variables
1. Smoking - is the act of consuming tobacco products such as cigars, cigarettes and the like
2. Smoker – any person who has a history of smoking or is currently smoking.
3. Non-smoker – any person who has never smoked
4. Semen analysis – evaluation of certain characteristics of a male's semen and the sperm
contained in the semen
5. Semen volume – normal volume is 2-5ml
6. Sperm morphology – shape of spermatozoa, which may be classified as normal-oval
shaped, tapered, amorphous, duplicated and immature. Normal spermatozoid must have an
oval form with smooth contour, acrosomal cap encompassing 40-70% of head, no
abnormalities of midpiece, or tail and no cytoplasmic vacuoles of more than half of the
sperm head. Head size is 5-6m M x 2.5-3.5m M. Any borderline sperm are counted as
abnormal (amorphous, tapered,duplicated, immature, coiled tail, blunted tail, midpiece
abnormalities).
7. Sperm motility – normal motility is when at least 50% of observed sperm move forward
normally.
8. Sperm count –or sperm concentration, measurement of the concentration of sperm in a
man's ejaculate. Normal count range considered in this study is 20-160 million/ml.
Anything less is considered oligospermia; absence of sperm is azoospermia.
9. Abstinence – defined as having no sexual contact within the past 72 hours prior to
specimen collection
CHAPTER IV
RESULTS AND DISCUSSION
Semen is composed of four fractions that are contributed by the testes and epididymis, the
seminal vesicles, the prostate, and the bulbourethral glands. The integration of all four fractions
during ejaculation is essential for the production of a normal semen specimen.
Analysis of semen includes several parameters such as: appearance, volume, viscosity, pH,
sperm concentration and count, motility and morphology. It has a gray-white color, appears
translucent with a characteristic musty odor. It usually liquefies within 30 to 60 minutes. Failure of
liquefaction occurs due to a deficiency in prostatic enzymes.
Normal semen volume ranges between 2 and 5 ml. Increased volume may be seen following
extended abstinence and a decreased volume is due to infertility with the improper functioning of
one of the semen-producing organs. Incomplete specimen collection is also one consideration.
Viscosity, on the other hand, refers to the consistency of the fluid may be related to specimen
liquefaction. Ratings of 0 (watery) to 4 (gel-like) can be assigned. The pH of semen is alkaline with
a range of 7.2 to 8.0. An increased pH is indicative of infection within the reproductive tract, while a
decreased pH is associated with increased prostatic fluid.
The normal value for sperm concentration is 20 to 160 million sperm per milliliter, while
the normal for total sperm count is greater than 40 million per ejaculate. It is computed as the
product of the sperm concentration and the specimen volume.
Sperm moves in a forward, progressive movement. Motility is evaluated as to the speed and
direction of the motility and is graded on a scale of 0 to 4. A grade of 4 indicates a rapid, straightline movement and 0 indicating no movement. A minimum of 50% motility with a rating of 2.0
after 1 hour is considered normal.
With regards to sperm morphology, it is evaluated with to both the head and tail
appearance. Abnormalities with head morphology are associated with poor ovum penetration;
whereas tail abnormalities affect motility.
The normal sperm has an oval shaped head
approximately 5μm long and 3 μm wide, with a long, flagellar tail approximately 45 μm long. The
sperm morphology is evaluated from a thinly smeared stained slide stained with Giemsa, Wright’s
or Papanicolau stain.
Abnormalities in the head structure include: double heads, giant and
amorphous heads, pinheads, tapered heads and constricted heads. Sperm tail abnormalities are
frequently double, coiled, or bent. The normal morphology is >30% normal forms (strict criteria)
and >50% normal forms (routine criteria). White blood cells may also be noted and a count of <1.0
million/ml is considered normal.
RESULTS
Table 3. Sociodemographic Characteristics of the Smoker and Nonsmoker,
Smoker Group
Non-smoker Group
(N = 24)
(N = 6)
Charateristic
Age – yr
Married - no./total no.
Comorbidities - no/total no.
Personal & Social History
Alcoholic beverage drinker
Illicit drug use
22-57
19/24 (79.2%)
11/24 (45.8%/)
28-48
4/6 (66.7%)
1/6 (16.7%)
19/24 (79.2%)
3/24 (12.5%)
2/6 (33.3%)
1/6 (16.7%)
The study sample consisted of 30 participants, of whom 80% (24/30) were smokers and
20% (6/30) were non-smokers. Smoking history ranged from 0.9 – 37-pack years. Study population
included men ages 22 – 57 years old of whom 76.7% (23/30) were married, 19/24 in the smoker
group and 4/6 in the non-smoker group. The following comorbidities encountered were asthma,
allergy, hypertension, heart diseases, pulmonary tuberculosis, and nephrolithiasis. The study
population had comobidities in 45.8% (11/24) of subjects in the smoker group and 16.7% (1/6) in
the non-smoker group. The personal and social history included alcohol intake and drug use, 79.2%
and 12.5% in the smoker group and 33.3% and 16.7% in the non-smoker group respectively.
20
15
10
5
0
normal
abnormal
Figure 10. Semen Volume of Cigarette Smokers in Barangay Cembo, Makati City .
Table 4. Sperm Volume, 2x 2 Table showing odds ratio and p value
Sperm
Volume
Exposure
+
-
+
-
4
20
2
OR =
4
0.4
p value =
0.36943
8
Semen volume was compared with the normal value of 2-5mL. Using the Odds ratio, data
has revealed that smoking has a protective effect, however the association is not significant, P value
at 0.3694375.
25
20
15
10
5
0
normal
abnormal
Figure 11. Sperm Motility of Cigarette Smokers in Barangay Cembo, Makati City
Table 5. Sperm Motility, 2x 2 Table showing odds ratio and p value
Sperm Motility
Exposure
+
+
3
21
-
1
5
OR =
p value =
0.71
0.791757
Sperm motility was observed from the semen samples of the patients, and the data shows
that the odds ratio is 0.71 and a p value of 0.791757, it show here that smoking is protective, how
ever this could be explained by chance.
25
20
15
10
5
0
normal
abnormal
Figure 12. Sperm Morphology of Cigarette Smokers in Barangay Cembo, Makati City
Table 6. Sperm Morphology, 2x 2 Table showing odds ratio and p value
Sperm Morphology
Exposure
+
+
2
22
-
1
5
OR =
p value =
0.45
0.549605
Morphology is then observed, compared to a value of >60%, and the majority of the subjects
belong to the normal category. Using the Odds Ratio, data has revealed that the odds ratio is 0.45
and a p value of 0.549605, it also shows that smoking is protective, however this could also be
explained by chance.
25
20
15
10
5
0
normal
abnormal
Figure 13. Sperm Count of Cigarette Smokers in Barangay Cembo, Makati City
Table 7. Sperm Count, 2x 2 Table showing odds ratio and p value
Sperm Count
Exposure
+
+
2
22
-
2
5
OR =
p value =
0.227273
0.166801
The sperm cells were then counted using a standard measure and was compared to a value
of 60-160 million. Likewise, Using the Odds Ratio, data has revealed the Odds ratio is 0.227273 and
a p value of 0.166801, which show that smoking is protective, however this could also be explained
by chance.
The hazards of cigarette smoking and its effects on male fertility have been the concern of
growing interest on a global scale. At present there are a number of studies that have been done
which show varying associations between smoking and sperm parameters. According to Vine at al
(2005), a mean reduction in sperm concentration of 13%, a mean reduction of sperm motility of
10%, and a mean reduction of morphologically normal sperm of 3% was reported in smokers. On
the other hand, in a study conducted by Sepaniak et al (2006), there was no significant correlation
between the conventional sperm parameters of smokers and non-smokers in terms of sperm
density, motility, viability and morphology. In light of this, the proponents felt the need to conduct
this study to shed light on the said matter, and at the same time, to serve as pilot study in the local
setting.
From the statistical analysis, it was seen that smoking is protective for semen volume (0.4),
sperm motility (0.71), sperm morphology (0.45), sperm count (0.2272) suggested by the resultant
value of the odds ratio, however the relationships are not significant and these could be explained
by chance due to a small sample size .
DISCUSSION
The review of related literature has shown varied results of studies done on smoking and its
effect on the semen parameters particularly the semen volume, motility, morphology and count.
Majority of these, as supported by Chia et al (1998), Hellstrom et al (2006), Eskenazi et al (2003),
Sofikitis et al (1995), Zinaman et al (2000), Sloter et al (2006), Mehrannia, T. (2007), claimed that
smoking causes a decrease in the said parameters. However, based on the statistical analysis of this
study, it was shown that smoking is protective, but is not significant enough to establish a clear
association between exposure and changes in the semen parameters. This inconclusive result may
be attributed to the small sample size of the study. Using the formula to determine standard sample
size, the ideal number for the study would have been 369 subjects. However, there were only 30
individuals who voluntarily agreed to participate. In addition to this, other confounding variables
such as age, consumption of alcohol, illegal medications or drugs, stress, dietary modifications and
other factors may have synergistic or independent effects on sperm quality as well. Accounting for
all these, the results are inconclusive because these are only crude odds ratio, and the effect of
possible confounders has not been eliminated.
The abnormal semen volume and motility may be attributed to age. There has been an
association seen between aging and a functional decline in Leydig cells. Smaller semen volume and
lower sperm motility have been found to accompany advancing age in fertile individuals (Gray,
1999). The length of abstinence may cause an increase in semen volume. However for motility,
abstinence seemed to have caused decrease in progressive motility and normal morphology
percentage (Pellestor, 1994).
Increase in number of morphologically abnormal sperms results in impaired motility as
normal intact sperm morphology is a prerequisite for linear progressive motility. Gandini et al
(2000) postulated that sperm function is strictly correlated with sperm morphology and that sperm
motility is the best predictor of fertility potential in man. In a study by Sobriero 2005, no
statistically significant differences in the sperm quality where observed between smoking and nonsmoking patients or between the consumption groups in terms of cigarettes per day.
Sperm count, on the other hand, may have yielded abnormal results due to increased serum
levels of Cotinine and Nicotine which are components of cigarette smoke. These factors adversely
affect the spermatogenesis and the sperm fertilizing potential (Mehrann 2007).
It is important to bear in mind that, in the majority of cases, smoking is just one aspect of a
lifestyle that may include the consumption of alcohol, illegal medications or drugs, stress, dietary
modifications and other factors that may have synergic or independent effects on sperm quality.
CHAPTER V
SUMMARY
Cigarette smoking has always been a concern because of its numerous adverse effects on
health. The government advocates various anti-smoking campaigns but its success is still
questionable. Although this study may not be enough to dissuade or prevent people from smoking,
this will give people one more reason to think about when they smoke.
Various studies have already found some relationship between cigarette smoking and
sperm volume, sperm motility, morphology and sperm count but there has not been significant
local research regarding this. The study therefore aimed to investigate the effect of smoking on
semen and its parameters such as volume, motility, morphology, and sperm count of Male residents
living in Cembo, Makati City. Moreover, this study may also be helpful in providing us with some
baseline knowledge about this matter.
Smokers and non-smokers who were at least 21 years old were included in this study.
Specimens were collected after a period of at least 3 days of abstinence, with the appropriate
instructions. Considering the small population of the study. prevalence Proportion was used to
analyze the given data.
Based on the statistical analysis, data shows that the exposure factor in this study, which is
smoking, is protective. However, the relationships are not significant. The results are not conclusive
because these are only crude odds ratio. If there are confounders, their effects have not been
removed.
The study serves to provide baseline information on the association of cigarette smoking on
the sperm parameters of our sample population, consisting of males aged 21 and above, residing in
Cembo, Makati. In conclusion, the present study found that cigarette smoking had a protective on
the various semen parameters. As aforementioned, the results are not significant because of
confounders and population size.
RECOMMENDATIONS
Due to small population size of this study, the researchers recommend a more significant
(n=60) population size with equal number of smokers and non-smokers. Further studies should
also standardize the manner of semen collection and ensure strict compliance of the subjects to the
recommended abstinence period prior to collection. In addition, further studies may describe comorbid conditions present in the subjects that may have an effect on the results of the sperm
analysis. Moreover, future studies should be conducted to further evaluate the correlation of the
number of smoking pack years the abnormalities in sperm parameters.
BIBLIOGRAPHY
Chen, Z., Godfrey-Bailey, L., Schiff, I and Hauser, R. (2004). Impact of seasonal variation, age and
smoking status on human semen parameters: The Massachusetts General Hospital
experience. Journal of Experimental and Clinical Assisted Reproduction.
Chia, S., Tay, S., Lim, S. (1998). What constitutes a normal seminal analysis? Semen parameters of
243 fertile men. Human Reproduction 13 (12); 3394-3398.
Colagar, A., Jorsaraee, G., Marzony, E. (2007). Cigarette Smoking and the risk of male infertility.
Pakistan Journal of Biological Sciences 10 (21); 3870-3874.
Eskenazi B., Wyrobek A. J., Loster E., Kidd S.A., Moore L., Young S., Moore D. (2003). The Association
of Age and Semen Quality in Healthy Men. Human Reproduction 18:2 447 – 454.
Evenson, DP., Wixon, R. 2006. Clinical aspects of sperm DNA fragmentation detection and male
infertility. Theriogenology 65, 979-991.
Harald Trummer, Helga Habermann, Josef Haas and Karl Pummer (2002). The impact of cigarette
smoking on human semen parameters and hormones. Human Reproduction, Vol. 17, No. 6,
1554-1559
Hellstrom, W.J.G. and J.W. Overstreet et al. Semen and Sperm Reference Ranges for Men 45 Years of
Age and Older. J Androl (27):421–428. 2006.
Kunze, R., Mueller MD., Drescher, H., (2003). Semen quality of male smokers and nonsmokers in
infertile couples. Fertil Steril. 79:287-291.
Langgassner, J. (1999) Rauchgewohnheiten der österreichischen Bevölkerung. Statistische
Nachrichten, 5, 319–326.
Lewin, A., Gonen, O., Orvieto, R. and Schenker, J.G. (1991) Effect of smoking on concentration,
motility and zona-free hamster test on human sperm. Arch. Androl., 27, 51–54.
Mehrannia, T. (2007). The effect of cigarette smoking on semen quality of infertile men. Park J Med
Sci. Vol.23, No.5 717-719.
Okonofua, F., Menakaya, U., Onemu, S., Omo-Aghoja, L., Bergstrom, S. (2005). A case-control study of
risk factors for male infertility in Nigeria. Asian J Androl 2005; 7 (4): 351–361
Pacific, R., Altieri, I., Gandini, L., Lenzi,. Pichini, S., Rosa, M., Zuccaro, P., Dondero, F. 1993. Nicontine,
Cotinine, and trans-3-hydroxycotinine levels in seminal plasma of smokers: effects on
sperm parameters. Ther. Drug Monit. 15, 358-363.
Ramlau-Hansen, C.H., Thulstrup, A.M., Aggerholm, A.S., Jensen, M.S., Toft, G. and Bonde, J.P. (2006).
Is smoking a risk factor for decreased semen quality? A cross-sectional analysis. Human
Reproduction 2007 22(1):188-196.
Rubes, J., Selevan, SG., Evenson, DP., Zudova, D., Vozdova, M., Zudova, Z., Robbins WA., and Perreault,
S.D. 2005. Episodic air pollution is associated with increased DNA fragmentation in human
sperm without other changes in semen quality. Human Reprod.20, 2776-2783.
Sepaniak, S., Forges, T., Gerard, H., Foliguet, B., Bene, MC., and Monnier-Barbarino, P. (2006). The
influence of cigarette smoking on human sperm quality and DNA fragmentation.
Department of Reproductive Medcine, Maternite Regionale Universitaire, Nancy, France.
Stillman, RJ., Rosenberg, MJ., Sachs, BP. 1986. Smoking and reproduction. Fertil.Steril. 46, 545-566.
Sloter, E. And T.E. Schmid et al. Quantitative effects of male age on sperm motion. Human
reproduction (21):11 pp. 2868–2875, 2006.
Sobreiro, B.P.; Lucon, A.M.; Pasqualotto, F.F.; Hallak, J.; Athayde, K.S.; Arap, S. (2005). Semen
analysis in fertile patients undergoing vasectomy: reference values and variations according
to age, length of sexual abstinence, seasonality, smoking habits and caffeine intake. Sao
Paulo Med J. 123(4): 161-6.
Sofikitis, N.; Miyagawa, I.; Dimitriadis, D.; Zavos, P.; Sikka, S.; Hellwtrom, W. (1995). Effect of
smoking on testicular function, semen quality and sperm fertilizing capacity. J Urol 154(3):
1030-4
Thomson, ML and JE Myers et al. (1998) Prevalence odds ratio or prevalence ratio in the analysis of
cross sectional data: what is to be done? Occupational and Environmental
Medicine 1998;55:272-277.
Vine, MF., Margolin, BH., Morrison, HI., Hulka, BS. 1994. Cigarette smoking and sperm density: a
meta-analysis. Fertil, Steril. 61, 35-43.
Zenses, MT., Bielecki, R., Reed, TE. 1999. Detection of benzo(a)pyrene diol epoxide-DNA adducts in
sperm of men exposed to cigarette smoke. Fertil. Steril. 72, 330-335.
Zinaman, M.J.; Brown, C.C.; Selevan, S.G.; Clegg, E.D. (2000). Semen quality and human fertility: a
prospective study with healthy couples. J Androl 21(1): 145-53.
APPENDIX
Questionnaire Contents
TALAAN
Pangunahing Impormasyon
Pangalan
Edad
Tirahan
Estado Sibil
Trabaho
Para sa may mga asawa na:
Anong taon ka ikinasal?
Ilang taon ka na kasal?
Ilang ang iyong anak?
Anong taon kayo unang nagtalik ng iyong asawa?
_______
_______
_______
_______
Kaalamang Pangkalusugan
Ikaw ba ay mayroon sakit sa mga nabanggit sa ibaba? Lagyan lamang ng tsek kung mayroon.
 Hypertension/High blood
 Diabetes
 Allergy
 TB/Tuberculosis
Kung mayroon, sa ano?
 Sakit sa puso
 Sakit sa bato
Ano ang sakit sa inyong pamilya?
 Hypertension/High blood
 Allergy
Kung mayroon, sa ano?
 Sakit sa puso
 Asthma/Hika
 Iba pang sakit sa baga
 Kanser
 Diabetes
 TB/Tuberculosis
 Asthma/Hika
 Iba pang sakit sa baga
 Sakit sa bato
 Kanser
Kaalamang Personal
Ikaw ba ay naninigarilyo?
 Oo
Hindi
Kung oo, anong edad ka nagsimula manigarilyo?
Ilang pirasong sigarilyo ang nauubos mo sa isang araw?
Ilang taon ka na naninigarilyo?
Ikaw ba ay umiinom ng alak?  Oo
Hindi
Ikaw ba ay nakagamit na ng ipinagbabawal na gamot?  Oo
_______
_______
_______
Hindi
Kaalamang Sekswal
Nakapag “masturbate” ka na ba?
 Oo
Hindi Kung oo, anong edad ka unang nakapag “masturbate”?
Gaano ka kadalas nakapag ”masturbate”?
Kailan ka huling nakapag “masturbate”?
Nakipagtalik ka na ba?
 Oo
Hindi
Kung oo, anong edad ka unang nakipagtalik?
Ilan na ang nakasama mo sa pakikipagtalik?
Gaano ka kadalas nakikipagtalik?
Kailan ka huling nakipagtalik?
Gumagamit ka ba ng condom?
_______
_______
_______
_______
_______
_______
_______________
 Oo Hindi
May
410
1. Choosing a topic for research
2. Identify research problem and
objective
3. Conduct review of related literature
4. Define
actual
problem
and
objectives in specific terms
5. Formulate hypothesis and define
the study variables
6. Conduct the research design
7. Design tools for data collection
8. Design tools for data analysis
9. Collect data
10. Process data
11. Analyze data
12. Make conclusions
13. Write the research report
14. Disseminate and utilize results
Legend:
Done (as of May 24)
Due May 25-31
Due on June 1-14
Due June 8-14
Due June 15-30
May
1117
May
1824
May
2531
June
1-7
June
8-14
June
1521
June
2230
26 Mayo 2009
Kgg. Leonardo Magpantay
Punong Barangay
Barangay Cembo
Makati City
Kgg. Magpantay:
Mabuhay!
Kami ay mga Doctor ng Makati Medical Center na naatasan maglingkod sa inyong Barangay sa mga
buwan ng Mayo at Hunyo. Kasama sa aming katungkulan ay siyasatin at pagaralan ang kalusugan ng
inyong nasasakupan. Batay sa aming napagtalakayan at sang-ayon na rin sa panuto ng aming mga
tagapayong Doctor, kami ay magsasaliksik ukol sa epekto ng paninigariyo sa semilya ng mga lalaki, sa
ilalim ng pamagat na: “A cross sectional study on the effect of cigarette smoking among males 21 years
old and above at Barangay Cembo, Makati City from May – June 2009.”
Hinggil dito, buong galang namin ipinapahayag ang gawain naming ito, at umaasa sa inyong mabuting
pagtanggap sa amin. Kami ay magsasagawa ng isang programa upang maipaalam sa mga taong maaaring
makasama sa aming pagsasaliksik, at isang araw ng koleksiyon ng datos at specimen. Bagkus, kami rin ay
magagalak na makatanggap ng pagtulong mula sa inyong tanggapan para sa aming magiging mga
gawain. Kalaunan, sa pagwakas ng aming pagsasaliksik, igagawad naming sa inyo ang resulta ng aming
pag-aaral.
Maaari po kayong makipag-ugnayan sa aming grupo sa numerong 0915-217-9876 at sa email na
gr8testal@yahoo.com. Bukas po kami para sa inyong mga katanungan at suhestiyon.
Lubos na gumagalang,
Alexandra Jean C. Palis
Kinatawan
Post Graduate Intern Group I-J
Makati Medical Center
NABATID:
Ma. Luisa Villavicencio, MD
Tagapyo
Makati Medical Center
Rogin Sison MD
Tagapayo
Makati Medical Center
26 Mayo 2009
Dr. Concordia Eva Garcia
Punong Barangay
Barangay Cembo
Makati City
Dr. Garcia:
Mabuhay!
Kami ay mga Doctor ng Makati Medical Center na naatasan maglingkod sa inyong Barangay sa mga
buwan ng Mayo at Hunyo. Kasama sa aming katungkulan ay siyasatin at pagaralan ang kalusugan ng
inyong nasasakupan. Batay sa aming napagtalakayan at sang-ayon na rin sa panuto ng aming mga
tagapayong Doctor, kami ay magsasaliksik ukol sa epekto ng paninigariyo sa semilya ng mga lalaki, sa
ilalim ng pamagat na: “A cross sectional study on the effect of cigarette smoking among males 21 years
old and above at Barangay Cembo, Makati City from May – June 2009.”
Hinggil dito, buong galang namin ipinapahayag ang gawain naming ito, at umaasa sa inyong mabuting
pagtanggap sa amin. Kami ay magsasagawa ng isang programa upang maipaalam sa mga taong maaaring
makasama sa aming pagsasaliksik, at isang araw ng koleksiyon ng datos at specimen. Bagkus, kami rin ay
magagalak na makatanggap ng pagtulong mula sa inyong tanggapan para sa aming magiging mga
gawain. Kalaunan, sa pagwakas ng aming pagsasaliksik, igagawad naming sa inyo ang resulta ng aming
pag-aaral.
Maaari po kayong makipag-ugnayan sa aming grupo sa numerong 0915-217-9876 at sa email na
gr8testal@yahoo.com. Bukas po kami para sa inyong mga katanungan at suhestiyon.
Lubos na gumagalang,
Alexandra Jean C. Palis
Kinatawan
Post Graduate Intern Group I-J
Makati Medical Center
NABATID:
Ma. Luisa Villavicencio, MD
Tagapyo
Makati Medical Center
Rogin Sison MD
Tagapayo
Makati Medical Center