Infertility/subfertility affects up to 15% of couples. Tobacco, cannabis, and tramadol misuse is prevalent in our society mainly among men who are at ages likely to be seeking infertility treatment. However, the effect of these substances on male fertility is still controversial. This study aimed to evaluate the effect of tobacco, cannabis, and tramadol on the semen quality of subfertile males. Our study is a case-control study that included eighty-five subfertile male patients. The following tests were performed on each patient: a full history, local examination of the genital organs, semen analysis, and qualitative and quantitative assessments of tobacco (cotinine), cannabis (tetrahydrocannabinol) metabolites, and tramadol in urine samples.

In our study, the tobacco group showed a significant decrease in sperm motility, while the cannabis and tramadol groups showed significantly higher sperm motility measured by both conventional and computer-assisted semen analysis.

Tobacco, cannabis, and tramadol negatively affect semen quality via different mechanisms. Tobacco decreases both the progressive and total motility of sperm. However, the mechanism through which cannabis and tramadol cause infertility is not fully understood. Our study indicates that cannabis and tramadol induce increased sperm motility (hyperactivation). Hyperactivation is required as the sperm approaches the egg. Premature hyperactivation may lead to early sperm burnout, reducing the fertilization capacity.