Lifestyle Factors and Semen Parameters in Rural and Urban Populations of Chhattisgarh: A Systematic Review

Abstract

Background: Regional evidence linking modifiable exposures with semen quality in Chhattisgarh is sparse, and clinic or agricultural settings cannot be assumed to represent urban or rural residence. Objective: To synthesise associations between lifestyle-related or occupational/environmental exposures and conventional semen parameters or sperm DNA fragmentation among men studied in Chhattisgarh, and assess whether rural-urban comparisons were possible. Methods: Openly accessible sources were searched on 5 July 2026 for reports published from 1 January 2000 to 30 June 2026 using four reproducible discovery batches covering broad web search, source-restricted PubMed/Europe PMC/PMC discovery, publisher platforms and ClinicalTrials.gov. Eligible human studies measured a modifiable exposure and a direct semen outcome. One reviewer screened records, linked companion reports, extracted data and applied ROBINS-E. Findings were synthesised without meta-analysis because studies and outcomes were not sufficiently comparable. The review was not registered. Results: Twenty-nine records yielded 22 unique records after seven duplicates. Nine reports were sought; one was not retrieved. Eight full texts were assessed, and four reports representing two studies and 295 unique participants were included. In one Raipur infertility-clinic cohort (195 men), smoking was associated with less favourable semen volume, count, motility, vitality and morphology and higher DNA fragmentation. Adjusted DNA-fragmentation ratios were also higher with smoking, mobile-phone use exceeding 6 hours/day and abstinence longer than 2 days. A Dhamtari farmer study (100 men) reported higher DNA fragmentation with agrochemical exposure, but omitted conventional semen results and had critical risk of bias. Neither study classified residence, so no direct rural-urban comparison was possible. Conclusions: Very-low-confidence evidence suggests adverse associations for smoking, high mobile-phone use and agrochemical exposure in two highly selected, non-comparable samples. Causality and rural-urban differences remain unestablished. Prospective population-based studies with objective exposures, standardised semen assessment and residence-based sampling are needed.