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People who live in areas with low levels of selenium or iodine, where a baseline shortage increases response because resolving baseline deficits can enhance antioxidant selenium enzyme activity (selenium), restore thyroid hormone synthesis and metabolism (iodine), and possibly lower thyroid autoimmunity—as a result, effect sizes may seem larger in deficient settings than in replete populations [2,18,36,47]

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The results may show abnormal semen parameters such as oligozoospermia, asthenozoospermia and teratozoospermia or a combination of these, or a complete absence of sperm in the ejaculate (azoospermia), which is identified in 10–15% of infertile men (Rowe et al