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It does not include medication

The most common offenders are retinoids, Mraz Robinson says

The SELECT study showed in November 2023 that semaglutide delivers a 20 percent reduction in major obesity-related adverse cardiovascular events, such as heart attacks or strokes

If the blood-testis barrier becomes compromised through events (eg, surgery or infection) or due to vascular abnormalities (eg, varicocele), the development of antisperm antibodies, which target sperm and decrease their motility, can occur

Those aberrations can be detected by FISH testing using commercial probes targeting loci on 6p25, 6q23, 6cent, and 11q