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However, also dietary/drinking water Se excess is associated with infertility and testicular degeneration in experimental animals, related to higher GPX4 and lactate dehydrogenase activity and higher hydrogen selenide production, and reduced spermatozoa motility, concentration, and typical spermatozoa morphological defects (with the fusion of two midpieces, vacuolization of the cytoplasm, and twisted tails) (85, 105, 117, 169)

We believe that a focused and complete workup followed by a treatment plan taking all factors into account is preferable, although some like a more sequential approach

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