Best Practice & Research Clinical Obstetrics & Gynaecology
2Assessment of male factor
Section snippets
Background to male infertility
The incidence of infertility in men is difficult to establish reliably, but current evidence suggests that up to 20–25% of young men have poor semen quality and, in 30–50% of couples undergoing in-vitro fertilisation (IVF), a male factor contributes to infertility.1 Unlike the situation in some cases of female infertility (e.g. amenorrhea), possible male infertility is not outwardly obvious because, macroscopically, the ejaculates of fertile and infertile men appear the same. It is only when
Background to semen analysis
Antonie van Leeuwenhoek12 first described human spermatozoa in 1678, although it wasn't until the 1950s when the first clinical descriptions of the relationship between semen quality and conception were made.13, 14, 15 In 1980, the World Health Organization (WHO) then published an internationally agreed ‘reference range’ designed to help clinicians make decisions using data on semen quality16; over the next 30 years, four further updates17, 18, 19, ∗20 were produced as shown in Table 1.
As these
Background to sperm function tests
Sperm function tests differ from the measurements undertaken at semen analysis, as they set out to try and examine aspects of sperm biology that have physiological relevance as sperm ascend through the female reproductive tract43 or are used in the various techniques of assisted conception.44 Clearly, during natural (unassisted) conception, sperm need to undertake a greater range of functional steps (e.g. passage through cervical mucus or the ability to migrate through the utero-tubal junction)
Conclusion
Semen analysis remains the main technique of assessing male fertility, and revisions to the WHO manual and the publication of revised reference ranges has been a useful step forward and are, for the first time, evidence-based. Although many putative tests of sperm function and selection have been proposed, relatively few have made it into routine clinical practice; randomised-controlled trials of IMSI, however, and the binding of sperm to hyaluronan, are ongoing. Perhaps, surprisingly, although
Conflict of interest
None declared.
References (69)
Sperm, human fertility and society
- et al.
What is new in cryptorchidism and hypospadias – a critical review on the testicular dysgenesis hypothesis
J Pediatr Surg
(2010) Fertility issues in survivors from adolescent cancers
Cancer Treat Rev
(2007)- et al.
Real time PCR shows that density centrifugation does not always remove Chlamydia trachomatis from human semen
Fertil Steril
(2009) - et al.
The male factor in fertility and infertility. II. Spermatozoon counts in 1000 men of known fertility and in 1000 cases of infertile marriage
J Urol
(1951) - et al.
The male factor in fertility and infertility. III. An analysis of motile activity in the spermatozoa of 1000 fertile men and 1000 men in infertile marriage
Fertil Steril
(1951) - et al.
The male factor in fertility and infertility. IV. Sperm morphology in fertile and infertile marriage
Fertil Steril
(1951) - et al.
Lack of standardisation in performance of the semen analysis among laboratories in the United States
Fertil Steril
(2002) - et al.
Semenology training programs: 8 years' experience
Fertil Steril
(2010) - et al.
Relation between semen quality and fertility: a population-based study of 430 first-pregnancy planners
Lancet
(1998)
Sperm DNA fragmentation: mechanisms of origin, impact on reproductive outcome, and analysis
Fertil Steril
Relationship among head size, morphology and chromosome structure in human spermatozoa
Fertil Steril
Selectivity of hyaluronic acid binding for spermatozoa with normal Tygerberg strict morphology
Reprod Biomed Online
Double probing of human spermatozoa for persistent histones, surplus cytoplasm, apoptosis and DNA fragmentation
Reprod Biomed Online
Intracytoplasmic morphologically selected sperm injection: a prospective randomized trial
Reprod Biomed Online
Intracytoplasmic sperm injection outcome versus intracytoplasmic morphologically selected sperm injection outcome: a meta-analysis
Reprod Biomed Online
Correlation between semen analysis by motile sperm organelle morphology examination and sperm DNA damage
Fertil Steril
WHO manual for the standardized investigation, diagnosis and management of the infertile male
Testicular dysgenesis syndrome: an increasingly common developmental disorder with environmental aspects
Hum Reprod
Trends in sperm counts: the saga continues
Epidemiology
Evidence for decreasing quality of semen during past 50 years
BMJ
Environmental/lifestyle effects on spermatogenesis
Philos Trans R Soc Lond B Biol Sci
Occupation and male infertility: glycol ethers and other exposures
Occup Environ Med
Semen quality of men with asymptomatic chlamydial infection
J Androl
Observationes D. Anthonii Lewenhoeck, de Natis e semine genitalis Animalculis
Philosophical Transactions
WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction
WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction
WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction
WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction
WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction
External quality assessment for semen analysis and sperm antibody detection: results of a pilot scheme
Hum Reprod
Lack of compliance in UK andrology laboratories to World Health Organization recommendations for sperm morphology assessment
Hum Reprod
ESHRE basic semen analysis courses 1995-1999: immediate beneficial of standardized training
Hum Reprod
Lessons learned from a sperm morphology quality control programme
Andrologia
Cited by (13)
Imaging in Male Infertility
2023, Current Problems in Diagnostic RadiologyLaboratory evaluation of bulk seminal parameters
2018, Encyclopedia of ReproductionApplication of microfluidic technologies to the quantification and manipulation of sperm
2016, Urological ScienceCitation Excerpt :Despite the advancement in sperm counting based on microfluidic technologies, there is still a large discrepancy between the daily clinical usage and bench work of these technologies. There has been no substantial substitution for the accepted gold standard of microscopic techniques and technologies, such as manual and computer-assisted methods, for sperm counting.9 One of the reasons for such a slow evolution in semen analysis is that newly developed methods need to be verified through well-designed trials (accuracy) and they should fulfill users' requirements for privacy and convenience.
Variance in total levels of phospholipase C zeta (PLC-ζ) in human sperm may limit the applicability of quantitative immunofluorescent analysis as a diagnostic indicator of oocyte activation capability
2013, Fertility and SterilityCitation Excerpt :In the present study, we attempted to examine whether PLC-ζ may be used as a diagnostic predictor of sperm fertilization ability. At present, sperm morphology and motility are considered to be the “gold standard” for selection of “viable” sperm (51, 52) and are routinely used to measure the fertility potential of semen samples (53). Indeed, Stalf et al. (2005) (54) indicated that ICSI using immotile sperm resulted in a lower rate of successful fertilization whether the source was ejaculated or testicular sperm.
Predicting human conception: The elusive 'fertility test'
2020, BMJ Sexual and Reproductive HealthThe association of some cytokines, ceruloplasmin oxidase activity and copper concentration in male infertile patients
2018, Journal of Pharmaceutical Sciences and Research