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Assessment of male factor

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The assessment of male infertility is largely based around the examination of a freshly produced ejaculate by a trained technician according to laboratory methods agreed by the World Health Organization. Although many suggestions have been made to improve this approach, the basic techniques of semen analysis established in the 1950s are still being used. Although several putative tests of sperm function have been developed (e.g. the measurement of sperm hyperactivation, sperm acrosomal status, or sperm penetration through mucus or binding to zona pellucida), none have made it into routine clinical practice. Recently, several ‘new’ tests of sperm function and sperm selection have been developed. These include the use of microfluidic chambers, electrophoresis, the binding of sperm to hyaluronic acid, and high magnification sperm selection. Randomised-controlled trials are needed to evaluate these as a replacement or addition to routine semen analysis or current sperm preparation methods.

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.

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