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Sperm Assessment: Traditional Approaches and Their Indicative Value

  • Tania R. Dias
  • Chak-Lam Cho
  • Ashok AgarwalEmail author
Chapter

Abstract

Late child-bearing and global low fertility rates led to an increasing number of couples seeking medical counseling and assistance to achieve conception. The specific evaluation of male partners is pivotal in the investigation of infertile couples. Semen assessment represents the cornerstone in the evaluation of the fertility potential of the male partner. Although a number of computer-assisted sperm analysis (CASA) systems have been developed, the traditional methods have a greater clinical acceptance and wider application. Standard procedures of semen analysis include the macroscopic and microscopic evaluation of ejaculates by a laboratory technician. The result of semen analysis provides important information to the clinician not only about the quantity and quality of spermatozoa, but also the functioning of male accessory glands and genital tract. Although semen parameters alone are insufficient in defining male fertility, they provide clues to the severity of subfertility and assist in the diagnosis by indicating the altered parameters. This information is particularly important in the selection of the most suitable assisted reproductive technology (ART) for infertile couples. Recent developments in semen analysis are focused towards standardization and cost reduction. Several commercially available semen analysis kits allow a private, cost-effective, and easier home testing alternative to patients.

Keywords

Home testing Male infertility Semen assessment Sperm parameters Sperm quality 

References

  1. 1.
    Skakkebaek NE, Rajpert-De Meyts E, Louis GMB, Toppari J, Andersson A-M, Eisenberg ML, Jensen TK, Jørgensen N, Swan SH, Sapra KJ. Male reproductive disorders and fertility trends: influences of environment and genetic susceptibility. Physiol Rev. 2016;96(1):55–97.PubMedCrossRefGoogle Scholar
  2. 2.
    ESHRE Capri Workshop Group, Baird D, Barri P, Bhattacharya S, Devroey P, Evers J, Gianaroli L, Somigliana E, Tapanainen J. Economic aspects of infertility care: a challenge for researchers and clinicians. Hum Reprod. 2015;30(10):2243–8.CrossRefGoogle Scholar
  3. 3.
    Lalinde-Acevedo PC, Mayorga-Torres BJM, Agarwal A, du Plessis SS, Ahmad G, Cadavid ÁP, Maya WDC. Physically active men show better semen parameters than their sedentary counterparts. Int J Fertil Steril. 2017;11(3):156.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Agarwal A, Mulgund A, Hamada A, Chyatte MR. A unique view on male infertility around the globe. Reprod Biol Endocrinol. 2015;13(1):37.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Centola GM. Semen assessment. Urol Clin. 2014;41(1):163–7.CrossRefGoogle Scholar
  6. 6.
    Jequier AM. Clinical andrology—still a major problem in the treatment of infertility. Hum Reprod. 2004;19(6):1245–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Snow-Lisy D, Sabanegh E Jr. What does the clinician need from an andrology laboratory? Front Biosci (Elite Ed). 2013;5:289–304.CrossRefGoogle Scholar
  8. 8.
    WHO. WHO laboratory manual for the examination and processing of human semen. In: In. 5th ed. Geneva: World Health Organization; 2010.Google Scholar
  9. 9.
    Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker HW, Behre HM, Haugen TB, Kruger T, Wang C, Mbizvo MT, Vogelsong KM. World Health Organization reference values for human semen characteristics. Hum Reprod Update. 2010;16(3):231–45.  https://doi.org/10.1093/humupd/dmp048.PubMedCrossRefGoogle Scholar
  10. 10.
    Esteves SC. Clinical relevance of routine semen analysis and controversies surrounding the 2010 World Health Organization criteria for semen examination. Int Braz J Urol. 2014;40(4):433–53.CrossRefGoogle Scholar
  11. 11.
    Esteves SC, Zini A, Aziz N, Alvarez JG, Sabanegh ES, Agarwal A. Critical appraisal of World Health Organization's new reference values for human semen characteristics and effect on diagnosis and treatment of subfertile men. Urology. 2012;79(1):16–22.PubMedCrossRefGoogle Scholar
  12. 12.
    Guzick DS, Overstreet JW, Factor-Litvak P, Brazil CK, Nakajima ST, Coutifaris C, Carson SA, Cisneros P, Steinkampf MP, Hill JA. Sperm morphology, motility, and concentration in fertile and infertile men. N Engl J Med. 2001;345(19):1388–93.PubMedCrossRefGoogle Scholar
  13. 13.
    Björndahl L, Barratt CL, Mortimer D, Jouannet P. How to count sperm properly’: checklist for acceptability of studies based on human semen analysis. Hum Reprod. 2015;31(2):227–32.PubMedGoogle Scholar
  14. 14.
    Agarwal A, Gupta S, Sharma R. Basic semen analysis. In: Andrological evaluation of male infertility. Cham: Springer; 2016. p. 39–46.CrossRefGoogle Scholar
  15. 15.
    Du Plessis SS, Gokul S, Agarwal A. Semen hyperviscosity: causes, consequences, and cures. Front Biosci (Elite Ed). 2013;5:224–31.Google Scholar
  16. 16.
    Nallella KP, Sharma RK, Aziz N, Agarwal A. Significance of sperm characteristics in the evaluation of male infertility. Fertil Steril. 2006;85(3):629–34.PubMedCrossRefGoogle Scholar
  17. 17.
    Sikka SC, Hellstrom WJ. Current updates on laboratory techniques for the diagnosis of male reproductive failure. Asian J Androl. 2016;18(3):392.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Björndahl L, Kvist U. Sequence of ejaculation affects the spermatozoon as a carrier and its message. Reprod Biomed Online. 2003;7(4):440–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Wang C, Swerdloff RS. Limitations of semen analysis as a test of male fertility and anticipated needs from newer tests. Fertil Steril. 2014;102(6):1502–7.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Amann RP. Evaluating spermatogenesis using semen: the biology of emission tells why reporting total sperm per sample is important, and why reporting only number of sperm per milliliter is irrational. J Androl. 2009;30(6):623–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Wang W, Zhong Z, Su N, Peng Y, Huang T. Location of semen collection and semen quality: clinic-collected versus home-collected samples. Zhonghua nan ke xue= Natl J Androl. 2014;20(11):995–8.Google Scholar
  22. 22.
    Mayorga-Torres JM, Agarwal A, Roychoudhury S, Cadavid A, Cardona-Maya WD. Can a short term of repeated ejaculations affect seminal parameters? J Reprod Infertil. 2016;17(3):177.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Esteves SC, Miyaoka R, Agarwal A. An update on the clinical assessment of the infertile male. Clinics. 2011;66(4):691–700.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile male: a committee opinion. Fertil Steril. 2015;103(3):e18–25.CrossRefGoogle Scholar
  25. 25.
    Tomlinson M, Naeem A, Hopkisson J, Campbell B. Brief communication: assessment and validation of nonspermicidal condoms as specimen collection sheaths for semen analysis and assisted conception. Hum Fertil. 2012;15(3):140–3.CrossRefGoogle Scholar
  26. 26.
    De Lamirande E. Semenogelin, the main protein of the human semen coagulum, regulates sperm function. In: Seminars in thrombosis and hemostasis, vol. 1. New York: Thieme Publishers; 2007. p. 60–8.Google Scholar
  27. 27.
    Rodríguez-Martínez H, Kvist U, Ernerudh J, Sanz L, Calvete JJ. Seminal plasma proteins: what role do they play? Am J Reprod Immunol. 2011;66(s1):11–22.PubMedCrossRefGoogle Scholar
  28. 28.
    Lwaleed BA, Greenfield R, Stewart A, Birch B, Cooper AJ. Seminal clotting and fibrinolytic balance: a possible physiological role in the male reproductive system. Thromb Haemost. 2004;92(4):752–66.PubMedGoogle Scholar
  29. 29.
    Agarwal A, Bragais FM, Sabanegh ES Jr. Laboratory assessment of male infertility—a guide for the urologist. US. Urology. 2009;4(1):70–3.Google Scholar
  30. 30.
    Tadeu Andrade-Rocha F. Physical analysis of ejaculate to evaluate the secretory activity of the seminal vesicles and prostate. Clin Chem Lab Med. 2005;43(11):1203–10.CrossRefGoogle Scholar
  31. 31.
    Elia J, Delfino M, Imbrogno N, Capogreco F, Lucarelli M, Rossi T, Mazzilli F. Human semen hyperviscosity: prevalence, pathogenesis and therapeutic aspects. Asian J Androl. 2009;11(5):609.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Tahir B, Rakesh KS, Ashok A. Sperm preparation and selection techniques. In: Botros RMB, Rizk AA, Aziz N, Sabanegh Jr E, editors. Medical & surgical management of male infertility. New Delhi: Jaypee Brothers Medical Publishers; 2014. p. 244–51.Google Scholar
  33. 33.
    Esfandiari N, Burjaq H, Gotlieb L, Casper RF. Seminal hyperviscosity is associated with poor outcome of in vitro fertilization and embryo transfer: a prospective study. Fertil Steril. 2008;90(5):1739–43.PubMedCrossRefGoogle Scholar
  34. 34.
    Henkel R, Maass G, Jung A, Haidl G, Schill WB, Schuppe HC. Age-related changes in seminal polymorphonuclear elastase in men with asymptomatic inflammation of the genital tract. Asian J Androl. 2007;9(3):299–304.PubMedCrossRefGoogle Scholar
  35. 35.
    Lam KK-W, Li RH-W, Ng EH-Y, Ho P-C, Yeung WS-B. Semen analysis–what a clinician should know. World Health. 2005;26:11.Google Scholar
  36. 36.
    Weiske WH, Sälzler N, Schroeder-Printzen I, Weidner W. Clinical findings in congenital absence of the vasa deferentia. Andrologia. 2000;32(1):13–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Ford W. Ignorance but not bliss: too little is known about the determinants of semen quality. Asian J Androl. 2013;15(2):174.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Sousa AP, Amaral A, Baptista M, Tavares R, Campo PC, Peregrín PC, Freitas A, Paiva A, Almeida-Santos T, Ramalho-Santos J. Not all sperm are equal: functional mitochondria characterize a subpopulation of human sperm with better fertilization potential. PLoS One. 2011;6(3):e18112.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    El-Taieb MA, Herwig R, Nada EA, Greilberger J, Marberger M. Oxidative stress and epididymal sperm transport, motility and morphological defects. Eur J Obstet Gynecol Reprod Biol. 2009;144:S199–203.PubMedCrossRefGoogle Scholar
  40. 40.
    Barratt C, Havelock L, Harrison P, Cooke I. Antisperm antibodies are more prevalent in men with low sperm motility. Int J Androl. 1989;12(2):110–6.PubMedCrossRefGoogle Scholar
  41. 41.
    Jarow JP, Sanzone JJ. Risk factors for male partner antisperm antibodies. J Urol. 1992;148(6):1805–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Berg U, Brucker C, Berg FD. Effect of motile sperm count after swim-up on outcome of intrauterine insemination. Fertil Steril. 1997;67(4):747–50.PubMedCrossRefGoogle Scholar
  43. 43.
    Keel BA. How reliable are results from the semen analysis? Fertil Steril. 2004;82(1):41–4.PubMedCrossRefGoogle Scholar
  44. 44.
    Bartoov B, Berkovitz A, Eltes F, Kogosowski A, Menezo Y, Barak Y. Real-time fine morphology of motile human sperm cells is associated with IVF-ICSI outcome. J Androl. 2002;23(1):1–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Auger J. Assessing human sperm morphology: top models, underdogs or biometrics? Asian J Androl. 2010;12(1):36.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Gatimel N, Moreau J, Parinaud J, Léandri R. Sperm morphology: assessment, pathophysiology, clinical relevance, and state of the art in 2017. Andrology. 2017;5(5):845–62.PubMedCrossRefGoogle Scholar
  47. 47.
    Chemes HE, Rawe VY. Sperm pathology: a step beyond descriptive morphology. Origin, characterization and fertility potential of abnormal sperm phenotypes in infertile men. Hum Reprod Update. 2003;9(5):405–28.PubMedCrossRefGoogle Scholar
  48. 48.
    Correa-Pérez JR, Fernández-Pelegrina R, Aslanis P, Zavos PM. Clinical management of men producing ejaculates characterized by high levels of dead sperm and altered seminal plasma factors consistent with epididymal necrospermia. Fertil Steril. 2004;81(4):1148–50.PubMedCrossRefGoogle Scholar
  49. 49.
    Agarwal A, Gupta S, Sharma R. Eosin-Nigrosin staining procedure. In: Andrological evaluation of male infertility: Springer; 2016. p. 73–7.Google Scholar
  50. 50.
    Björndahl L, Söderlund I, Kvist U. Evaluation of the one-step eosin-nigrosin staining technique for human sperm vitality assessment. Hum Reprod. 2003;18(4):813–6.PubMedCrossRefGoogle Scholar
  51. 51.
    Stanger JD, Vo L, Yovich JL, Almahbobi G. Hypo-osmotic swelling test identifies individual spermatozoa with minimal DNA fragmentation. Reprod Biomed Online. 2010;21(4):474–84.PubMedCrossRefGoogle Scholar
  52. 52.
    Cincik M, Ergur A, Tutuncu L, Muhcu M, Kilic M, Balaban B, Urman B. Combination of hypoosmotic swelling/eosin Y test for sperm membrane integrity evaluation: correlations with other sperm parameters to predict ICSI cycles. Arch Androl. 2007;53(1):25–8.PubMedCrossRefGoogle Scholar
  53. 53.
    Shekarriz M, Sharma R, Thomas A, Agarwal A. Positive myeloperoxidase staining (Endtz test) as an indicator of excessive reactive oxygen species formation in semen. J Assist Reprod Genet. 1995;12(2):70–4.PubMedCrossRefGoogle Scholar
  54. 54.
    Agarwal A, Gupta S, Sharma R. Leukocytospermia Quantitation (ENDTZ) Test. In: Andrological evaluation of male infertility. Cham: Springer; 2016. p. 69–72.CrossRefGoogle Scholar
  55. 55.
    Bachir BG, Jarvi K. Infectious, inflammatory, and immunologic conditions resulting in male infertility. Urol Clin North Am. 2014;41(1):67–81.PubMedCrossRefGoogle Scholar
  56. 56.
    Mahfouz R, Sharma R, Thiyagarajan A, Kale V, Gupta S, Sabanegh E, Agarwal A. Semen characteristics and sperm DNA fragmentation in infertile men with low and high levels of seminal reactive oxygen species. Fertil Steril. 2010;94(6):2141–6.PubMedCrossRefGoogle Scholar
  57. 57.
    Lackner JE, Herwig R, Schmidbauer J, Schatzl G, Kratzik C, Marberger M. Correlation of leukocytospermia with clinical infection and the positive effect of antiinflammatory treatment on semen quality. Fertil Steril. 2006;86(3):601–5.PubMedCrossRefGoogle Scholar
  58. 58.
    Agarwal A, Gupta S, Sharma R. Qualitative seminal fructose. In: Andrological evaluation of male infertility: Springer; 2016. p. 83–4.Google Scholar
  59. 59.
    Aziz N. The importance of semen analysis in the context of azoospermia. Clinics. 2013;68(Suppl 1):35–8.PubMedPubMedCentralCrossRefGoogle Scholar
  60. 60.
    Daudin M, Bieth E, Bujan L, Massat G, Pontonnier F, Mieusset R. Congenital bilateral absence of the vas deferens: clinical characteristics, biological parameters, cystic fibrosis transmembrane conductance regulator gene mutations, and implications for genetic counseling. Fertil Steril. 2000;74(6):1164–74.PubMedCrossRefGoogle Scholar
  61. 61.
    von Eckardstein S, Cooper TG, Rutscha K, Meschede D, Horst J, Nieschlag E. Seminal plasma characteristics as indicators of cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations in men with obstructive azoospermia. Fertil Steril. 2000;73(6):1226–31.CrossRefGoogle Scholar
  62. 62.
    Amann RP, Waberski D. Computer-assisted sperm analysis (CASA): capabilities and potential developments. Theriogenology. 2014;81(1):5–17. e13.PubMedCrossRefGoogle Scholar
  63. 63.
    Lu J, Huang Y, Lü N. Computer-aided sperm analysis: past, present and future. Andrologia. 2014;46(4):329–38.PubMedCrossRefGoogle Scholar
  64. 64.
    Tomlinson MJ, Pooley K, Simpson T, Newton T, Hopkisson J, Jayaprakasan K, Jayaprakasan R, Naeem A, Pridmore T. Validation of a novel computer-assisted sperm analysis (CASA) system using multitarget-tracking algorithms. Fertil Steril. 2010;93(6):1911–20.PubMedCrossRefGoogle Scholar
  65. 65.
    Cai J, Zeng Y, Song C, Mo M, Yin B, Lin Q, Huang J. Quality evaluation of 3 sperm counting chambers by computer-assisted sperm analysis system. Zhonghua nan ke xue=. Natl J Androl. 2009;15(3):241–3.Google Scholar
  66. 66.
    Hu Y, Lu J, Shao Y, Huang Y, Lü N. Comparison of the semen analysis results obtained from two branded computer-aided sperm analysis systems. Andrologia. 2013;45(5):315–8.PubMedCrossRefGoogle Scholar
  67. 67.
    Garrett C, Liu D, Clarke G, Rushford D, Baker H. Automated semen analysis:‘zona pellucida preferred’sperm morphometry and straight-line velocity are related to pregnancy rate in subfertile couples. Hum Reprod. 2003;18(8):1643–9.PubMedCrossRefGoogle Scholar
  68. 68.
    Mortimer ST, van der Horst G, Mortimer D. The future of computer-aided sperm analysis. Asian J Androl. 2015;17(4):545.PubMedPubMedCentralCrossRefGoogle Scholar
  69. 69.
    Cooper TG, Yeung C-H. Computer-aided evaluation of assessment of “grade a” spermatozoa by experienced technicians. Fertil Steril. 2006;85(1):220–4.PubMedCrossRefGoogle Scholar
  70. 70.
    Larsen L, Scheike T, Jensen TK, Bonde JP, Ernst E, Hjollund NH, Zhou Y, Skakkebæk NE, Giwercman A, Team DFPPS. Computer-assisted semen analysis parameters as predictors for fertility of men from the general population. Hum Reprod. 2000;15(7):1562–7.PubMedCrossRefGoogle Scholar
  71. 71.
    Shibahara H, Obara H, Hirano Y, Suzuki T, Ohno A, Takamizawa S, Suzuki M. Prediction of pregnancy by intrauterine insemination using CASA estimates and strict criteria in patients with male factor infertility. Int J Androl. 2004;27(2):63–8.PubMedCrossRefGoogle Scholar
  72. 72.
    Coetzee K, de Villiers A, Kruger TF, Lombard CJ. Clinical value of using an automated sperm morphology analyzer (IVOS). Fertil Steril. 1999;71(2):222–5.PubMedCrossRefGoogle Scholar
  73. 73.
    Yu S, Rubin M, Geevarughese S, Pino J, Rodriguez H, Asghar W. Emerging technologies for home-based semen analysis. Andrology. 2017;6(1):10–9.PubMedPubMedCentralCrossRefGoogle Scholar
  74. 74.
    Coppola M, Klotz K, K-a K, Cho H, Kang J, Shetty J, Howards S, Flickinger C, Herr J. SpermCheck® fertility, an immunodiagnostic home test that detects normozoospermia and severe oligozoospermia. Hum Reprod. 2010;25(4):853–61.PubMedPubMedCentralCrossRefGoogle Scholar
  75. 75.
    Vij SC, Agarwal A. Editorial on “an automated smartphone-based diagnostic assay for point-of-care semen analysis”. Ann Transl Med. 2017;5(24):307.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Tania R. Dias
    • 1
    • 2
    • 3
    • 4
  • Chak-Lam Cho
    • 5
  • Ashok Agarwal
    • 1
    Email author
  1. 1.American Center for Reproductive Medicine, Cleveland ClinicClevelandUSA
  2. 2.Universidade da Beira InteriorCovilhãPortugal
  3. 3.Department of Microscopy, Laboratory of Cell BiologyInstitute of Biomedical Sciences Abel Salazar and Unit for Multidisciplinary Research in Biomedicine, University of PortoPortoPortugal
  4. 4.LAQV/REQUIMTE - Laboratory of Bromatology and Hydrology, Faculty of PharmacyUniversity of PortoPortoPortugal
  5. 5.Department of SurgeryUnion HospitalHong KongChina

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