I-10: The Search for The Best Spermatozoon -A Multi-Regional Study

Assessment of sperm has over the years by many been regarded as something secondary to assessment of ova, oocytes and embryos. Often the most inexperienced of the laboratory staff have been asked to evaluate the semen sample. It is our belief that the outcome of subfertility treatment could be improved considerably, if semen and sperm assessment would be taken more seriously. This may not be as simple as it may sound. This lecture will deal with subjective and objective semen analysis. The lack of accuracy and standardization using the older subjective method can make it difficult, if not impossible, for physicians to interpret semen analysis results or to compare results obtained from different laboratories. We will discuss the mistakes, which can inadvertently be made during a subjective analysis, and the advantages - and disadvantages - of an automated computer aided sperm assay (CASA) system. The total concentration of sperm is fairly easy to determine, but makes only sense, if we know the motility and morphology, both of which can be very hard to determine. If the motility is very poor, we still may be able to use the sperm for ICSI, if we can show that an immotile spermatozoon is actually alive. The presence of antisperm antibodies may prevent fertilization by IUI or IVF, but ICSI may still work. Severe sperm DNA fragmentation can make IUI and even IVF impossible, but again ICSI can maybe lead to success and a healthy baby. DNA fragmentation assays are relatively expensive, but in cases where the sperm sample has a good concentration, good motility, good morphology and good vitality, but does not bring about fertilization, it may be worthwhile to do a DNA fragmentation assay. Based on this background, an extremely important subject, particularly in patients on the border line of fertility is that it is (wrongly) assumed that a two day period of abstinence is required for both good semen analysis as well as for artificial fertilization/ART procedures. Recent research on humans as well as a very wide group of animals show that an ejaculate obtained relatively few hours after a first ejaculate is better than the first. A study of the sperm parameters in 2 or 3 consecutive sperm samples obtained within two days from a sufficient number of patients in several populations provides a quantitative (objective) knowledge in terms of reference values for semen/sperm using these newer techniques.