Semen function and analysis in coming century: Way Ahead

Abstract
Understanding of human sperm and fertilization biochemistry has improved
over the years after WHO started standardizing the semen analysis and new
research results became available. Objective data and information about
important measures like kinematics of sperm capacitation, hyper activation
of sperm, the ability of sperm to bind zona-pellucida and subsequent drilling,
acrosome reaction and zone digestion, the ability of sperm to fuse with
oocyte and finally decondensation of sperm nucleus to form male pronucleus
started coming in improving our knowledge of events leading to fertilization
and formation of embryo. This new information is helping us to diagnose new
forms of male sub-fertility, predict success of attempts at natural or assisted
conception and to design in vitro sperm function tests and treatments to
overcome the diagnosed dysfunction.
Many feel and believe that sperm function testing is now irrelevant due to
advances in, In vitro fertilization technology especially intracytoplasmic
sperm injection technique. ICSI has definitely given hope to couples who
previously had virtually no chance of conception with their own gametes. But
leaving apart medical reasons financial reasons alone in India preclude the
use of ICSI in only those cases where it is absolutely needed. Many couples
without severe sperm defects can be treated by less invasive and less
expensive option provided we can provide better sperm function tests to
ensure normal fertilization without use of ICSI. Ideally an accurate and
inexpensive test is needed to determine which men require ICSI and which
do not. The current fascination with ICSI as largely stifled the development
and implementation of such a test. Overrated and wrongly designed function
tests in past also had their share of bad repute.
Potential benefits of sperm function testing remains high as many doctors
require and patients desire tests that can help them plan their treatment and
to predict the outcome of these treatments. Large number patients cant
afford and insist on less expensive options than ICSI.
Beyond these two important and practical considerations lies the ultimate
benefit; we will gain knowledge and understanding of the causes of male sub
fertility by trying to answer these basic questions. Only with an increased
understanding of basic and applied biology of fertilization and sub fertility we
can hope to address the medical problems important to our patients and
society.
There is still a gap in understanding of complex nature of molecular interactions
between oocyte and sperm leading to fertilization. Exact chain of events need

further clarification, with identification of specific molecules and gamete function

should become basis of new diagnostic tests. Since there is more than one sperm
function involved, no single test of a single function will have perfect sensitivity.
Therefore battery of tests are required for diagnosis. Ideal goal should be a test
incorporating all critical functions. Major goal of new tests should be identification of
molecular defects in sperm function, allowing rapid development of biochemical
tests, with goal to specifically target therapies towards male subfertility.
Sperms in male or female genital tract live in varied environment, at times very
harsh; and need to interact with other cells and body fluids. Some tests may require
to separate sperms from the contaminating cells and fluids carefully so that
iatrogenic influence on tests can be minimized.
With advent of IVF and ICSI need to predict fertility is reduced considerably. But now
there is renewed need to revalidate most of the function test to predict pregnancy
by IUI.
Most of the presently available sperm function tests perform better as predictors of
dysfunction rather than normality. There is need to interpret the test results,
specifically normal test result cautiously as untested and occult abnormality may be
present in spite of normal results. Tests with high sensitivity, high predictive value
and low false positive rate are desirable. Valid and more predictive tests need to be
developed with strict validation and specificity. Development of tests of more than
one sperm function on individual sperm remains an important goal.