VIEWS AND REVIEWS
Introduction: Beyond bulk semen parameters Mark Sigman, M.D. Division of Urology, Warren Alpert Medical School of Brown University; and Division of Urology, Rhode Island and Miriam Hospital, Providence, Rhode Island
What can the analysis of semen reveal about the fertility potential of sperm? A series of articles reviews the current status and limitations of basic and advanced semen testing. (Fertil SterilÒ 2014;102:1501. Ó2014 by American Society for Reproductive Medicine.) Discuss: You can discuss this article with its authors and with other ASRM members at http:// fertstertforum.com/sigmanm-beyond-bulk-semen-parameters/
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his month's ‘‘Views and Reviews’’ addresses an ongoing issue in reproduction: how to best assess the fertility potential of semen. Semen analysis is the standard initial laboratory evaluation of the male partner. Although it has been performed for many decades, it remains a suboptimal test. In most cases the distribution of standard parameters (sperm count, motility, morphology) of fertile and infertile men overlap considerably; the test cannot separate fertile from infertile populations very well. We have asked a group of experts to assess a variety of approaches to the determination of the fertility potential of sperm. To start, Drs. Wang and Swerdloff describe the current state of semen analysis. They have been asked to assess its value and weaknesses and to point us toward future directions to improve the value of the assay. There follow a series of articles addressing other laboratory approaches. Some have seen their heyday and are rarely if ever used any more, whereas others are gaining popularity while others struggle to find their
place. The authors have been asked to address a variety of questions such as: What does the assay measure? What are the indications for ordering the test? How does one interpret the results? What are the therapeutic implications of the test results? Does the result change management of the couple? Can therapy improve test results, and does this improvement correlate with higher pregnancy and delivery rates? We, as readers, should keep these questions in mind when evaluating any proposed diagnostic test of male fertility. As is commonly the case, more studies may be needed to properly assess a test's true value. We have asked the authors to suggest appropriate study designs or future directions needed to determine the true utility of the tests or to improve our ability to more accurately assess fertility. Dr. Oehninger et al. review sperm functional tests, explaining what the tests measure, their potential value, and the pitfalls that have led almost to an abandonment of their use in the clinical andrology laboratory. Reactive
Use your smartphone to scan this QR code and connect to the discussion forum for this article now.* * Download a free QR code scanner by searching for “QR scanner” in your smartphone’s app store or app marketplace.
oxygen species play a double-edged role in male fertility: A little is good, too much is bad. Dr. Ko et al. evaluate the assays of ROS and review the potential benefits of the test as well as the reasons it has not become a routine assay for the evaluation of the infertile man. In the current age of genetics, tests of sperm DNA are available, but proper indications for their use are often unclear. Dr. Palermo et al. address sperm chromatin integrity, a test that has proponents and detractors and has generated much research. They review published data as well as present their personal experience, results, and interpretations, indicating that more studies are still needed. Dr. Ramasamy et al. address sperm fluorescence in situ hybridization, a test with potentially significant clinical value but with technical difficulties causing it to have limited availability. This series of articles provides a suberb overview of the state of the art of evaluation of the semen sample by a group of authors with years of experience that allows us to see the forest and not just the trees.
Received October 9, 2014; accepted October 10, 2014. Reprint requests: Mark Sigman, M.D., Division of Urology, Rhode Island Hospital, 2 Dudley Street, Suite 174, Providence, Rhode Island 02905 (E-mail: [email protected]). Fertility and Sterility® Vol. 102, No. 6, December 2014 0015-0282/$36.00 Copyright ©2014 American Society for Reproductive Medicine, Published by Elsevier Inc. http://dx.doi.org/10.1016/j.fertnstert.2014.10.015 VOL. 102 NO. 6 / DECEMBER 2014
1501
Introduction: Beyond bulk semen parameters Mark Sigman, M.D. Division of Urology, Warren Alpert Medical School of Brown University; and Division of Urology, Rhode Island and Miriam Hospital, Providence, Rhode Island
What can the analysis of semen reveal about the fertility potential of sperm? A series of articles reviews the current status and limitations of basic and advanced semen testing. (Fertil SterilÒ 2014;102:1501. Ó2014 by American Society for Reproductive Medicine.) Discuss: You can discuss this article with its authors and with other ASRM members at http:// fertstertforum.com/sigmanm-beyond-bulk-semen-parameters/
T
his month's ‘‘Views and Reviews’’ addresses an ongoing issue in reproduction: how to best assess the fertility potential of semen. Semen analysis is the standard initial laboratory evaluation of the male partner. Although it has been performed for many decades, it remains a suboptimal test. In most cases the distribution of standard parameters (sperm count, motility, morphology) of fertile and infertile men overlap considerably; the test cannot separate fertile from infertile populations very well. We have asked a group of experts to assess a variety of approaches to the determination of the fertility potential of sperm. To start, Drs. Wang and Swerdloff describe the current state of semen analysis. They have been asked to assess its value and weaknesses and to point us toward future directions to improve the value of the assay. There follow a series of articles addressing other laboratory approaches. Some have seen their heyday and are rarely if ever used any more, whereas others are gaining popularity while others struggle to find their
place. The authors have been asked to address a variety of questions such as: What does the assay measure? What are the indications for ordering the test? How does one interpret the results? What are the therapeutic implications of the test results? Does the result change management of the couple? Can therapy improve test results, and does this improvement correlate with higher pregnancy and delivery rates? We, as readers, should keep these questions in mind when evaluating any proposed diagnostic test of male fertility. As is commonly the case, more studies may be needed to properly assess a test's true value. We have asked the authors to suggest appropriate study designs or future directions needed to determine the true utility of the tests or to improve our ability to more accurately assess fertility. Dr. Oehninger et al. review sperm functional tests, explaining what the tests measure, their potential value, and the pitfalls that have led almost to an abandonment of their use in the clinical andrology laboratory. Reactive
Use your smartphone to scan this QR code and connect to the discussion forum for this article now.* * Download a free QR code scanner by searching for “QR scanner” in your smartphone’s app store or app marketplace.
oxygen species play a double-edged role in male fertility: A little is good, too much is bad. Dr. Ko et al. evaluate the assays of ROS and review the potential benefits of the test as well as the reasons it has not become a routine assay for the evaluation of the infertile man. In the current age of genetics, tests of sperm DNA are available, but proper indications for their use are often unclear. Dr. Palermo et al. address sperm chromatin integrity, a test that has proponents and detractors and has generated much research. They review published data as well as present their personal experience, results, and interpretations, indicating that more studies are still needed. Dr. Ramasamy et al. address sperm fluorescence in situ hybridization, a test with potentially significant clinical value but with technical difficulties causing it to have limited availability. This series of articles provides a suberb overview of the state of the art of evaluation of the semen sample by a group of authors with years of experience that allows us to see the forest and not just the trees.
Received October 9, 2014; accepted October 10, 2014. Reprint requests: Mark Sigman, M.D., Division of Urology, Rhode Island Hospital, 2 Dudley Street, Suite 174, Providence, Rhode Island 02905 (E-mail: [email protected]). Fertility and Sterility® Vol. 102, No. 6, December 2014 0015-0282/$36.00 Copyright ©2014 American Society for Reproductive Medicine, Published by Elsevier Inc. http://dx.doi.org/10.1016/j.fertnstert.2014.10.015 VOL. 102 NO. 6 / DECEMBER 2014
1501
