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Counting sperm does not add up any more: time for a new equation?

¹ Reproductive Biology and Genetics Group, Division of Reproductive and Child Health, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK, ² Department of Physiology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, ³ School of Biosciences, University of Birmingham, Birmingham B15 2TT, UK, ⁴ The Center of Reproductive Medicine, Peking University Third Hospital, Beijing 100083, China and ⁵ Assisted Conception Unit, Birmingham Women’s Hospital, Birmingham B15 2TG, UK

Correspondence should be addressed to C L R Barratt who is now at Division of Reproductive and Child Health, The Medical School, University of Birmingham, Room WX 1.30, West Wing, Birmingham B15 2TT, UK; Email: c.l.barratt{at}bham.ac.uk

Although sperm dysfunction is the single most common cause of infertility, we have poor methods of diagnosis and surprisingly no effective treatment (excluding assisted reproductive technology). In this review, we challenge the usefulness of a basic semen analysis and argue that a new paradigm is required immediately. We discuss the use of at-home screening to potentially improve the diagnosis of the male and to streamline the management of the sub-fertile couple. Additionally, we outline the recent progress in the field, for example, in proteomics, which will allow the development of new biomarkers of sperm function. This new knowledge will transform our understanding of the spermatozoon as a machine and is likely to lead to non-ART treatments for men with sperm dysfunction.

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