Quantitative ultramorphological analysis of human sperm: Fifteen years of experience in the diagnosis and management of male factor infertility

The advantages of quantitative ultramorphological (QUM) sperm analysis in t he diagnosis and treatment of male infertility are presented. The QUM metho dology is based on three elements: complementary scanning electron microsco py and transmission electron microscopy observations of 7 sperm cell subcel lular organelles (acrosome, postacrosomal lamina, nucleus, neck, axoneme, m itochondrial sheath, and outer dense fibers); systematic classification of the specific ultramorphological malformations into 4 pathological and the n ormal categories, indicating the morphological stale of each subcellular or ganelle; and comparison between well-defined reference groups with opposite fertility status or treatment conditions. QUM has established 2 indices fo r the in vivo and in vitro male fertility potential: (1) Natural Fertility Index (NFI), with accurate prediction (97% sensitivity and 90% specificity) of 80% of the male patients; and (2) IVF score, with prediction of 76% of the nonfertilizing and 90% of fertilizing IVF groups. QUM has enabled asses sment of ultramorphological indications for varicocele and radiation exposu re. Varicocele causes defects in sperm head organelles related to early spe rmatid development, whereas ionizing radiation causes amorphous head shape. QUM established criteria for specific non-in-vitro therapeutic interventio ns, including varicocelectomy, follicle-stimulating hormone (FSH) administr ation, and acupuncture. The varicocele index enabled correct classification of 79 and 89% of patients with and without varicocele. Males with idiopath ic impairment of sperm acrosome and nucleus are potential responders to FSH treatment, whereas patients exhibiting low sperm activity are candidates f or acupuncture treatment. Patients with a low Natural Fertility Index are r ecommended for an assisted reproduction technique (ART), based on the ultra morphology of the tail axoneme. Patients who achieved pregnancy following i ntrauterine insemination or in vitro fertilization and those whose wives co nceived only following intracytoplasmic sperm injection were classified wit h accuracy of 78 and 74%, respectively. QUM sperm analysis is clinically in formative, nontraumatic, and cost-effective, and is recommended when the ma le infertility factor cannot be clearly diagnosed by routine tests prior to first ART trial.