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This article is, in part, a review of present knowledge regarding the lipid metabolism of the sperm cell and the lipid composition of the sperm plasma membrane. It is also a summary of our research on this topic, reporting published and unpublished data. The article tries to cover both basic and clinical research. Sperm cells use lipid metabolic pathways for the production of part of their energy. The double leaflets of the membrane are not simply a passive, bilayer, lipidic film in which the receptors receive their molecular specific signals, but are a very specialized structure. Complete maturation of the lipids of the sperm cell membrane is reached after passage of the spermatozoon through the epididymis. A specific composition of phospholipids and a significant concentration of polyunsaturated fatty acids (PUFA) have been shown to be present in sperm membranes. Plasmalogen is a special kind of phospholipid found exclusively in spermatozoa and other cells with the capacity to react promptly to stimuli. In addition, we have found a high concentration of the n-3 PUFA family in the sperm membrane. Seminal plasma has a highly specialized scavenger system that defends the sperm membrane against lipoperoxidation. Various pathologies and systemic predisposition can lead to an antioxidant/pro-oxidant disequilibrium. Clinical trials with natural scavengers could be a useful research area in which to seek a treatment for these pathologies. Of the natural scavengers, glutathione has been shown to restore the physiological constitution of PUFA in the cell membrane under certain conditions.

The aim of our work was to define and better understand apoptosis in the spermatozoa of normal subjects, infertile patients and patients affected by specific tumoral diseases employing the method of the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling and confirming the results by electron microscopy. We studied 23 healthy, normozoospermic subjects (group A), 29 oligoasthenoteratozoospermic patients, affected by various andrological pathologies (group B), 28 patients with Hodgkin's disease (C1) and 30 patients with testicular cancer (C2). Our data demonstrate that the percentage of apoptosis in normozoospermic subjects (group A) is significantly lower than in all the other groups (B, C1, C2) (P < 0.001). This confirms that high DNA fragmentation is one of the characteristics of spermatogenetic failure. The induction of apoptosis, which can also be a basic response to neoplastic disease, can even act right up to the mature male gamete. Our results suggest that apoptosis could be the final result of various pathologies and of a deregulation of spermatogenesis control systems.

There is still controversy over whether analytical techniques currently in use are able to identify the level of damage to spermatozoa. Large-scale studies should be conducted in different clinical settings to determine the effects of sperm DNA damage on the outcome of ART.

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