Simplified sperm testing devices: a possible tool to overcome lack of accessibility and inconsistency in male factor infertility diagnosis. An opportunity for low- and middle- income countries.

Abstract

Background: Manual semen assessment (MSA) is a key component in a male’s fertility assessment. Clinicians rely on it to make diagnostic and treatment decisions. When performed manually, this routine laboratory test is prone to variability due to human intervention which can lead to misdiagnosis and consequently over- or under-treatment. For standardization, continuous training, quality control (QC) programs and pricy Computer-Assisted Sperm Analysis (CASA) systems have been proposed, yet, without resolving intra- and inter-laboratory variability. In response, promising simplified sperm testing devices, able to provide cost-effective point-of-care male infertility diagnosis are prospected as a plausible solution to resolve variability and increase access to sperm testing. Materials and methods: A throughout literature research for semen testing, sperm analysis, smart-phone assisted semen analysis, ‘at-home’ semen testing, male infertility, infertility in developing countries, infertility in low- and middle-income countries (LMIC) and quantitative sperm analysis was performed. A total of 14 articles, specific to ‘at-home’ simplified sperm assessment, were included to treat the core subject. Results: Continuous training and consistent QC, are sine qua none conditions to achieve accurate and comparable MSA. Compliance does not rule-out variability, nevertheless. Emerging simplified sperm assessment devices are an actual alternative to resolve lack of standardization and accessibility to sperm analysis. YO®, SEEM®, and ExSeed® are commercially available, user-friendly smartphone-based devices which can accurately measure volume, sperm concentration (millions/ml) and total motile sperm count. More broadly, by cost-effectiveness, availability, accuracy and convenient application, these devices could effectively sort patients for first-line artificial reproduction treatments such as intrauterine insemination. Conclusions: Accuracy and cost-effectiveness make smart-phone based sperm testing devices a practical and realistic solution to overcome variability in MSA. Importantly, these tools represent an actual opportunity to standardize and affluence male subfertility diagnosis and treatment, especially in LMIC. However, before clinical application is possible, guidelines, further testing with special attention on accuracy in washed sperm, availability, cost-benefit and reliability are required.

New horizons in human sperm selection for assisted reproduction

“…These protocols are facilitated by the purification of sperm cells from seminal plasma with swim-up techniques or, more commonly, with density gradient centrifugation based on the use of colloidal silica suspensions. More innovative sperm selection strategies including microfluidics (36) and electrophoresis (Felix ™ ; Further, smart phone technology is making semen analyses more accessible with at home YO sperm tests (41), and artificial intelligence (AI) advances have enabled new holographic 3D sperm imaging (28) and sperm quality assessment. Finally, technological advancements in omics platforms (34, 42) are permitting the identification of molecular biomarkers with which to stratify infertile patients, allowing enhanced evaluation of subfertility phenotypes, aiding our understanding of the genetic and epigenetic causes of male infertility, and potentially revolutionising fertility treatment with personalized therapeutic regimens.…”

Evolution of the basic semen analysis and processing sperm

“…These benefits have led to the emergence of several POC testing devices in recent years [12,19]. The application of these simplified sperm testing devices can improve access to fertility care for men who are embarrassed to seek care, have poor access to fertility care or are limited by socioeconomic constraints [20 ▪ ,21]. Using these devices as screening tools for the detection of semen abnormalities can also help identify patients who need further evaluation in clinical settings [12].…”

“…The advent of compact and automated semen analysis platforms using lensfree on-chip microscopy has informed further applications using the imaging capacity of smartphones for POC testing [28,29]. These technological advances make POC testing even more accessible for patients [20 ▪ ]. Manual evaluation of images from a device that paired a smartphone with a 555× magnifying ball lens microscope showed a strong correlation with the motile and static sperm counts obtained from CASA testing [30].…”

“…Tsao et al [11 ▪ ] developed an efficient POC colorimetric semen testing device using an MTT test strip to identify men with low total motile sperm count and results were evaluated using a smartphone with a sensitivity of 96%. Furthermore, the ExSeed Home Sperm Test that utilizes a double chamber slide to provide quantitative measures for basic semen parameters has improved precision and reproducibility [20 ▪ ]. The advantages and disadvantages of the different POC tests are listed in Table 2.…”

Micronutrientes en el tratamiento de la infertilidad masculina idiopática

“…El volumen del líquido seminal disminuyó en 20% en el mismo periodo de tiempo. 5,6 Otros informes también encontraron que la calidad del semen se redujo en los últimos 20 años. [7][8][9] Debido a que la baja en la producción de esperma es relativamente reciente, se debe considerar que la combinación de factores ambientales, estilo de vida y hábitos dietéticos podría interferir con el proceso de espermatogénesis.…”