Recent advances in human sperm pathology.

Electron microscopy is a valuable tool in understanding not only the presence but also the nature of sperm malformation causing human infertility. In the past, we have examined patients affected by severe teratospermia concomitant with andrological pathologies such as varicocele, cryptorchidism, and infection. In particular, we have demonstrated that, in the case of varicocele, a combination of different phenotypic defects typical of immature spermatozoa is present. This general study was carried out on 2000 infertile men who presented for sperm analysis at our laboratory over the course of 10 years. The ejaculate of all of them was examined by electron microscopy, statistically evaluated by a formula created by us (J of Andrology, 1995), and cytogenetically checked by fluorescence microscopy techniques. First of all, this study concerned the techniques of assisted reproduction, i.e. intracytoplasmic sperm injection (ICSI), partial zona disruption (PZD), and in vitro fertilization (IVF). The conclusion was that the evaluation of the sperm quality of males attempting artificial insemination must concern not only motility or staining characteristics but mainly submicroscopical and molecular properties. Moreover, the effect of follicle stimulating hormone (FSH) treatment on human sperm quality has been evaluated by our group testing the ultrastructure and the function of spermatozoa before and after the therapy. Using the sperm as an andrological monitor, it seems that the therapeutic effect of FSH depends on the type of sperm affections. In particular, phenotypic defects as apoptosis and immaturity can be corrected by FSH treatment. More recently, we approached the problem of genotypic sperm infertility. We demonstrated that some very peculiar defects, detected by electron microscopy, show a hereditary transmission having a genetic basis. In fact, they are much more frequent in consanguineous patients, and are clearly related to different degrees of consanguinity. Frequently, chromosomal translocations have sometimes been found correlated to these defects.A consequence of these demonstrations is that most of the present sperm defects are phenotypic and can be submitted to surgical or pharmaceutical cares, but others have genetic origin and cannot be corrected by surgical or pharmaceutical treatment. These malformations are transmitted to the offspring by techniques of assisted fertilization.