Findings from a Human Reproduction Update on sperm count trends have been used in a BBC report, to highlight an ongoing decline in sperm counts.  The geographic groups found to have a 50-60% decrease were located in North America, Europe, Australia and New Zealand.

According to the report, potential causes are varied but can include lifestyle factors (diet, smoking, and stress), endocrine disrupting chemicals, heat, medications, and pesticides.

Sperm count is a crucial component of semen analysis, and the first step to identify male factor infertility.  It is estimated that male factor is involved in 40-50% of all infertility cases.

Having a low sperm count, fewer than 15 million sperm per milliliter or less than 39 million sperm per ejaculate, can make it more difficult to conceive naturally.

With reducing sperm numbers, more couples may have to resort to assisted conception.  Even then, determining not only numbers but also quality of the sperm being produced can contribute to better outcomes.

There are various diagnostic tools on the market for sperm analysis, but our range of andrology products are the only ones available that use Hyaluronan (HA).

The Role of Hyaluronan

Within the female reproductive tract, HA is believed to play a critical role in the selection of functionally competent sperm during fertilization.  Only mature spermatozoa have developed specific receptors for HA, enabling them to bind to the cumulus complex, digest HA, reach the oocyte and fertilize it.

HA-bound spermatozoa show lower rates of chromosomal aneuploidies and DNA fragmentation and good nuclear morphology.

How HA Products Work

HBA® Assay

Placing a prepared or unprepared sperm sample on the grid-marked slide, which is coated with HA, helps identify mature sperm as these will bind.

Designed to provide both a qualitative and quantitative assessment of sperm quality, maturity, and fertilizing potential, the HBA device can be used to decide which treatment is best for patients.

“The HBA score allows us to successfully identify patients who would benefit from PICSI (Physiological Intracytoplasmic Sperm Injection), a specialist technique that enables the embryologists to select only the mature sperm for injection.

“Our trial in March (2016), identified 26.5% of our patients would benefit from PICSI and we were delighted to report a clinical pregnancy rate of 53.1% and the birth of our first seven babies from the technique.”

Nicola Townsend, Laboratory Manager, Herts & Essex Fertility Centre, UK


Within the PICSI Dish, sperm is added to a dot of HA and within minutes bound sperm are attached by their heads to the surface of the dot.

Selecting an individual bound sperm with enhanced genetic and developmental integrity in this way ensures it is of optimal quality.


SpermSlow is used for the selection of an individual sperm with enhanced genetic and developmental integrity, for ICSI.  A semi-viscous liquid, it is placed in a dish next to a sperm suspension drop and then the two are connected using a junction.  Individual sperm with enhanced genetic and developmental integrity are those that reach the HA first.

Significant improvements in clinical outcomes in the US, Italy and Singapore have been demonstrated using these HA-based products.

“As an alternative to PVP (PolyVinylPyrrolidone), SpermSlow allows easy handling of individual sperm with the huge additional benefit of allowing the selection of sperm that is more likely to be fully mature, and less likely to be genetically compromised. This leads to better treatment outcomes for patients.”

David Morroll PhD, Director of Clinical Support, CooperSurgical 

Summary of Conclusions

The HA sperm selection method for ICSI, which is based on a relationship between sperm receptors for zona pellucida and HA, will likely reduce the potential genetic complications and adverse public health effects of ICSI.

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In couples where ≤ 65% of sperm-bound HA, the selection of HA-bound sperm for ICSI led to a statistically significant reduction in pregnancy loss rate.

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Spematozoa bound to HA show a significant reduction in DNA fragmentation and a significant improvement in nucleus normalcy compared with spermatozoa immersed in PVP.

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The higher the HBA score, the better the fertilization, pregnancy, and cleavage rates. This shows that HBA does have the ability to select mature sperm with normal chromosome development and oocyte-binding capability.

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“Embryologists are now able to undertake varied types of sperm analysis to help give patients the best chance of success,” says Steven Fleming PhD, Director of Embryology for CooperSurgical.

“HBA and sperm DNA fragmentation assays correlate with fertility prognosis whereas PICSI and SpermSlow increase the likelihood of successful ICSI treatment outcomes.”

ICSI and Sperm Selection Training

Qualitative analysis can only take place using specialized skills, tools and equipment.  We run training days that incorporate lectures, demonstrations and hands-on practical sessions for andrology.  Follow the links below to find out more about them.

Introduction to ICSI – Suited to embryologists with general experience

Sperm Selection for ICSI – Suited to embryologists with experience of ICSI

Check out our full training schedule

Publications Summary for Further Reading

The impact of drugs on male fertility: a review, M Semet, M Paci, J Saïas-Magnan, C Metzler-Guillemain, R Boissier, H Lejeune, J Perrin, Andrology, The American Society of Andrology, Volume 5, Issue 4, July 2017, Pages 640–663

Healthy diets and men’s contribution to fertility; is semen quality good enough? J E Chavarro, Fertility and Sterility, Volume 107, Issue 4, April 2017, Pages 906–907

Elevated seminal plasma myeloperoxidase is associated with a decreased sperm concentration in young men, J M Pullar, A C Carr, S M Bozonet, P Rosengrave, A J Kettle, M C M Vissers, Andrology, The American Society of Andrology, Volume 5, Issue 3, May 2017, Pages 431–438

A new media without animal component for sperm cryopreservation: motility and various attributes affecting paternal contribution of sperm, A Tiwari, M Tekcan, L Sati, W Murk, J Stronk, G Huszar, Journal of Assisted Reproduction and Genetics, Volume 34, Issue 5, March 2017, Pages 647–657

Sperm chemorepulsion, a supplementary mechanism to regulate fertilization, H A Guidobaldi, M Cubilla, A Moreno, M V Molino, L Bahamondes, L C Giojalas, Human Reproduction, Volume 32, Issue 8, June 2017, Pages 1560-1573

Biological basis for human capacitation – revisited, C D Jonge, Human Reproduction Update, Volume 23, Issue 3, January 2017, Pages 289–299

Cryopreservation of testicular tissue or testicular cell suspensions: a pivotal step in fertility preservation, J Onofre, Y Baert, K Faes, and E. Goossens, Human Reproduction Update, Volume 22, Issue 6, November 2016, Pages 744–761

DNA fragmentation in spermatozoa: a historical review, A S Rex, J Aagaard, J Fedder, Andrology, The American Society of Andrology, Volume 5, Issue 4, July 2017, Pages 622–630

Does combining magnetic-activated cell sorting with density gradient or swim-up improve sperm selection? Z Cakar, B Cetinkaya, D Aras, B Koca, S Ozkavukcu, İ Kaplanoglu, A Can, O Cinar, Journal of Assisted Reproduction and Genetics, Volume 33, Issue 8, August 2016, Pages 1059–1065

Does cryopreservation of sperm affect fertilization in nonobstructive azoospermia or cryptozoospermia? N Schachter-safrai, G Karavani, E Levitas, M Friger, A Zeadna, E Lunenfeld, I Har-Vardi, Fertility and Sterility, Volume 107, Issue 5, May 2017, Pages 1148–1152

Effect of semen preparation technique and its incubation on sperm quality in the Moroccan population, S Aboulmaouahib, A Madkour, I Kaarouch, B Saadani, O Sefrioui, N Louanjli, H Copin, R Cadi, M Benkhalifa, Andrologia, Volume 49, Issue 6, August 2017, e12688

Effects of n-6 and n-3 polyunsaturated acid-rich soybean phosphatidylcholine on membrane lipid profile and cryotolerance of human sperm, A A Vireque, A Tata, O FLLO Silva, E G LoTurco, A Azzolini, C R Ferreira, M H Y Dantas, R A Ferriani, R M Reis, Fertility and Sterility, Volume 106, Issue 2, August 2016, Pages 273–283.e6

Healthy offspring from freeze-dried mouse spermatozoa held on the International Space Station for 9 months, S Wakayama, Y Kamada, K Yamanaka, T Kohda, H Suzuki, T Shimazu, M N Tada, I Osada, A Nagamatsu, S Kamimura, H Nagatomo, E Mizutani, F Ishino, S Yano, T Wakayama, PNAS, Volume 114, Issue 23, June 2017, Pages 5988-5993

Hyaluronan-binding system for sperm selection enhances pregnancy rates in ICSI cycles associated with male factor infertility, R Erberelli, R M Salgado, D H Mendes Pereira, P Wolff, JBRA Assisted Reproduction, Jan-Mar 2017, Volume 21, Issue 1, Pages 2-6

Influence of sperm DNA damage on human preimplantation embryo metabolism, S Uppangala, S Pudakalakatti, F D’souza, S R Salian, G Kalthur, P Kumar, H Atreya, S K Adiga, Reproductive Biology, Volume 16, Issue 3, September 2016, Pages 234-241

Magnetic cell sorting of semen containing spermatozoa with high DNA fragmentation in ICSI cycles decreases miscarriage rate, P Sánchez-Martín, M Dorado-Silva, F Sánchez-Martín, M G Martínez, S D Johnston, J Gosálvez, Reproductive BioMedicine Online, Volume 34, Issue 5, May 2017, Pages 506-512

MicroSort® sperm sorting causes no increase in major malformation rate, D P Marazzo, D Karabinus, L A Johnson, J D Schulman, Reproduction, Fertility and Development, Volume 28, 2016, Pages 1580–1587

miR-424/322 is downregulated in the semen of patients with severe DNA damage and may regulate sperm DNA damage, K Zhao, Y Chen, R Yang, Y Bai, C Li, H Li, C Xiong, Reproduction, Fertility and Development, Volume 28, Issue 10, April 2015, Pages 1598-1607

Optimization of microelectrophoresis to select highly negatively charged sperm, L Simon, K Murphy, K I Aston, B R Emery, J M Hotaling, D T Carrell, Journal of Assisted Reproduction and Genetics, Volume 33, Issue 6, June 2016, Pages 679–688

Phospholipase C zeta (PLCζ) and male infertility: Clinical update and topical developments, S N Amdani, M Yeste, C Jones, K Coward, Advances in Biological Regulation, Volume 61, May 2016, Pages 58-67

Predicting the clinical outcome of ICSI by sperm head vacuole examination, K Pocate-Cheriet, I Heilikman, R Porcher, V Barraud-Lange, N Sermondade, C Herbemont, J P Wolf, C Sifer, Systems Biology in Reproductive Medicine, Volume 63, Issue 1, February 2017, Pages 29-36

Predictive value of sperm deoxyribonucleic acid (DNA) fragmentation index in male infertility, B Wiweko, P Utami, Basic and Clinical Andrology, Volume 27, Issue 1, September 2016

Role of the Na+/K+-ATPase ion pump in male reproduction and embryo development, D R Câmara, J P Kastelic, J C Thundathil, Reproduction, Fertility and Development, Volume 29, Issue 8, July 2016, Pages 1457-1467

Sedimentation properties in density gradients correspond with levels of sperm DNA fragmentation, chromatin compaction and binding affinity to hyaluronic acid, F Torabi, A Binduraihem, D Miller, Reproductive BioMedicine Online, Volume 34, Issue 3, March 2017, Pages 298-311

Selection of physiological spermatozoa during intracytoplasmic sperm injection, B Torki-Boldaji, M Tavalaee, M Bahadorani, M H Nasr-Esfahani, Andrologia, Volume 49, Issue 1, February 2017

Separation efficiency of a microfluidic sperm sorter to minimize sperm DNA damage, K Shirota, F Yotsumoto, H Itoh, H Obama, N Hidaka, K Nakajima, S Miyamoto, Fertility and Sterility, Volume 105, Issue 2, February 2016, Pages 315-321

Sperm DNA damage and assisted reproductive technologies: reasons to be cautious! J R Drevet, Basic and Clinical Andrology, Volume 26, Issue 11, 27 September 2016

Sperm DNA fragmentation and mitochondrial membrane potential combined are better for predicting natural conception than standard sperm parameters, S Malić Vončina, B Golob, A Ihan, A Nataša Kopitar, M Kolbezen, B Zorn, Fertility and Sterility, Volume 105, Issue 3, March 2016, Pages 637-644

Sperm processing for advanced reproductive technologies: Where are we today? K L Rappa, H F Rodriguez, G C Hakkarainen, R M Anchanf, G L Mutter, W Asghar, Biotechnology Advances, Volume 34, September-October 2016, Pages 578-587

Status of sperm-born oocyte activating factors (PAWP, PLCζ) and sperm chromatin in uncapacitated, capacitated and acrosome-reacted conditions, M Tavalaee, K Parivar, AH Shahverdi, K Ghaedi, M H Nasr-Esfahani, Human Fertility, Volume 20, Issue 2, January 2017, Pages 96-103

Supplementation of freezing and thawing media with brain-derived neurotrophic factor protects human sperm from freeze-thaw-induced damage, A Najafi, E Asadi, A R Moawad, S Mikaeili, F Amidi, E Adutwum, M Safa, A G Sobhani, Fertility and Sterility, Volume 106, Issue 7, Pages 1658–1665

The pellet swim-up is the best technique for sperm preparation during in vitro fertilization procedures, A Volpes, F Sammartano, S Rizzari, S Gullo, A Marino, A Allegra, Journal of Assisted Reproduction and Genetics, Volume 33, Issue 6, June 2016, Pages 765–770

The role of antioxidants in sperm freezing: a review, F Amidi, A Pazhohan, M S Nashtaei, M Khodarahmian, S Nekoonam, Cell and Tissue Banking, Volume 17, Issue 4, December 2016, Pages 745–756

Variation of DNA Fragmentation Levels During Density Gradient Sperm Selection for Assisted Reproduction Techniques – A Possible New Male Predictive Parameter of Pregnancy? M Muratori, N Tarozzi, M Cambi, L Boni, A L Lorio, C Passaro, B Luppino, M Nadalini, S Marchiani, L Tamburrino, G Forti, M Maggi, E Baldi, A Borini, Medicine, Volume 95, Issue 20, May 2016, Pages e36246