Identification of Sperm Oxidative Stress

Evidence for oxidative damage to sperm is present in 30-80% of infertile men's sperm, depending upon the techniques used to measure oxidative stress and the patient population studied [6]. Since oxidative stress is such a common pathology, it would appear logical that all infertile men should be screened for its presence. Surprisingly, however, this is not current standard clinical practice. The reasons for this are multiple but include a general ignorance amongst treating physicians of the importance of oxidative stress as a cause of male infertility, a perceived lack of cost-effective assays for sperm oxidative stress and the absence of a universally accepted treatment regime. Chapters 13 and 14 have already outlined the various assays for sperm oxidative stress. The Luminol assay is probably the most commonly used direct measure of oxidative stress, but more than 30 other assays currently exist [ 6 ] . The Luminol assay is the only assay of sperm oxidative stress described in the current WHO semen analysis manual, but unfortunately has the disadvantage of requiring expensive specialised equipment (Luminometer) not commonly present in clinical andrology laboratories and can be quite technically demanding from a quality control perspective [8] . In my own fertility clinic, we measure sperm oxidative stress with the Nitro Blue Tetrazolium (NBT) assay, since this is easy to perform with limited specialised equipment and is relatively inexpensive, making it an ideal assay for a clinical andrology laboratory [9]. It will be left up to the discretion of individual clinician to decide on what oxidative stress assay they should adopt based on the relative merits of each assay described in Chaps. 13 and 14. However, for the purposes of this discussion it will be assumed that none of these direct or indirect assays of sperm oxidative stress are available, as is the most common current clinical scenario, with the diagnosis of presumptive oxidative stress being made solely based on clinical history, physical examination and interpretation of the routine WHO semen analysis.

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