Abstract Infertility affects one in six couples worldwide, and fertility continues to deteriorate globally, partly owing to a decline in semen quality. Sperm analysis has a central role in diagnosing and treating male factor infertility. Many emerging techniques, such as digital holography, super-resolution microscopy and next-generation sequencing, have been developed that enable improved analysis of sperm motility, morphology and genetics to help overcome limitations in accuracy and consistency, and improve sperm selection for infertility treatment. These techniques have also improved our understanding of fundamental sperm physiology by enabling discoveries in sperm behaviour and molecular structures. Further progress in sperm analysis and integrating these techniques into laboratories and clinics requires multidisciplinary collaboration, which will increase discovery and improve clinical outcomes.

Key Points

  • Technical advances have improved the accuracy, speed and efficiency in the analysis of sperm motility, morphology and genetics.

  • Advances in sperm analysis improve sperm selection for infertility treatment by measuring sperm behaviour and biomarkers of fertility potential.

  • Discoveries in sperm locomotion and behaviour improve understanding of sperm motion and guidance within the female reproductive tract.

  • Analyses of sperm structure and molecules such as CatSper channels and ubiquitin increase understanding of sperm physiology and contribute to the identification of biomarkers of fertility potential.

  • Further progress in sperm analysis promises non-invasive testing for sperm selection, increased efficiency and accuracy via automation and artificial intelligence, and improved access to point-of-care assays.

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