Clinical Chemistry 59:3 493–501 (2013) Automation and Analytical Techniques Direct Characterization of Motion-Dependent Parameters of Sperm in a Microfluidic Device: Proof of Principle Yu-An Chen,1† Ken-Chao Chen,1† Vincent F.S. Tsai,2 Zi-Wei Huang,1 Ju-Ton Hsieh,2 and Andrew M. Wo1* BACKGROUND: Semen analysis is essential for evaluating male infertility. Besides sperm concentration, other properties, such as motility and morphology, are critical indicators in assessing sperm quality. Nevertheless, rapid and complete assessment of these measures still presents considerable difficulty and involves a range of complex issues. Here we present a microfluidic device capable of quantifying a range of properties of human sperm via the resistive pulse technique (RPT). Infertility is a critical challenge facing the aging world population. The infertility rate for couples with females aged between 25 and 49 years has been reported to be 15%–30% in various countries (1 ). Male and female infertility issues contribute equally to the infertility rate (2 ), and semen analysis is a cornerstone of the diagnostic evaluation of the male contribution to infertility (3 ). Clinically, a male infertility workup should begin with a thorough history and physical examination and at least 2 semen analyses (4 ). According to the fifth WHO manual, the lower limit of the reference interval for sperm concentration is 15 ⫻ 106 per mL (fifth percentile and 95% CI) (5 ). Besides concentration, the important characteristics of sperm include motility, vitality, and morphology. Moreover, morphology has gained emphasis because of its relationship with the acrosome reaction (4, 6 ), the zona pellucida (4 ), reactive oxygen species (4, 6 ), and DNA fragmentation (4 ). The 2 main techniques to analyze sperm in a semen sample are optical and electrical detection. The gold standard optical approach to quantifying the kinematics of sperm is computer assisted sperm analysis (CASA),3 which is based on microscopic observation. By leveraging an image recognition technique, a CASA system comprehensively quantifies sperm motion, including such features as swim velocity, beat cross frequency, and morphology. Nevertheless, a CASA system— composed of a microscope, a high-speed charge-coupled device (CCD), and image-processing modules—may not be accessible to researchers or clinicians with limited resources. The resistive pulse technique (RPT), an electrical impedance-based approach, uses an aperture for sensing the passage of a particle. This technique is also used to extract information on particle size from the signal amplitude (7, 8 ). The status of the particle shape and orientation can be acquired as well. For aspheric particles, such as red blood cells and spermatozoa, shape and orientation can be measured by changes in the signal amplitude of the electric field (7, 9 –13 ). Berge et al. experimentally demonstrated this shape effect by 1 † METHODS: An aperture, designed as a long channel, was used to allow the quantification of various properties as sperm swam through. RESULTS: The time trace of the voltage drop across the aperture during sperm passage contained a wealth of information: the sperm volume was presented by the amplitude of the induced pulse, the swim velocity was evaluated via the duration, and the beat frequency was calculated from the voltage undulation superposed on the pulse signal. The RPT measurement of swim velocity and beat frequency showed a correlation with the same observation in a microscope (R2 ⫽ 0.94 and 0.70, respectively). CONCLUSIONS: The proposed proof of principle enables substantial quantification of the motion-dependent properties of sperm. Because this approach requires only a current/voltage source and data analysis, it is economically advantageous compared with optical methods for characterizing sperm motion. Furthermore, this approach may be used to characterize sperm morphology. © 2012 American Association for Clinical Chemistry Institute of Applied Mechanics, National Taiwan University, Taiwan; Department of Urology, National Taiwan University Hospital, Taipei, Taiwan. * Address correspondence to this author at: Institute of Applied Mechanics, National Taiwan University, Taipei, Taiwan 10617. Fax ⫹886-2-23639290; e-mail [email protected]. 2 Yu-An Chen and Ken-Chao Chen contributed equally to the work, and both should be considered as first authors. Received August 4, 2012; accepted December 12, 2012. Previously published online at DOI: 10.1373/clinchem.2012.190686 3 Nonstandard abbreviations: CASA, computer assisted sperm analysis; CCD, charge-coupled device; RPT, resistive pulse technique; VSL, straight-line velocity. 493 Fig. 1. Schematic and photograph of the microdevice. (A), Microchannel network with an aperture at the intersection. A hydrostatic flow field was arranged to eliminate the flow drag on sperm. (B), Photograph of the microdevice. The device was assembled with 3 layers: glass as substrate, polydimethylsiloxane (PDMS) bulk with microchannels in relief, and 3 reservoirs for holding liquid columns at the same height. flushing aspheric particles through a long orifice, and they reported the swim velocity via pulse duration and size from amplitude (14, 15 ). Along with beat frequency, these kinematic characteristics reflect the biological status of sperm, a critical indicator of the fertilization ability of a particular sperm cell. Capacitation of sperm, which is required to render sperm competent to fertilize an oocyte, causes a change in sperm kinematic motion (16 ), and a positive correlation exists between fertility efficiency and other properties, such as straight-line velocity (VSL), beat cross frequency, and motility (17 ). Besides image and resistive pulse methods, sperm concentration and fertility are also monitored by immunofluorescence with flow cytometry (18 ), enzymatic activity (19 ), and a microenvironment mimicking in vivo conditions (20 ). Microchips also have been used to characterize sperm quality (20 –25 ). Few studies, however, have reported measurements on sperm’s beat frequency. We incorporated RPT in a microfluidic device to characterize details of sperm kinematics, including simultaneous measurement of VSL and beat cross frequency. Instead of the image-based method used in clinical laboratories, the proposed resistive pulse approach could serve as an alternative to quantify complete details related to sperm motion at low cost and with relative ease. used in this study was a long narrow channel, 46 m long (so that the passage of sperm cells took ⬎0.5 s), 7 m wide (the same as the width of aperture for a previous homemade microdevice) (24 ), and 11 m high (where the Makler chamber is 10 m in height), as illustrated in Fig. 1A. Fig. 1B shows a photograph of the microfluidic device for sperm motion characterization. The microchannel network in the device comprised 3 channels with an aperture embedded at the intersection. The ends of the 3 channels were open to reservoirs. A buffer solution was filled in reservoirs A and C before the processed sperm suspension was added to reservoir B. A hydrostatic flow field was required to eliminate the viscous drag of the flow on sperm while swimming through the aperture, thus sperm cells were introduced gently. Hence, liquids in each reservoir were loaded to almost the same height (about 2 mm high, measured from the top of the bulk polydimethylsiloxane). One wall was fabricated to connect directly to the channel where sperm would swim along from reservoir B. This geometric design, based on the tendency of sperm to swim along the channel wall, provided guidance for sperm to migrate toward the aperture (21 ). The details of the design and fabrication of the device are provided in the Supplemental Data file accompanying the online version of this article at http://www.clinchem.org/content/vol59/issue3. Materials and Methods SPERM AND BUFFER SOLUTION PREPARATION CONFIGURATION OF THE MICROFLUIDIC DEVICE An aperture is critical in detecting the presence of a particle in impedance measurements. The aperture 494 Clinical Chemistry 59:3 (2013) Sperm used in this study were acquired from patients in the National Taiwan University Hospital with the approval of the National Taiwan University Hospital Electrical Measurement of Sperm Motion Fig. 2. Voltage trace of 3 sperm cells migrating through the aperture. (A), Three sperm cells, A, B, and C, passed through aperture consecutively. (B), Enlarged pulse of sperm B shows undulation of voltage while sperm B was migrating. Institutional Review Board. Experiments were conducted within several hours after semen retrieval, with samples stored at room temperature, and after liquefaction was completed (about 30 min from ejaculation). Seminal plasma was separated from sperm cells after centrifugation (⬃100g for 5 min) and was extracted (via a pipette) and mixed with RPMI1640 (No. 11835– 030, Invitrogen) at a ratio of 200 L seminal plasma to 800 L RPMI1640. This mixture was helpful to prevent sperm adhesion to the glass surface (26 ). Furthermore, to confirm that a stagnant flow field was achieved around the aperture, we added 1-m diameter polystyrene beads (4009a; Thermo Scientific) at a ⬍0.1% fraction of the volume. The swim-up method was used to sort motile sperm cells from raw semen. One milliliter of semen was first loaded in a 15-mL centrifuge tube and covered by 1 mL RPMI1640. The tube was placed in a 37 °C water bath for 1 h. After the swim-up process, the upper layer of RPMI1640 was retrieved for subsequent experimentation. EXPERIMENTAL SETUP The microchannel network was filled with buffer solution before the 3 reservoirs were filled with sperm suspension in buffer solution to a height of 2 mm. Two Ag/AgCl electrodes were immersed in the buffer solution in reservoirs A and C, as illustrated in Fig. 1B, to allow the flow of steady current and recording of voltage drop. Ionic currents from the electrode in reservoir A flowed toward the intersection of the channel networks, passed through the aperture, and finally arrived at the other electrode in reservoir C. While sperm passed through the aperture, the voltage drop across these 2 electrodes was sampled at a frequency of 1 kHz (PCI-6250, SHC68 – 68-EPM Shielded Cable, and SCB-68 screw terminals; National Instruments). A CCD (Fire-i400; Unibrain) on a microscope recorded video of sperm passing through the aperture (30 frames/s) as measurements of voltage drop were ac- quired. Voltage recordings were postprocessed by a digital low-pass Butterworth filter to remove noise. Results CHARACTERIZATION OF 3 SPERM CELLS DEPICTED VIA RPT Conceptually, when sperm cells enter the aperture, the voltage trace rises to a certain level with undulation owing to the sperm’s vibration, and the signal reduces to the original level once the sperm leaves the aperture. Based on the Coulter principle, the voltage rise is inversely proportional to the volume of the aperture. To make the sperm signal prominent, the volume of the aperture, and thus the width, height, and length of the aperture, must be limited. Fig. 2A shows a trace of the voltage drop between 2 electrodes during migration of 3 sperm cells (A, B, and C) through the aperture. The baseline of the voltage was fixed at about 2.72–2.74 V. The voltage rapidly increased by several millivolts from the original baseline when sperm cells entered the aperture. For example, the voltage changed from 2.724 to 2.728 V in the case of sperm A, and from 2.720 to 2.728 V in the case of sperm B. This increase in voltage was attributed to partial displacement of aperture space by relatively insulated sperm. On the basis of the Coulter principle, the voltage rise in the case of sperm A was determined to be 4 mV, and the size of sperm A was estimated to be approximately 14 m3. In the case of sperm B, there was an 8 mV rise, corresponding to a volume of 28 m3, which was larger than that of sperm A. Both cases showed that the volumes estimated via RPT fit the range of volume of a normal sperm head (the tail, normally thinner than 1 m, was ignored) from a few to 50 m3. After the voltage rise, all 3 sperm cells showed undulations for 1–2 s. Fig. 2B shows that after sperm B entered the aperture (i.e., at around 7 s) the voltage rose to a higher level from the original baseline, and a regular voltage undulation was observed that most likely Clinical Chemistry 59:3 (2013) 495 tential drop rose as the angle of the prolate spheroid to the electric field increased. Furthermore, at a fixed angle, the potential drop differed from each type. When the angle was equal to zero, (i.e., the axis of revolution of the prolate spheroid was parallel to the electric field), type 4 displayed a potential drop smaller than that for type 1 (about 777.2 mV to 778.8 mV). This result could be based on the physics, for which a sphere is much more resistant to current flow than a prolate spheroid that is oriented parallel to the current. On the basis of the dependence of the potential drop on both the shape and angle of a prolate spheroid to an electric field, the amplitude of undulation when a sperm cell migrates through the aperture depends on both the deviation angle and shape (volume is also a factor but is consistent for all types). SPERM MOTION DETECTION VIA AN APERTURE OF STRAIGHT CHANNEL Fig. 3. Amplitude of undulation of voltage while sperm cells are vibrating within the aperture is dependent on the angle between the orientation of the sperm head and electric field and on the shape of the sperm head. resulted from the zigzag motion of sperm B. The zigzag motion of sperm generates a propulsive force to allow sperm cells to migrate through the aperture; this timevarying posture of sperm cells will cause the resistance of the aperture to be time dependent. More specifically, the time-varying posture causes a change in the shape factor, which is dependent on the orientation and shape of sperm, as a sperm cell progresses through the aperture. The online Supplemental Data file contains further details for the estimation of sperm volume, along with theoretical and numerical analysis of the effect of sperm vibration on the potential drop. DEPENDENCE OF THE POTENTIAL DROP ON THE SHAPE AND DEVIATION ANGLE OF SPERM Fig. 3 shows the calculated potential drop between the outlet and inlet of the aperture over the range of the angle between the axis of revolution of a prolate spheroid and the electric field for 4 types of prolate spheroids. These 4 types of prolate spheroids have different ratios of the axis of revolution to the equatorial axis, ranging from 1 to 2, which were chosen by considering the dimensions of a sperm head (about 2.5–3.5 m wide and 4 – 6 m long). The volume of all 4 types is set to be constant. For type 1, having an axial ratio equal to 1 (perfect sphere), the potential drop of the aperture was independent of the angle. For types 2– 4, the po496 Clinical Chemistry 59:3 (2013) Fig. 4A and 4B show sperm cells D and E, respectively, swimming through the aperture under hydrostatic background flow. These 2 images were taken from videos at an instant when sperm cells D and E were at the opening of the aperture on the left-hand side. A timelapse video of a sperm swimming through the aperture of the microdevice is provided in the online Supplemental Video that accompanies this report. Fig. 4, C and D show the corresponding trajectories of these 2 sperm cells drawn from real-time video images with simultaneous voltage recordings. Ellipsoids drawn along the trajectories represent the orientation of the sperm heads at each moment. The trajectory of sperm D showed a regular vibratory motion throughout the process of aperture passage. Compared with sperm E, sperm D displayed higher beat cross frequency, smaller head displacement, and faster VSL. For sperm E, a lower frequency and a larger displacement of the head were monitored. Inside the aperture, the vibration of sperm E was relatively irregular compared to that of sperm D. Furthermore, after leaving the aperture, sperm E trembled and slowly moved away, probably owing to the high electric field inside the aperture (approximately 2 ⫻ 104 V/m). Voltage traces for these 2 sperm cells are shown below the illustrated sperm paths. Both traces began with a drastic increase in voltage, hitting a plateau embedded with several small peaks, and finished with a sudden drop to the original level. The increase in voltage from the original level to a higher level indicated the volume of a sperm cell. The voltage rise induced by sperm cells D and E were around 7 and 10 mV, respectively, which implied that the volume of sperm D was smaller than that of sperm E. The VSL of sperm cells can be deduced from pulse duration. For instance, as shown in Fig. 4, C and D, the Electrical Measurement of Sperm Motion Fig. 4. Distinct trajectories of sperm cells D and E resulted in different voltage traces. (A), Image of sperm D taken from the video at the instant of entering the aperture. (B), Sperm E at the opening of the aperture. (C), Sperm D migrating through the long narrow aperture. (D) Sperm E swimming more slowly than sperm D. ALH, amplitude of lateral head displacement; BCF, beat cross frequency. pulse durations of sperm cells D and E were estimated to be 664 and 959 ms, respectively. During this time period, these 2 sperm cells passed through the 46-m long aperture, allowing the VSLs to be calculated as 69.3 and 48 m/s. As a comparison with the above measurement by the resistive pulse approach, videos simultaneously recorded with voltage traces were also used to measure VSL and beat frequency. These 2 characteristics of sperm motion measured via microscopy served as benchmarks to evaluate the resistive pulse method. Fig. 5A shows the comparison of VSL measurements between these 2 methods. VSLs of 10 sperm cells measured by both approaches showed that a high correlation existed between data from the RPT and the microscopy-based approach. The slope of 1.08 calculated from the regression model indicated linear consistency between the 2 methods. The intercept of ⫺5.75, compared with the measured VSL, which ranged from 30 to 90 m/s, suggested that the differ- ence in measurements between the 2 methods was relatively small. The narrow 95% CI was also indicative of the rather precise measurement of VSL by RPT, which should be attributed to the accurate measurement of the time spent by sperm cells migrating through the aperture via RPT. We evaluated the reproducibility of determining sperm VSL using the microdevice. Out of the total patient samples, 3 were randomly selected for this purpose, with 3 to 4 sperms tested per patient. For patient 1, the mean (SD) VSL was 80.7 (8.7) m/s. For patient 2, the mean (SD) VSL was 57.6 (10.8) m/s. For patient 3, the mean (SD) VSL was 37.6 (4.8) m/s. Although the mean VSLs ranged from 37.6 to 80.7 m/s, we believe that the corresponding SDs are acceptable considering that these samples originated from an outpatient clinic. Fig. 5B shows a comparison of the 2 measurements of beat frequency. From the image data, the beat freClinical Chemistry 59:3 (2013) 497 Fig. 5. Characterization of sperm motion: VSL and beat frequency. (A), Linear correlation between VSL measurements by RPT and the microscopic method. (B), Beat frequency of sperm measured by the resistive pulse method, showing consistency with the microscopic method. quency was calculated by counting the number of times a sperm head changed in orientation divided by the duration of passage. In the resistive pulse method, the number of peaks during undulation on the top of pulses was regarded as the number of times the orientation of the head changed. For example, sperm cells D and E in Fig. 4, C and D showed around 9 –10 and 5 peaks during undulations of voltage, respectively. Trajectories observed under a microscope for each sperm cell showed a corresponding number of changes in orientation along the aperture. This agreement confirmed the correlation between the pulse number and the observed orientation changes. With a known pulse number, the beat frequency can be calculated by dividing it by the pulse width. Most samples in Fig. 5B showed a linear relationship between the beat frequency acquired in the resistive pulse approach and that acquired from images. The data resided mostly within a 95% CI. Moreover, to verify the reproducibility of quantifying beat frequency using the current approach, sam- ples from 3 patients (the same 3 samples as those used for determining the mean VSL) were used. For patient 1, the mean (SD) beat frequency was 14.99 (2.12) Hz. For patient 2, the mean (SD) beat frequency was 9.56 (3.42) Hz. For patient 3, the mean (SD) beat frequency was 7.76 (1.43) Hz. Although the RPT mainly depicted sperm motion within the aperture, sperm motion influenced by the geometry of the aperture and the strength of the electric field inside also was observed. Table 1 summarizes the beat frequency and VSL of sperm cells D and E measured by direct image microscopy at 2 locations: before entering the aperture and within the aperture. Compared with results from images of sperm within the aperture, RPT was demonstrated to characterize both types of sperm motions well. Nevertheless, microscopic measurements conducted at distinct locations showed differences in characteristics of sperm motion. The velocity of sperm D increased from 49.2 m/s before entering the aperture to 67.7 m/s within the ap- Table 1. Summary of characteristics of sperm cells D and E detected via the electrical (RPT) and optical (microscopic) methods. Sperm D Sperm E Microscopic Characteristics of sperm motion Beat frequency, Hz VSL, m/s Microscopic Before entering aperture Within aperture RPT 9.4 13.2 (⬵ 9–10 pulses/664 ms) 49.2 67.7 69.3 (46 m/664 ms) 498 Clinical Chemistry 59:3 (2013) Before entering aperture Within aperture RPT 5.6 6.5 5.2 (⬵ 5 pulses/959 ms) 31.1 49.8 48 (46 m/959 ms) Electrical Measurement of Sperm Motion erture and the beat frequency from 9.4 –13.2 Hz. The VSL of sperm E was also different before and within the aperture. The shift of VSL or beat frequency between, before, and within the aperture could have resulted from the electrophoresis effect, electric shock (27 ), and sperm motion being confined by the aperture. would lower the amplitude of the pulse and make the electrical field nonuniform across the width, enhancing the ripples of the voltage pulses, therefore interfering with the signal from sperm beating. Special care should be taken to ensure that signal quality is not compromised during adjustment of the aperture width. Discussion COMPARISON WITH THE IMAGE-BASED APPROACH FOR SPERM In this study we aimed to show the utility of RPT in providing kinematic information among a myriad of quantities that characterizes sperm quality. Among other parameters, we studied the sperms’ beat frequency and VSL in the microfluidic device. Far upstream from the aperture, sperm swam toward the aperture via propulsion by the tail. In contrast, within the aperture, where the current converged to strengthen the electric field inside, sperm moved not only by tail motion but also by electrophoresis. The direction of the electric field within the aperture was opposite the direction of the sperm’s forward motion. Due to the sperm’s negatively charged nature, the velocity of sperm subjected to the electric field was enhanced accordingly. Engelmann et al. reported reduction in sperm motility by a strong electric field (27 ). In our case, the electric field intensity was numerically estimated to be approximately 2 ⫻ 104 V/m within the aperture, on the same order as that applied in the experiments of Engelmann et al. Observation under a microscope showed that 22 of the 68 sperm cells remained progressive after passing through the aperture. This rather low percentage of progressive sperm cells was evidence of the effect of an electric field on motility. The other 46 sperm cells were observed to tremble either upon leaving or within the aperture. The final cause of changing swimming behavior is the confinement of sperm vibration by the aperture width. The width of the aperture was fabricated to be around 7 m, which is not wide enough for the lateral displacement of all sperm cells (16 ). This could result in an increase in beat frequency because sperm cells cannot fully swing, forcing them to change their orientation more frequently than usual. An accompanying increase in swim velocity could be possible with increased beat frequency. The shift of VSL or beat frequency should be able to be improved by shortening or widening the aperture. Shortening the length of the aperture reduces the risk of the electric shock for sperm cells, and widening of the aperture prevents geometrical confinement to sperm vibration (so that the sperm’s tail would not hit the wall). The 2 geometrical parameters are tuned within the constraint of keeping the aperture volume essentially constant; thus, the voltage contrast would remain the same. Nevertheless, widening the aperture MOTION DETECTION The most critical feature in this approach is the signal profile recorded while sperm pass through the aperture. By analyzing the signal profile, the beat frequency, swim velocity, and volume of sperm are deduced with relative ease. Currently, the most widely accepted method for sperm motion detection is CASA, which also provides these 3 quantities. Our proposed method has advantages over CASA in characterizing sperm motion. For quantifying the beat frequency of a sperm head, image-based CASA first records a video and analyzes the video frame by frame. Afterward, a mean swimming path is determined mathematically for each sperm and the number of sperm crossing this path is counted. Finally, the number of crossings is divided by the duration of the video to obtain the beat cross frequency. Hence, the determination of beat frequency of sperms in CASA is highly dependent on the mathematical approach used in calculating the swimming path. In our approach, the beat frequency is calculated directly from undulation of the signal profile because it is strongly related to the orientation of the sperm head to the electric field, rendering minute changes in sperm head orientation detectable. Thus, the resistive pulse method does not require a priori knowledge of the swimming path, making it a more direct approach to quantify the beat frequency compared to image-based CASA. Both the sperm volume and the swim velocity can be calculated from CASA and the present approach. To determine the head shape in CASA, an objective lens with high magnification and a CCD with high resolution are required. Nevertheless, if the sperm heads are tilted, i.e., the symmetric axis of the sperm head is not in the focal plane, proportional inaccuracy would result. In the resistive pulse approach, the volume of a sperm head is proportional to the amplitude of the signal and requires knowledge of the shape factor. With the assistance of the vibration angle of sperm, the shape of sperm can also be determined. The capability of providing shape information makes this method a good alternative for studying the morphology of a sperm’s head. To find the swim velocity, VSL is 1 of the 3 parameters readily provided in CASA. In the resistive pulse Clinical Chemistry 59:3 (2013) 499 approach, VSL can be precisely calculated from the signal profile. In terms of cost, the resistive pulse method should be substantially more economical than CASA. In the resistive pulse approach, only a current source or a voltage source and an analog-to-digital converter are required. Both components are more cost-effective than optical-based CASA, which requires a microscope equipped with a highly magnified lens and a CCD with a high resolution and frame rate. Characteristics of sperm, including volume, VSL, and beat frequency, are demonstrated via the RPT. The effect of sperm vibration on resistance across an aperture was also addressed. Numerical and analytical results indicate that vibration of the sperm head causes time-dependent resistance at the aperture. By comparing these results with characteristics of sperm motion observed under the microscope, RPT proved to represent the properties of sperm motion accurately by use of the microdevice. The beat frequency and swim velocity of sperm passing through the aperture were deduced by counting the peaks of undulation on top of the signal pulse and metering the pulse duration. Although the proposed electrical resistive pulse method could not provide sperm motion analysis as comprehensive as that by CASA, e.g., less information on sperm vibration such as deviation angle and lateral head displacement, the reported proof of principle of this method demonstrates an economical approach to quantify sperm motion. The simple configuration of our method provides another tool that may cost less than the traditional image-based approach. Author Contributions: All authors confirmed they have contributed to the intellectual content of this paper and have met the following 3 requirements: (a) significant contributions to the conception and design, acquisition of data, or analysis and interpretation of data; (b) drafting or revising the article for intellectual content; and (c) final approval of the published article. Authors’ Disclosures or Potential Conflicts of Interest: Upon manuscript submission, all authors completed the author disclosure form. Disclosures and/or potential conflicts of interest: Employment or Leadership: None declared. Consultant or Advisory Role: None declared. Stock Ownership: None declared. Honoraria: None declared. Research Funding: Y.-A. Chen, National Science Council, Taiwan, grants NSC98-2120-M-002-009, NSC99-2120-M-002-004, and NSC100-2120-M-002-001; K.-C. Chen, National Science Council, Taiwan, grants NSC98-2120-M-002-009, NSC99-2120-M-002-004, and NSC 100-2120-M-002-001; Z.-W. Huang, National Science Council, Taiwan, grants NSC98-2120-M-002-009, NSC99-2120-M002-004, and NSC 100-2120-M-002-001; A.M. Wo, National Science Council, Taiwan, grants NSC98-2120-M-002-009, NSC99-2120-M002-004, and NSC 100-2120-M-002-001. Expert Testimony: None declared. Patents: V.F.S. Tsai, Taiwan patent: application no. 098143216. Role of Sponsor: The funding organizations played no role in the design of study, choice of enrolled patients, review and interpretation of data, or preparation or approval of manuscript. References 1. Rutstein SO, Shah IH. DHS comparative reports, No. 9. Infecundity, infertility, and childlessness in developing countries. Geneva: World Health Organization; 2004. http://www.who.int/ reproductivehealth/topics/infertility/DHS-CR9.pdf. (Accessed January 2013). 2. Sabanegh E Jr, Agarwal A. Male infertility. In: Wein AJ, editor-in-chief; Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh urology. 10th ed. Philadelphia: Saunders Elsevier; c2012. p. 616 – 47. 3. De Jonge C. Semen analysis: looking for an upgrade in class. Fertil Steril 2012;97:260 – 6. 4. Franken DR, Oehninger S. Semen analysis and sperm function testing. Asian J Androl 2012;14:6–13. 5. WHO. WHO laboratory manual for the examination and processing of human semen. 5th ed. Geneva: World Health Organization; 2010. http:// www.who.int/reproductivehealth/publications/ infertility/9789241547789/en/index.html. (Accessed January 2013). 6. Agarwal A, Monette F, Sabanegh E. Assessing sperm function. Urol Clin North Am 2008;35: 157–71. 7. Hurley J. Sizing particles with a coulter counter. Biophys J 1970;10:74 –9. 8. DeBlois RW, Bean CP. Counting and sizing of submicron particles by the resistive pulse tech- 500 Clinical Chemistry 59:3 (2013) nique. Rev Sci Instrum 1970;41:909 –16. 9. Drochon A. Use of cell transit analyser pulse height to study the deformation of erythrocytes in microchannels. Med Eng Phys 2005;27:157– 65. 10. DeBlois RW. Analysis of morphology of sperm cells using a resistive-pulse technique. Biophys J 1978;21:149a. 11. Waterman CS, Atkinson EE Jr, Wilkins B Jr, Fischer CL, Kimzey SL. Improved measurement of erythrocyte volume distribution by aperturecounter signal analysis. Clin Chem 1975;21: 1201–11. 12. Golibersuch DC. Observation of aspherical particle rotation in poiseuille flow via the resistance pulse technique. I. Application to human erythrocytes. Biophys J 1973;13:265– 80. 13. Grover NB, Naaman J, Bensasso S, Doljansk F. Electrical sizing of particles in suspensions. I. Theory. Biophys J 1969;9:1398 – 414. 14. Berge LI, Feder J, Jossang T. A new perspective on particle sizing by the coulter principle: particle dynamics. In: Stanley-Wood NG, Lines RW, eds. Particle size analysis. Cambridge: The Royal Society of Chemistry; 1992. p. 374 – 83. 15. Berge LI, Feder J, Jossang T. A novel method to study single-particle dynamics by the resistive pulse technique. Rev Sci Instrum 1989;60:2756 – 63. 16. Mortimer ST, Mortimer D. Kinematics of human spermatozoa incubated under capacitating conditions. J Androl 1990;11:195–203. 17. King LM, Holsberger DR, Donoghue AM. Correlation of CASA velocity and linearity parameters with sperm mobility phenotype in turkeys. J Androl 2000;21:65–71. 18. Ferrara F, Daverio R, Mazzini G, Bonini P, Banfi G. Automation of human sperm cell analysis by flow cytometry. Clin Chem 1997;43:801–7. 19. Ruiz-Pesini E, Diez C, Lapena AC, Perez-Martos A, Montoya J, Alvarez E, et al. Correlation of sperm motility with mitochondrial enzymatic activities. Clin Chem 1998;44:1616 –20. 20. Xie L, Ma R, Han C, Su K, Zhang QF, Qiu TA, et al. Integration of sperm motility and chemotaxis screening with a microchannel-based device. Clin Chem 2010;56:1270 – 8. 21. Lopez-Garcia MDC, Monson RL, Haubert K, Wheeler MB, Beebe DJ. Sperm motion in a microfluidic fertilization device. Biomed Microdevices 2008;10:709 –18. 22. Su TW, Erlinger A, Tseng D, Ozcan A. Compact and light-weight automated semen analysis platform using lensfree on-chip microscopy. Anal Chem 2010;82:8307–12. 23. Segerink LI, Sprenkels AJ, terBraak PM, Vermes I, van den Berg A. On-chip determination of Electrical Measurement of Sperm Motion spermatozoa concentration using electrical impedance measurements. Lab Chip 2010;10: 1018 –24. 24. Chen YA, Huang ZW, Tsai FS, Chen CY, Lin CM, Wo AM. Analysis of sperm concentration and motility in a microfluidic device. Microfluid Nano- fluid 2011;10:59 – 67. 25. Spencer D, Morgan H. Positional dependence of particles in microfludic impedance cytometry. Lab Chip 2011;11:1234 –9. 26. Stephens DT, Acott TS, Hoskins DD. A cautionary note on the determination of forward mo- tility protein-activity with bovine epididymal spermatozoa. Biol Reprod 1981;25:945–9. 27. Engelmann U, Krassnigg F, Schatz H, Schill WB. Separation of human X and Y spermatozoa by free-flow electrophoresis. Gamete Res 1988;19: 151–9. Clinical Chemistry 59:3 (2013) 501
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