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Agarwal A, Sharma R, Gupta S, Finelli R, Parekh N, Panner Selvam MK, Henkel R, Durairajanayagam D, Pompeu C, Madani S, Belo A, Singh N, Covarrubias S, Darbandi S, Sadeghi R, Darbandi M, Vogiatzi P, Boitrelle F, Simopoulou M, Saleh R, Arafa M, Majzoub A, Kandil H, Zini A, Ko E, Alvarez JG, Martinez M, Ramsay J, Jindal S, Busetto GM, Sallam H, Maldonado I, Anagnostopoulou C, Alves MG, Sengupta P, Gilany K, Evenson DP, Lewis SEM, Gosalvez J, Ambar RF, Shah R. Sperm Morphology Assessment in the Era of Intracytoplasmic Sperm Injection: Reliable Results Require Focus on Standardization, Quality Control, and Training. World J Mens Health 2022; 40:347-360. [PMID: 34169687 PMCID: PMC9253798 DOI: 10.5534/wjmh.210054] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/21/2021] [Accepted: 05/09/2021] [Indexed: 11/19/2022] Open
Abstract
Semen analysis is the first, and frequently, the only step in the evaluation of male fertility. Although the laboratory procedures are conducted according to the World Health Organization (WHO) guidelines, semen analysis and especially sperm morphology assessment is very difficult to standardize and obtain reproducible results. This is mainly due to the highly subjective nature of their evaluation. ICSI is the choice of treatment when sperm morphology is severely abnormal (teratozoospermic). Hence, the standardization of laboratory protocols for sperm morphology evaluation represents a fundamental step to ensure reliable, accurate and consistent laboratory results that avoid misdiagnoses and inadequate treatment of the infertile patient. This article aims to promote standardized laboratory procedures for an accurate evaluation of sperm morphology, including the establishment of quality control and quality assurance policies. Additionally, the clinical importance of sperm morphology results in assisted reproductive outcomes is discussed, along with the clinical management of teratozoospermic patients.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - Rakesh Sharma
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Sajal Gupta
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Neel Parekh
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Manesh Kumar Panner Selvam
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Urology, Tulane University Health Sciences Center, New Orleans, LA, USA
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
- LogixX Pharma, Theale, Reading, Berkshire, UK
| | - Damayanthi Durairajanayagam
- Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
| | | | - Sarah Madani
- Department of Biology and Physiology of Organisms, Faculty of Biological Sciences, University of Science and Technnology, Houari Boumedien, Algiers, Algeria
| | - Andrea Belo
- Huntington Centro de Medicina Reproditiva S/A, Sao Paulo, São Paulo, Brazil
| | | | | | - Sara Darbandi
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran
| | - Raha Sadeghi
- Department of Physiology, University of San Francisco, CA, USA
| | - Mahsa Darbandi
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran
| | - Paraskevi Vogiatzi
- Andromed Health & Reproduction, Fertility Diagnostics Laboratory, Maroussi, Athens, Greece
| | - Florence Boitrelle
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France
- Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
| | - Mara Simopoulou
- Department of Experimental Physiology, School of Health Sciences, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Mohamed Arafa
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Ahmad Majzoub
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | - Armand Zini
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Edmund Ko
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | | | - Marlon Martinez
- Section of Urology, University of Santo Tomas Hospital, Manila, Philippines
| | | | - Sunil Jindal
- Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India
| | - Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia Policlinico Riuniti of Foggia, Foggia, Italy
| | - Hassan Sallam
- Department of Obstetrics and Gynaecology, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | | | | | - Marco G Alves
- Department of Anatomy, Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Pallav Sengupta
- Department of Physiology, Faculty of Medicine, MAHSA University, Selangor, Malaysia
| | - Kambiz Gilany
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | | | - Sheena E M Lewis
- Queens University Belfast, Belfast, Northern Ireland, UK
- Examenlab Ltd., Weavers Court, Belfast, Northern Ireland, UK
| | - Jaime Gosalvez
- Genetic Unit, Department of Biology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rafael F Ambar
- Department of Urology, Centro Universitario em Saude do ABC/Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
| | - Rupin Shah
- Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
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Jørgensen N, Lamb DJ, Levine H, Pastuszak AW, Sigalos JT, Swan SH, Eisenberg ML. Are worldwide sperm counts declining? Fertil Steril 2021; 116:1457-1463. [PMID: 34836581 DOI: 10.1016/j.fertnstert.2021.10.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Niels Jørgensen
- University Department of Growth and Reproduction, University of Copenhagen, Copenhagen, Denmark
| | - Dolores J Lamb
- Department of Urology, Weill Cornell Medical College, New York, New York; Englander Institute for Precision Medicine, Weill Cornell Medical College, New York, New York; Center for Reproductive Genomics, Weill Cornell Medical College, New York, New York
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem, Israel
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah Health Science Center, Salt Lake City, Utah
| | - John T Sigalos
- Department of Urology, University of California Los Angeles, Los Angeles, California
| | - Shanna H Swan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael L Eisenberg
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California; Department of Urology, Stanford University School of Medicine, Stanford, California.
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Lu JC, Zhang HY, Hu YA, Huang YF, Lü NQ. A survey on the status of semen analysis in 118 laboratories in China. Asian J Androl 2009; 12:104-10. [PMID: 19234484 DOI: 10.1038/aja.2008.41] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Collecting baseline information on how laboratories perform testing is a reasonable first step towards establishing intra- and inter-laboratory standardization and quality control for semen analysis. We carried out a survey of the laboratories performing the testing in Mainland China. A questionnaire, composed of 36 questions covering all aspects of semen analysis, was designed, and a copy was distributed to each of the 145 laboratories. Of these, 118 laboratories completed the questionnaires. The survey results showed that semen volume was measured visually in 53.6% (59/110) of the responding laboratories, and 70.9% (73/103) of laboratories analysed incompletely liquefied semen without any treatment. In addition, both manual-microscopic and computer-assisted semen-analysis systems were applied to analyse sperm concentration, motility and morphology. However, more than five methods were employed in routine sperm staining. An enzyme-linked immunosorbent assay was commonly used for determining whether antisperm antibodies were present. Several seminal biochemical markers were analysed in only 27.1% (32/118) of the responding laboratories. Generally, there was a lack of intra- and inter-laboratory quality control measures for semen analysis in all laboratories responding to this survey. In conclusion, the methods of semen analysis and the interpretation of test results in the surveyed laboratories differed markedly. In particular, many laboratories employed methods other than those recommended by the World Health Organization Laboratory Manual for the Examination of Human Semen and Spermcervical Mucus Interaction (1999). These findings suggest an urgent need for the standardization of semen analysis with acceptable quality controls for each parameter to make the results repeatable and meaningful.
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Affiliation(s)
- Jin-Chun Lu
- Department of Laboratory Science, Nanjing Hospital, Jiangsu Corps, The Armed Police Force, PLA, Nanjing, China
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