Quality control, quality assurance, and proficiency testing in the andrology laboratory

Evaluation of sperm counting accuracy on computer-assisted sperm analysis with GoldCyto® slides and glass slides

Worldwide, various counting chambers and computer-assisted sperm analysis (CASA) devices are in use. The semen's concentration can vary depending on the depth of the counting chamber and how it is loaded. The study's objectives were to analyze the effects of various counting chambers on semen concentration results using a GoldCyto® slide and a glass slide in the CASA system and to ascertain the precision of concentration measurements made using glass slides on CASA. The study's control group was composed of samples with known concentrations (72-80 million sperm/mL) as determined by a spectrophotometer. A total of 21 frozen straws from the same bull of the same date were thawed at 37°C for 30 s and loaded into two different sperm-counting chambers (GoldCyto® slide and glass slide). The sample semen placed in the sperm counting chambers was 5 μL and the same value was entered in the CASA software as 5 μL. Measurements were done and evaluated in 5 different areas. According to the data we obtained, using the glass slide were statistically lower than the spectrophotometer (p < 0.001). GoldCyto® slide results were consistent with spectrophotometer results. Consequently, measurements with GoldCyto® slides in the CASA had consistent results, while measurements with glass slides were inconsistent. It was concluded that GoldCyto® slides are more suitable than glass slides in the concentration examinations of semen. Therefore, more study is needed to optimize the use of glass slides.

Sperm Morphology Assessment in the Era of Intracytoplasmic Sperm Injection: Reliable Results Require Focus on Standardization, Quality Control, and Training

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.

Semen analysis standardization: is there any problem in Polish laboratories?

The aim of the study was to determine the degree of compliance of Polish laboratories with World Health Organization (WHO) recommendations, with regard to semen analysis methodology. A survey requesting information about methods of semen analysis was distributed to employees of 55 laboratories. Respondents who had participated in external seminological workshops (31%) were termed certified respondents (CR), the remaining (69%)-non-certified respondents (NCR). Only one laboratory (6%) in the CR group and none in the NCR were compliant with WHO guidelines for methods and equipment used to evaluate seminal volume, sperm motility, concentration, vitality and morphology. Most problems were of volume measurement (weighing method was reported by 17% of CR and 10% of NCR) and staining method for sperm morphology (Papanicolau or Diff-Quik were found in 33% of CR and 23% of NCR). A three- or four-point grading of sperm motility was used by the majority of respondents; however, 17% of CR and 37% of NCR did not use a laboratory counter to tally spermatozoa. Although a haemocytometer method was used by 80% of laboratories in each group, the improved Neubauer chamber was used only by 42% of CR and 19% of NCR. In each group, 24% of laboratories did not perform a vitality test. Procedural errors and the interchangeable utilization of two or even three methods to analyse a given parameter was observed in both groups. The results indicate a need for standardisation of the methods and continuous, unified training in semen analysis in Polish laboratories.

Ten years' experience with an external quality control program for semen analysis

OBJECTIVE

To gauge the performance of laboratories and impact of the German semen analysis external quality control program (QuaDeGA) over its first 10 years.

DESIGN

Retrospective analysis of QuaDeGA's twice yearly distribution of fixed semen samples and electronic material documenting sperm motility. Ranking of each participant's responses was determined according to their relation to a "target window."

SETTING

Multicenter. PAITENT(S): Healthy donors.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Laboratory performance, World Health Organization (WHO) adherence.

RESULT(S)

Over 19 runs, there was a steady increase of participants (280 laboratories), the largest group being private urologic practices. Although use of WHO-recommended Neubauer chamber (from 33% to 55%) and diluent (from 11% to 32%) increased, the opposite occurred with morphology staining protocols (from 41% to 19%). Overall, <8% of laboratories truly followed WHO guidelines. Median-based comparisons, replacing reference laboratories, resulted in a merging of performance rankings regardless of the protocols used.

CONCLUSION(S)

Adherence to WHO recommendations is low, with the majority of laboratories using methods expressly opposed by the guidelines. Participation in QuaDeGA was found to improve the performance of the laboratories involved in the program. However, the use of median-based ranking, while decreasing the extent of variance between laboratories, brings into question the significance of the rankings.

A survey on the status of semen analysis in 118 laboratories in China

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.

Preliminary investigations on the standardisation and quality control for the determination of ?-glutamyltranspeptidase activity in seminal plasma

The present study was designed to assess the effects of centrifugation velocity, standing time after dilution, freezing-thawing and chymotrypsin on the determination of gamma-glutamyltranspeptidase (gamma-GT) activities in seminal plasma, and to establish an instruction for the standardisation and quality control for the determination of gamma-GT within the same laboratory and among different laboratories. The gamma-GT level and sperm concentration of each of 72 samples of seminal plasma obtained by centrifugation at 1000 g for 10 min or 3000 g for 15 min were assayed. In addition, gamma-GT activities in diluted seminal plasma with different standing time and in samples with or without chymotrypsin were measured. The results showed that there was a significant difference of gamma-GT levels in seminal plasma obtained by centrifugation at different velocities (P < 0.001), and that gamma-GT activities in seminal plasma measured after standing for 30 min after dilution were notably lower than those measured immediately after dilution (P < 0.001). However, the data indicated that both chymotrypsin and freezing-thawing had no apparent effect on the determination of seminal gamma-GT. In conclusion, standing time after dilution and centrifugation velocity should be standardised, and frozen seminal plasma could serve as quality control products for the determination of gamma-GT activity among different laboratories.

Preliminary investigations on the standardization and quality control for the determination of acid phosphatase activity in seminal plasma

BACKGROUND

The determination of ACP in seminal plasma was considered as an appropriate biochemical marker to evaluate prostate function, as recommended by the WHO manual. However, few reports on the standardization and quality control for the determination of biochemical markers in seminal plasma have been documented.

METHODS

Two frozen samples of seminal plasma with or without phenylmethylsulfonyl fluoride were determined for their acid phosphatase (ACP) levels. The ACP level and sperm concentration of each of 72 samples of seminal plasma obtained at 1000xg for 10 min or 3000xg for 15 min centrifugation were assayed. ACP activity in 10 samples of seminal plasma was measured immediately or standing for 30 min after dilution. The ACP levels in seminal plasma with or without chymotrypsin were also assayed.

RESULTS

There was no significant difference of ACP levels (P=0.166) but of sperm concentrations (P=0.000) in seminal plasma obtained by centrifugation at different velocity. ACP activities in seminal plasma measured when standing for 30 min after dilution were significantly lower than those measured immediately after dilution (P=0.001). Both chymotrypsin and freezing-thawing had no apparent effect on the determination of ACP in seminal plasma.

CONCLUSION

The results indicated that standing time after dilution and centrifugation velocity should be standardized, and frozen seminal plasma could serve as the quality control products for the determination of ACP activity among different laboratories.

Standardization and quality control for the determination of alpha-glucosidase in seminal plasma

We attempted to provide an instruction for the standardization of alpha-glucosidase level determination and quality controls within the same laboratory and among different laboratories. Each of 51 semen samples was divided into two aliquots, centrifuging at 1000 g for 10 min or 3000 g for 15 min. The alpha-glucosidase level and sperm concentration of each sample were assayed. The alpha-glucosidase level in seminal plasma obtained at 3000 g for 15 min centrifugation was significantly lower than that at 1000 g for 10 min (p = 0.001). An additional 6 samples of seminal plasma with or without phenylmethylsulfonyl fluoride (PMSF), obtained at 3000 g for 15 min centrifugation, were frozen for 20 days, and each of 6 samples was determined for their alpha-glucosidase levels after thawing every other day. There was no significant difference between alpha-glucosidase levels in seminal plasma regardless of the presence of PMSF. The alpha-glucosidase level increased with the length of abstinence period. In conclusion, centrifugal velocity and abstinence time should be standardized in the alpha-glucosidase determination. Frozen seminal plasma may serve as the sample for quality control among clinical laboratories.

High percentage of abnormal semen parameters in a prevasectomy population

OBJECTIVE

To evaluate semen characteristics, testicular volume, and hormonal levels of normal fertile men requiring vasectomy for sterilization.

DESIGN

Retrospective study.

SETTING(S)

Academic medical centers.

PATIENT(S)

A total of 889 patients underwent a vasectomy for sterilization.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Semen volume, sperm concentration, motility, and morphology according to the World Health Organization (WHO); complex motion parameters evaluated by computer-assisted semen analyzer; FSH, LH, and T levels; and both testicular volumes.

RESULT(S)

When compared with the WHO values, 87.2% of the patients presented normal sperm morphology below the normal level. The other semen parameters (semen volume, pH, sperm concentration, and sperm motility) differed from the WHO parameters in 6%-32.2% of patients. Semen volume and sperm concentration presented a progressive increase according to the duration of sexual abstinence. However, patients with 5 days or more of abstinence had a decrease in sperm motility. Mean testicular size had the strongest correlation with serum FSH levels, total sperm count, and sperm concentration.

CONCLUSION(S)

Low sperm motility and morphology were found in men who request a vasectomy for sterilization. Semen volume and sperm concentration present a progressive increase and sperm motility a decrease according to the duration of sexual abstinence. Sperm concentration had stronger correlations with testicular size than did sperm quality. Therefore, the WHO normal values need to be reconsidered.

How reliable are results from the semen analysis?

Based on the results of a number of studies that have evaluated the reliability of semen analysis testing, it would appear that there is a significant lack of standardization in the performance and reporting of semen analyses among laboratories. A large degree of variation and disagreement exists among different laboratories performing this test, and quality control procedures are not routinely performed in a majority of these laboratories. These observations significantly impact physicians who have to interpret and compare results among laboratories, who receive patients and test results referred from other clinics, or who have to rely on reference or other unknown laboratories for semen analysis testing.