Computer-aided sperm analysis (CASA) system has been accepted and used commonly as a routine semen analysis instrument in hospital clinical laboratories worldwide. However, technicians in clinical laboratories have little informed knowledge about the principles of CASA system and the sources of analysis errors. In this review, we focus on the concept of CASA, the development course of CASA technology, the clinical application of CASA systems and the factors influencing the accuracies of results, such as frame rate, sperm counting chambers affiliated to the CASA system, algorithms and sperm concentration. These factors and lack of internal quality control may result in huge errors of the CASA between systems and laboratories. It is therefore necessary to perform the standardisation and quality control for CASA.
Immunoinfertility is one of several causes of infertility in humans. Although progress on antisperm immunity and infertility has advanced during the past three decades, the nature of a real antisperm antibody (ASA) is still poorly understood. Dozens of sperm antigens have been isolated and characterized in association with infertility. However, it is difficult to identify a single predominant target antigen that could interact with all the ASAs. There are some protective mechanisms preventing ASA production in males and females. As chronic infection, vasectomy and vasovasostomy, heavy metals, and testicular cancer and torsion may induce the production of ASAs, they may be responsible for decreased motility and sperm penetration of cervical mucus, and the blockage of the acrosome reaction and the sperm-egg interaction. Many ASA assay methods have been developed, each with advantages and disadvantages. Efforts for the treatment of ASA-mediated infertility have been attempted. However, current therapy for ASA-associated infertility is almost empiric and largely unproven.
The study evaluated the comparability of two branded computer-aided sperm analysis (CASA) systems commonly used in andrology laboratories in China. The same semen sample was analysed using two branded CASA systems (WLJY-9000 and CFT-9200) by one well-trained technician. Results of semen analysis obtained from two branded CASA systems were then compared. The accuracy of counting results of CASA systems was evaluated using latex bead solutions with known concentrations of (35 ± 5) × 10⁶ ml⁻¹ and (18 ± 2.5) × 10⁶ ml⁻¹. There were significant differences in all parameters (P < 0.01) except for LIN and WOB. The counting results of CFT-9200 were close to the standard solutions [(38.86 ± 3.79) × 10⁶ ml⁻¹ and (19.03 ± 1.99) × 10⁶ ml⁻¹], while those of WLJY-9000 were underestimated [(28.53 ± 2.06) × 10⁶ ml⁻¹ and (14.62 ± 0.95) × 10⁶ ml⁻¹]. But the coefficient of variation of WLJY-9000 was lower than that of CFT-9200 (7.22%, 6.50% vs. 9.82%, 10.46%). It is concluded that factors such as parameter settings and evaluation algorithms could significantly affect the results obtained from these two branded CASA systems. Great attention should also be paid to the quality control in semen analysis with CASA.
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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