Afterword to Semen Analysis in 21st Century Medicine special issue in Asian Journal of Andrology

Abstract

We summarise and comment on the topics discussed by the contributors to this Special Issue. As an introduction, Ann Jequier's [1] generally positive assessment of the new-look manual was tempered with her reservations about reference values, on which other chapters dwelt at length. Aspects of laboratory technique were discussed by Charlene Brazil [2], whose offering gives a rare insight into the actual workings of andrology laboratories and highlights the need for greater involvement of laboratory directors (often clinicians) in assessing the quality of data provided. Experience with the German external quality control programme for semen analysis confirms that some laboratories treat the quality control (QC) samples differently (using a Neubauer chamber, for instance) from routine samples (a Makler chamber) so that the exercise may be undermined and fail to provide proper control of the lab's quality of work. It is one thing to have QC accepted in principle but the essential job of "policing" semen analysis QC falls in no-one's court. Allan Pacey's [3] contribution supports wholeheartedly quality assurance (QA) in andrology but also zeros in on a potential quantitative problem in the precision of normal sperm morphology assessment, when such values are low.Rune Eliasson's [4] characteristically blunt contribution lambasts the whole process of scientific consensus, the mainstay of world health organization (WHO) committees' recommendations. He considers that the perspective of the handbook are too narrow; its recommendations on assessing sperm morphology are inadequate; there to be insufficient emphasis on interpretation of results (cumulative importance of laboratory findings, interpretation of reference limits) or on manipulation of data (e.g. dividing total sperm numbers by days of abstinence and the testicular volume) and finds no mention of how to measure testicular volume. He laces this with invective against the lack of scientific method of those working in ART and reserves particular venom for the morphology method espoused in WHO3 [5] and WHO4 [6] that is given even more prominence in WHO5 [7].Once our hackles are down again, though, his view contain some prickly wisdom. First, if only normal forms are examined, the analysis could provide little indication of testicular dysfunction (other than the reduced output of normal forms) that may be indicated by production of particular abnormal forms. Second, as the normative reference values are so low, it can provide little scope for diagnosis, making it a meaningless end-point.Eliasson's [4] suggestion is that different criteria for categorising spermatozoa as morphologically normal (borderline forms considered normal, as in earlier editions of the WHO manual) should be implemented. These should provide higher percentages of normal forms and thus increase the possibility of distinguishing men with lower perentages of such forms. Thus far more workable and informative reference limits around 40%-60% would be provided by using less restrictive assessment. Howe...

Another look at human sperm morphology

“…borderline aspects to be abnormal. The marked difference between these two values could correspond primarily to the inclusion or exclusion of the borderline aspects in the normal sperm categorization (Eliasson, 2010;Handelsman and Cooper, 2010). The use of a set of criteria for borderline aspects (Rothmann et al, 2013) could be useful in answering the question of whether the borderline aspects per se matter or not.…”

Semen analysis and sperm function testing

“…The decision to reject categorizing progressive spermatozoa into fast and slow in the WHO 2010 manual was also based on the inability of technicians to gauge velocities accurately and the manual suggests that if velocities need to be known, a computer assisted sperm analyser system should be employed. 19 The wet preparation The wet preparation, i.e., a preparation made with undiluted semen from a specific semen volume and cover slip area, forms an important part of the semen analysis. The wet preparation is used to determine the dilution of semen required to allow accurate measurement of the sperm concentration.…”