Manual vs. computer-assisted sperm analysis: can CASA replace manual assessment of human semen in clinical practice?

Abstract

Objectives: The aim of the study was to check the quality of computer-assisted sperm analysis (CASA) system in comparison to the reference manual method as well as standardization of the computer-assisted semen assessment. Material and methods:The study was conducted between January and June 2015 at the Andrology Laboratory of the Division of Infertility and Reproductive Endocrinology, Poznań University of Medical Sciences, Poland. The study group consisted of 230 men who gave sperm samples for the first time in our center as part of an infertility investigation. The samples underwent manual and computer-assisted assessment of concentration, motility and morphology. A total of 184 samples were examined twice: manually, according to the 2010 WHO recommendations, and with CASA, using the program settings provided by the manufacturer. Additionally, 46 samples underwent two manual analyses and two computer-assisted analyses. The p-value of p < 0.05 was considered as statistically significant.Results: Statistically significant differences were found between all of the investigated sperm parameters, except for non-progressive motility, measured with CASA and manually. In the group of patients where all analyses with each method were performed twice on the same sample we found no significant differences between both assessments of the same probe, neither in the samples analyzed manually nor with CASA, although standard deviation was higher in the CASA group. Conclusions:Our results suggest that computer-assisted sperm analysis requires further improvement for a wider application in clinical practice.

Automated semen analysis by SQA Vision®versus the manual approach-A prospective double-blind study

“…Reference values of up to 25% and 10th percentiles from 3% to 5% normomorphic spermatozoa have been shown in studies regarding fertility, in vitro fertilisation and in vivo fertility and for fertile male populations (Haugen, Egeland, & Magnus, ). Other studies reported 8% to 9% morphologically normal spermatozoa in healthy subjects (Paasch et al, ) and 4.8% and 3% in ejaculate samples of patients attending a fertility clinic (Henkel et al, ; Talarczyk‐Desole et al, ) after Papanicolaou staining.…”

A Novel Approach to Improving the Reliability of Manual Semen Analysis: A Paradigm Shift in the Workup of Infertile Men

“…Although much progress has been made, CASA results are still subject to high inter-observer variability due to a lack of frequent and uniform standardization of CASA techniques, CASA's requirement for precise recalibration (suggested at 6-month intervals), and the need to consistently retrain laboratory staff when software updates are implemented. Additionally, variations in technician proficiency in other laboratory techniques (e.g., pipetting, loading the counting chamber) can contribute to variations in CASA results [15,43]. Although SA performed by a technician highly trained in the use of CASA has shown improved precision over manual methods [44], proper operation of this technology requires constant supervision and calibration, which is costly and inefficient [12].…”

“…Chemiluminescence, which measures light emitted by a reaction between chemical reagents and ROS in the sample, is widely used in the evaluation of seminal ROS, but has several limitations. First, chemiluminescence cannot measure ROS in frozen samples [15]. Second, due to the 800 µL sample requirement to run the test, patients with low semen volume cannot be evaluated.…”

“…Although several technological advances have been made to conventional SA techniques, such as computerassisted sperm analysis (CASA), these novel developments have significant limitations, including highly variable results, the necessity of frequent recalibration, and costly investment in equipment and training with only marginal improvements in accuracy over manual SA [12][13][14][15]. In addition to these technological advances, sophisticated sperm function tests have been conceived that evaluate parameters, such as sperm DNA fragmentation (SDF), capacitation, acrosome reaction, and the presence of reactive oxygen species (ROS) [16,17].…”

CASA: tracking the past and plotting the future

“…However, this sceptical voice is not constrained to issues of count. A recent study by Talarczyk-Desole et al (2017) suggests that although there are positives to using CASA, the time CASA-Morph takes to perform a sperm morphology assessment, as well as the differences shown between CASA-Mot results and trained laboratory staff, mean that there are still improvements needed before CASA is routinely used in clinical practice.…”