PubMed · 16236054
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G Forti. 2005. The EAA educational programme.. https://doi.org/10.1111/j.1365-2605.2005.00595.x
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Quality assurance (QA) is a fundamental part of laboratory medicine, of which internal and external QA (proficiency testing) is an important part. In a recent debate article published in Human Reproduction, it was argued that it was no longer necessary for semen analysis to be subject to QA, primarily because it is now being performed robustly and there is little evidence that it has any real clinical value. In response to this argument, it is suggested here that although there may have been some improvements in the training of laboratory scientists, recent studies have shown that the techniques of semen analysis are still poorly implemented at many locations. Moreover, as the impact of the introduction of QA into the andrology laboratory begins to take effect, there are a growing number of studies showing that the results of semen analysis do correlate well with natural conception and some assisted reproductive technologies. However, since the processes of QA are central to the principles of total quality management, which in turn underpins the process of laboratory accreditation, QA needs to remain in the andrology (and embryology) laboratory so that they can achieve the same accredited status as medical laboratories in other disciplines.
OBJECTIVE: To determine how well technicians assess progressively motile spermatozoa. DESIGN: Comparison of computerized and technician assessments of "grade a" spermatozoa. SETTING: University fertility clinic. PATIENT(S): Infertile men of barren marriages. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Threshold velocities of spermatozoa categorized as "grade a." RESULT(S): The ability of andrology technicians to distinguish "grade a" from "grade b" spermatozoa was examined monthly. Computer-aided sperm analysis (CASA) provided the threshold velocities used by technicians to categorize "grade a" spermatozoa. The mean cutoff value for grades a/b (25.5 microm/s) was close to the designated velocity, but the cutoff for grades b/c sperm (9.9 microm/s) was higher. Cutoff values for "grade a" spermatozoa were significantly, positively, and linearly related with the mean velocity of spermatozoa obtained by CASA, and deviated from it in a systematic way. The percentage of "grade a" spermatozoa judged by technicians was poorly correlated with the percentage "grade a" indicated by CASA and the cutoff velocity of "grade a" spermatozoa depending on the overall sperm quality of the semen sample. CONCLUSION(S): Consideration should be given to replacing the subdivision of progressing spermatozoa into two categories with one of progressive spermatozoa, or the use of CASA to distinguish "grade a" sperm reliably should be insisted upon.