External Quality Control of Semen Analysis Reveals Low Compliance with WHO Guidelines

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Published in : J Reproduktionsmed Endokrinol Online
Authors : E. Nieschlag, T. Pock, B. Hellenkemper

Abstract : Semen analysis is the oldest and most commonly used surrogate parameter for male fertility. Like all other clinical laboratory tests, semen analysis should be under strict internal and external quality control. WHO has pioneered standardisation and quality control of semen analysis. The external Quality Control Program of the German Society of Andrology (QuaDeGA) is based on WHO guidelines and since 2011 participation in ring trials is compulsory for all laboratories performing semen analysis in Germany. However, many laboratories fail to follow these guidelines so that it remains unclear whether the wide scatter of results from ring trials is caused by protocol failures or is inherent to semen analysis. In order to resolve this question we performed a survey among 624 participants and received valid answers from 256 (42.5%). The answers revealed that many laboratories lack basic equipment such as mixers, vortex, positive displacement pipettes and appropriate microscopes, do not use the recommended improved Neubauer chamber for counting, use inappropriate staining methods and do not evaluate sufficient sperm. Most surprisingly, 23% of the laboratories apply no internal quality control and these have a higher failure rate than those with internal control (28 vs 8%). Laboratories performing more than 20 semen analyses per month score better than those with lower sample frequency. Strict observation of WHO guidelines and more intensive teaching and practical training of technicians appear to be the most important measures to improve results. Until better agreement of results within and between laboratories is achieved, arguing over normal reference and threshold values remains a secondary problem.