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UK sperm banks fail to meet WHO standards

BMJ 2005; 331 doi: (Published 18 August 2005) Cite this as: BMJ 2005;331:422
  1. Roger Dobson
  1. Abergavenny

    Only two of 37 UK andrology laboratories that were surveyed comply with all the World Health Organization's recommendations for sperm testing, reports a new study. The recommendations were introduced six years ago.

    “These results illustrate an urgent need for education and training initiatives to encourage laboratories to become compliant with current WHO guidelines for sperm morphology assessment,” says the report, which was published online ahead of print publication on 29 July in Human Reproduction (doi: 10.1093/humrep/dei230).

    It says, “The lack of compliance with WHO methodology described in this report is more than just of academic interest. Each area examined by this survey, if badly implemented in the laboratory, has the potential to undermine the accuracy of sperm morphology assessment and hence result in incorrect diagnostic information being generated for the patient.”

    A number of studies have shown that sperm morphology assessment can be used to predict the outcome of in vitro fertilisation treatment and the probability of unassisted conception. But it is also one of the hardest parts of semen analysis to carry out, and the purpose of WHO's 1999 Laboratory Manual was to lay down rigorous recommendations for sperm morphology assessment.

    The aim of the new research was to see how far the recommendations have been implemented in practice to help make sperm morphology more useful as a predictor of male fertility.

    The study's authors, from the University of Bristol and the Royal Hallamshire Hospital, Sheffield, contacted 53 laboratories. Of the 53, 24 were embryology or andrology laboratories that analysed semen either before assisted conception treatments or for infertility assessment or treatment. The remainder were laboratories in district general hospitals that analysed semen solely for referrals from primary care.

    The 37 laboratories (70%) that returned completed questionnaires gave data on practice in a number of areas, including staining methods and sperm counts. The authors compared the data with the WHO guidelines. The results showed that nearly half (16) of the laboratories used unstained preparations to estimate sperm morphology, contrary to the WHO guidelines. Only two laboratories complied with all current WHO guidelines regarding morphology assessment, including methods of staining and observation, classifying and sampling methods, and participation in internal and external quality control.

    “It is very disappointing, and somewhat surprising, that more than five years after the publication of the manual, the survey described here should find that only 5% of the UK laboratories that responded to the questionnaire were compliant with all of the WHO recommendations for sperm morphology assessment,” the authors wrote.

    “These results illustrate that there remains a great need for improvements in the standardisation of methodology in the UK with regard to sperm morphology assessment.

    “Improvements in andrology training and education are urgently needed to address these issues.”

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