Medical Laboratory and Biomedical Science: Uncertainty in Diagnostic Semen Analysis

Wednesday, October 23, 2013

Uncertainty in Diagnostic Semen Analysis

Uncertainty in relation to laboratory testing simply means the existence of doubt or level of error associated with a particular measurement. In general, if the evidence relating any given semen parameter with pregnancy outcome is weaker or controversial then it is likely that: either the study design was not particularly robust or the testing method used to measure that particular semen parameter is subject to a higher level of uncertainty.

From published evidence we are reasonably certain that the number, motility and morphology of sperm are important for a either natural or assisted conception. The conflicting evidence surrounding parameters such as DNA fragmentation or antisperm antibodies suggests that the testing procedures to measure these are subject to a higher level of ‘uncertainty’.

Evidence demonstrating Uncertainty associated with semen analysis

Changing clinical thresholds or reference ranges over the past 25 years (WHO, 1987, 1992, 1999, 2001).
A litany of publications questioning the clinical value of semen analysis.
Considerable variation in clinical practice in relation to treatment decision making based on sperm quality.
EQA data (UKNEQAS and American Association of Bioanalysts National Proficiency testing, Keel et al 2000).
Failure to establish consensus regarding the clinical significance or indeed the reference ranges for certain tests e.g. antisperm antibodies, DNA fragmentation (Barratt et al, 2010; Tomlinson et al, 2013).
Lack of automation in semen analysis in comparison to other areas of pathology.