A new study has shown that only a small percentage of sperm banks in the UK comply with recommendations on sperm testing set by the World Health Organisation (WHO) six years ago. WHO laid down rigorous recommendations for sperm morphology assessment, the results of which can be used to predict and assess fertility problems and the probability of successful IVF treatment. The aim of the study was to assess how far the WHO recommendations have been implemented in practice. The results have generated concern that procedures used may result in misdiagnosis of fertility problems.
The researchers, from the Universities of Bristol and Sheffield, asked 53 andrology laboratories asking them to give data about practice in a number of areas, including sperm staining, classifying and sampling methods and internal and external quality control procedures. Of the laboratories surveyed, 24 were embryology/andrology laboratories that analysed sperm samples before either assessment for assisted conception procedures, or treatments. The other laboratories were in district hospitals and analysed samples solely from referrals from primary care.
Thirty-seven laboratories returned data, which were then compared with the WHO guidelines. Nearly half used unstained preparations to estimate sperm morphology (size and shape), contrary to the WHO guidelines. Staining 'fixes' sperm so that its analysis is made easier. Only two laboratories actually complied with all the WHO recommendations. Morphology of sperm is one factor that might persuade a clinician to recommend ICSI (intracytoplasmic sperm injection) - a fertility treatment in which a single sperm is injected directly into an egg, to ensure fertilisation - instead of more conventional, cheaper treatments such as IVF or GIFT (Gamete Intra-fallopian Transfer).
The researchers say that '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'. Dr Allan Pacey, senior lecturer in andrology from the University of Sheffield, said that the results could mean that 'couples could be guided towards more costly treatments such as ICSI whereas less sophisticated treatments might have been just as effective'. Kate Whittington, lecturer in reproduction and development at the University of Bristol, and lead author of the study, said the fact that so few laboratories followed the WHO guidelines was 'very disappointing'.
A spokesperson for the Human Fertilisation and Embryology Authority, which regulates laboratories in which sperm is processed, said that 'work is already underway on establishing for the first time a set of ART laboratory standards which draws together guidelines from all professional bodies'.