ICSI/IVF treatments allocation using CASAs compared to manual semen analyses

Area of Science:

• Andrology
• Reproductive Medicine
• Medical Laboratory Science

Background:

• Manual semen analysis is crucial but labor-intensive and subjective.
• Computer-assisted sperm analysis (CASA) systems aim to improve efficiency and objectivity.
• Consistency of CASA results with manual methods, especially for male infertility diagnosis, remains unclear.

Purpose of the Study:

• To compare the consistency of three CASA systems (Hamilton-Thorne CEROS II, LensHooke X1 Pro, SQA-V Gold) with the manual semen analysis method.
• To evaluate the performance of CASA systems in diagnosing male infertility conditions like oligozoospermia, asthenozoospermia, and teratozoospermia.

Main Methods:

• A total of 326 individuals were recruited between January 2020 and October 2020.
• Manual semen analysis served as the gold standard.
• Pairwise comparisons using intraclass correlation coefficients (ICC) and kappa statistics were conducted between CASA systems and the manual method.

Main Results:

• LensHooke X1 Pro showed the best performance in sperm concentration (ICC=0.842), while CEROS II (ICC=0.723) and SQA-V Gold (ICC=0.631) had moderate agreement.
• Motility analysis showed moderate agreement with CEROS II (ICC=0.634) but poor agreement with LensHooke (ICC=0.417) and SQA-V Gold (ICC=0.451).
• Morphology analysis lacked consistency with manual results (LensHooke ICC=0.160, SQA-V Gold ICC=0.261). CASA systems tended to favor conventional IVF over ICSI, potentially skewing treatment allocation.

Conclusions:

• Current CASA systems demonstrate variable consistency with manual semen analysis, with significant discrepancies in motility and morphology.
• The manual method remains indispensable for andrology laboratories; tested CASA systems cannot replace it currently.
• Improvements in CASA algorithms, particularly for morphology, are necessary, and results should be interpreted cautiously pending further validation.