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Computer-Assisted Sperm Analysis (CASA) Versus Manual Evaluation and the Clinical Significance of Sperm
Maria Emanuela Ragosta1, Giulia Traini1, Francesca Benini2
1Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
Andrology
|April 21, 2026
Summary
Computer-assisted sperm analysis (CASA) offers objective semen analysis, with hyperactivated motility (HA) emerging as a key predictor of intracytoplasmic sperm injection (ICSI) success. This technology may enhance male infertility diagnostics and improve ICSI outcomes.
Area of Science:
- Andrology
- Reproductive Medicine
- Infertility Diagnostics
Background:
- Semen analysis is the primary male infertility test but suffers from subjectivity.
- Computer-assisted sperm analysis (CASA) aims to improve objectivity, but its clinical utility is debated.
Purpose of the Study:
- To compare manual semen assessment with a CASA system (Ceros II).
- To investigate if CASA-derived kinematic parameters, specifically hyperactivated motility (HA), predict intracytoplasmic sperm injection (ICSI) outcomes.
Main Methods:
- Manual and CASA assessments were compared using correlation analysis, regression, and Bland-Altman plots.
- Sperm kinematic parameters were analyzed for their association with ICSI success rates.
Main Results:
- CASA showed good correlation with manual assessment for sperm count and rapid progressive motility below 50 × 10⁶/mL.
- Hyperactivated motility (HA) measured by CASA was significantly higher in cycles resulting in clinical pregnancy and independently predicted pregnancy outcomes.
- CASA demonstrated good discriminative performance for predicting ICSI success.
Conclusions:
- CASA provides objective and reproducible sperm motility assessment.
- Hyperactivated motility (HA) is a clinically relevant marker for predicting ICSI outcomes.
- CASA can support routine semen analysis and identify meaningful kinematic parameters for improved infertility diagnosis.
