Ten years’ experience with an external quality control program for semen analysis

Capsule:
Voluntary participation in this external quality control program improved overall performance of semen analysis. Surprisingly,

Authors:
Con Mallidis, Ph.D., Trevor G. Cooper, Ph.D., Barbara Hellenkemper, M.T.A., Martin Lablans, Ph.D., Frank Ückert, Ph.D., Eberhard Nieschlag, M.D., Ph.D.

Volume 98, Issue 3, Pages 611-616.e4, September 2012

Abstract:

Objective:
To gauge the performance of laboratories and impact of the German semen analysis external quality control program (QuaDeGA) over its first 10 years.

Design:
Retrospective analysis of QuaDeGA’s twice yearly distribution of fixed semen samples and electronic material documenting sperm motility. Ranking of each participant’s responses was determined according to their relation to a “target window.”

Setting:
Multicenter

Patients:
Healthy donors.

Intervention:
None.

Outcome Measurements:
Laboratory performance, World Health Organization (WHO) adherence

Results:
Over 19 runs, there was a steady increase of participants (280 laboratories), largest group being private urological practices. Although use of WHO recommended Neubauer chamber (33% – 55%) and diluent (11% – 32%) increased, the opposite occurred with morphology staining protocols (41% – 19%). In toto, less than 8% of laboratories truly followed WHO guidelines. Median-based comparisons, replacing reference laboratories, resulted in a merging of performance rankings regardless of the protocols employed.

Conclusions:
Adherence to WHO recommendations is low with the majority of laboratories employing methods expressly opposed by the guidelines. Participation in QuaDeGA was found to improve the performance of the laboratories involved in the program. However, the use of median based ranking while decreasing the extent of variance between laboratories brings into question the significance of the rankings.

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