Sperm morphology assessment according to WHO and strict criteria: method comparison and intra-laboratory variability

Abstract

Background: Assessment of sperm morphology is one of the most important steps in the evaluation of male partner in infertile couples. However, signiAcant inter- and intra-laboratory variations can cause diEculties in interpretation, misdiagnoses, and consequently lead to confusion. Therefore, it is necessary to minimize these variations to eliminate consequential errors and ensure intra- and inter-laboratory reproducibility. Materials and methods: Semen specimens were obtained from 49 consecutive male patients attending AndrologyLab oratory for fertility evaluation. Two sperm morphology assessment criteria were compared: 1) semen smear prepared by Giemsa and assessed by World Health Organization (WHO) criteria; and 2) semen smear prepared by Spermac and assessed by strict criteria. Intra-laboratory comparison of morphological examination was also carried out. Results: The diagnosis of teratozoospermia by both WHO and strict criteria was concordant in 45 of 49 cases. Intra-rater agreement between the observers was similar for WHO and strict criteria (kappa, 0.700 vs. 0.715). Conclusions: Morphology assessment by WHO and strict criteria is concordant in diagnosing teratozoospermia and good inter-observer agreement can be achieved after proper training, mindful smear examination and complying with the classiAcation systems.