The validity and reliability of computer-aided semen analyzers in performing semen analysis: a systematic review

Renata Finelli, Kristian Leisegang, Samhita Tumallapalli, Ralf Henkel, Ashok Agarwal

American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA; School of Natural Medicine, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa; Case Western University, Cleveland, Ohio, USA; Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa; LogixX Pharma, Theale, Berkshire, UK

Abstract:

Background: Computer-aided sperm analyzers (CASA) are currently used worldwide for semen analysis. However, there are doubts about their reliability to fully substitute the human operator. Therefore, this study aimed to systematically review the current literature comparing results from semen evaluation by both CASA-based and manual approaches.

Methods: A systematic screening of the literature was performed based on the PRISMA guidelines and by searching on PubMed, Scopus, and Embase databases.

Results: A total of 14 studies were included. Our results showed a high degree of correlation for sperm concentration and motility when analysis was performed either manually or by using a CASA system. However, CASA results showed increased variability in low (<15 million/mL) and high (>60 million/mL) concentration specimens, while sperm motility assessment was inaccurate in samples with higher concentration or in the presence of non-sperm cells and debris. Morphology results showed the highest level of difference, due to the high amount of heterogeneity seen between the shapes of the spermatozoa either in one sample or across multiple samples from the same subject.

Conclusions: Overall, our study suggests CASA systems as a valid alternative for the evaluation of semen parameters in clinical practice, especially for sperm concentration and motility. However, further technological improvements are required before these devices can one day completely replace the human operator. Artificial intelligence-based CASA devices promise to offer higher efficiency of the analysis and improve the reliability of results.

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Translational Andrology and Urology; http://dx.doi.org/10.21037/tau-21-276
Submitted Apr 02, 2021. Accepted for publication May 27, 2021.