Achieving competency in reading stained smears for sperm morphology in an IVF laboratory.

Abstract

Objective: To determine the length of time necessary to achieve competency in accurately evaluating sperm morphology and identifying specific aspects of morphology that are most difficult to assess and therefore require most attention during training. Design: Morphologic assessment of sperm by the technology staff undergoing training in an IVF laboratory and comparing the readings to those of an expert andrologist. Materials/Methods: Smears for sperm morphology were prepared, stained and read by the same technologist in a large IVF laboratory during a 28 day training period where 1–2 slides were read/day. Smears were prepared using fresh semen, air dried and stained. Smears were evaluated microscopically (1000×) for sperm morphology based on a 200 cell count based on strict criteria in the following categories: Head (normal oval and abnormal forms [irregular (amorphous), tapered, large, small and duplicate]), Midpiece (bent or broken neck, misalignment of head and neck and thickness), Tail (coil, blunt, duplicate) and Cytoplasmic Droplet. During early training 10 slides were read over 10 days (Group 1). At midpoint, 10 slides were read over 9 days (Group II). In late training 9 slides were read over 9 days (Group III). These slides were then reread by the same technologist and by an expert. Paired group t-test was used for test of significance. Results: In the category of head defects, readings by the same technologist across the three groups revealed the following: oval, taper and large heads showed significant differences Group I and II (p < 0.05) and no significant difference in Group 3. Small and duplicate head categories showed a significant in Group II only (p < 0.02). The irregular head category showed significant differences across all three groups (p < 0.02). However, the mean differences decrease from Group I to Group III. With respect to tail abnormalities no significant difference was noted across the three groups except for coiled defects in group II (p < 0.05) and duplicate tails in group III (p < 0.02). The difference in the detection of mid-piece defects was significant only in group I (p < 0.01). No significant difference was noted in the morphologic assessment of nine randomly selected smears (3 from each group) by an expert andrologist and those of the technologist upon completion of training. Conclusions: 1) The length of training in this study was adequate to achieve competency in morphologic assessment of sperm based on strict criteria with regards to oval, taper, small, large, and duplicate head shapes. 2) The irregular (amorphous) head shape proved most difficult to evaluate accurately and therefore requires the greatest degree of attention during training. 3) Tail and mid-piece defects were easiest to detect accurately evidenced by the short length of time required to achieve proficiency.