Thursday, February 6, 2014

 

BACKGROUND:
The SQA-V technology for assessing sperm concentration is based on the principle of spectrophotometry coupled with software filters that eliminate ‘background’ factors that can influence the SQA-V results.

 

OVERVEIW:
It is well known that a semen ejaculate contains cells other than spermatozoa (1). These include epithelial cells from the genitourinary tract, as well as leukocytes (WBC) and immature germ cells (2). The presence of these non-sperm cells in semen may be indicative of testicular damage (immature germ cells), pathology of the efferent ducts (ciliary tufts) or inflammation of the accessory glands (leukocytes) (1).

These non-sperm cells or along with seminal plasma are all considered ‘background’ factors that interfere with the accurate assessment of sperm concentration using spectrophotometry technology. When the SQA-V assesses sperm concentration, the ‘background’ is subtracted by the software in order to eliminate its impact on the final and accurate assessment of sperm concentration. The normal SQA algorithm compensates for ‘normal’ levels of ‘background’ which are seen in most semen, however, abnormal levels of ‘background’ require a different algorithm that compensates for this. Hence, the operator is asked to assess for abnormal levels of WBC (the most contributing background factor) and select ≥ 1 M/ml in order to activate the appropriate algorithm required to measure the sample’s concentration.

The normal value for semen WBC is < 1 M/ml. In cases of inflammation, the leukocyte level is ≥ 1 M/ml and the semen will also contain seminal plasma compounds associated with inflammation. This increases the level of ‘background’ to subtract from the algorithm. This is why it is important to test if WBC’s are NORMAL or ABNORMAL and to select the proper input on the PATIENT DATA ENTRY SCREEN in order to activate the appropriate algorithm for sample testing.

 

INSTRUCTIONS:
WBC levels in semen can be tested using one of the following procedures:
• Using QwikCheck™Test Strips - recommended (please refer to the SQA-V User Guide Version 2.60 I-Button, Appendix 7: Measuring WBC's in Semen).
• Using the SQA-V visualization screen or the V-Sperm and visually/manually assessing the sample for WBC’s (please refer to the SQA-V User Guide Version 2.60 I-Button, Appendix 4: Counting Cells using the SQA-V Visualization System and Appendix 7: Measuring WBC's in Semen).

 

MANUFACTURER’S RECOMMENDATION:
WBC assessment should be conducted on FRESH and WASHED semen samples and the results entered in the SQA-V PATIENT/SAMPLE DATA ENTRY screen PRIOR to running automated semen analysis on the SQA-V and before any sample treatment with chymotrypsin or any other agent (enrichment, washing, dilution, etc.).

 

REFERENCES:
1. WHO laboratory manual for the examination and processing of human semen - 5th ed., World Health Organization 2010.
2. Johanisson E et al. (2000). Evaluation of “round cells” in semen analysis: a comparative study. Human Reproduction Update, 6:404-412.

 

Dr. Lev Rabinovitch, CTO MEDICAL ELECTRONIC SYSTEMS
Distribution: All SQA Users

 

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Thursday, January 22, 2014

BACKGROUND:
QwikCheck™ Test Strips are used to determine the pH and leukocyte level (WBCs) in semen based on comparing the color of the test strip pads to the color chart provided on the bottle label. They are for in vitro diagnostic use only.

OVERVEIW:

- pH: Normal values for semen pH are generally ≥ 7.2; the pH pad reports a range of 5.0 to 8.5. 

- Leukocyte Level: Normal values for semen Leukocytes are < 1 M/ml; the Leulocyte pad reports semi-quantitative results: NEG is <1M/mL and POSITIVE is ≥1 M/mL. If the Leulocyte pad color is equal to or exceeds the darkest lavender color of the chart within 60 seconds, the result is ≥1 M/mL, otherwise it is <1M/mL.

INSTRUCTIONS:
Please see the package insert for complete testing instruction details.

MANUFACTURER’S RECOMMENDATION:
Test results can be impacted by drugs or other chemical use. QwikCheck™Test Strip pHand WBC testing should be conducted PRIOR to any sample treatment with chymotrypsin or in any other way (enrichment, washing, dilution, etc.).

 

DOWNLOAD A COPY OF THIS TECHNICAL BULLETIN HERE

 

SEE ALL TECHNICAL BULLETINS HERE

Lev Rabinovitch, CTO MEDICAL ELECTRONIC SYSTEMS
Distribution: All SQA Users

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BACKGROUND:

 

The WHO 5th edition manual provides recommendations for testing post-vasectomy semen samples.

 

OVERVIEW:

Per the WHO 5th edition manual, it is not recommended to centrifuge the post-vasectomy sample if the technician is searching for motile spermatozoa, as centrifugation impacts sperm motility. If no spermatozoa are found in the ejaculate it is recommended to re-assess the sample after centrifuging and re-suspending the pellet in a small volume of seminal plasma.

 

INSTRUCTIONS:

 

Fast scan:
o Prepare a standard slide per the user guide instructions (10 μl liquefied ejaculate, 22mmx22mm coverslip). Search for spermatozoa using the SQA-V visualization system, set at “Zoom Out”.

If 1-2 MOTILE spermatozoa are found in each field of view:
o Run the sample in the SQA-V Post-vasectomy mode.

If >=2 MOTILE spermatozoa are found in each field of view:
o Run the sample in the SQA-V FRESH mode.

If only IMMOTILE spermatozoa are found:
o Count the sperm cells manually using the SQA-V visualization system set at Zoom Out. Count in duplicate using the same slide. Compute the total number of sperm divided by the number of assessed fields of view. This will roughly represent the sperm concentration in millions per ml.

If NO spermatozoa are found:
o Centrifuge the semen sample at 3000g for 15 minutes.
o Decant most of the supernatant.
o Re-suspend the sperm pellet in approximately 50μl of seminal plasma.
o Test the sample manually in duplicate using a standard slide (please see above).
o The presence of spermatozoa indicates cryptozoospermia; the absence of spermatozoa indicates azoospermia.
o This method cannot be used to determine sperm concentration or total sperm number. 

 

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Please reference the the following comparison table of WHO 4th and 5th Morphology criteria and Dr. Menkveld's (the author of publications used by the WHO) presentation at ESHRE SIG-Andrology Campus Meeting, 2009. 

 

Comparison of WHO 4th and 5th Morphology Criteria

 

The New 5th WHO Manual Semen Parameter Reference Values - Menkveld

 

Based on this comparison and Dr. Menkveld’s presentation, the following conclusions can be drawn:

 

• In the Dr. Menkveld presentation, no WHO 5th vs. WHO 4th Morphology criteria differences are mentioned, only a lower reference limit. Strict criteria is used for morphology assessment and grading in both manuals.

 

• The concept of normal spermatozoon by WHO 4th and 5th manuals are the same.

 

• Most of WHO 4th and 5th Morphology criteria are the same.

 

• There are the slight but not significant differences in some dimensional details that were updated in the WHO 5th manual.

 

• The WHO 4th manual Morphology reference value was not final and was updated in the WHO 5th edition.
The overall conclusion is that the WHO 4th and 5th Morphology criteria are similar, as they are based on the same strict principles, similar guidelines and reference publications. As the WHO 4th and 5th criteria are similar, we did not conduct any additional study for the WHO 5th morphology algorithm and stayed with the same developed for the WHO 4th. Only the reference value was changed in the V-Sperm.

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TECHNICAL BULLETIN: VISCOUS AND NON-LIQUEFIED SAMPLES TREATMENT WITH CHYMOTRYPSIN

BACKGROUND:

A semen sample that presents with delayed liquefaction or high viscosity should be reported during the testing process. These are abnormal parameters and are clinically significant because they may indicate a male accessory gland malfunction (Please see two abstracts below). Nevertheless, delayed liquefaction does not necessarily indicate infertility. A post-coital test (PCT) can answer this question (Please see below). There is no direct evidence that the female tract contains enzymes that promote semen liquefaction, but in some cases, motile sperm in non-liquefied specimens can be found when examining cervical mucus after sexual intercourse (Please see below).

OVERVIEW: LIQUEFACTION

What Is It? When semen is ejaculated, it is thick and gelatinous. This is to help it adhere to the cervix. The semen eventually liquefies to enable the sperm to swim better.

What Is Considered Normal? Semen should liquefy within 20 to 30 minutes of ejaculation.

What Might Be Wrong if Results Are Abnormal? Delayed liquefaction may indicate a problem with the prostate, the seminal vesicles, or the bulbourethral glands, which are also known as the male accessory glands. If delayed liquefaction occurs, your doctor may perform a post-coital test (PCT). This fertility test evaluates the woman's cervical mucus after sexual intercourse. If sperm are found and moving normally, then delayed liquefaction is not considered a problem.

SPERM TRANSPORT

The transport of sperm is dependent upon several factors. The sperm must be capable of propelling themselves through the environment of the female vagina and cervix. This environment, which is under cyclic hormonal control, must be favorable to admit the sperm without destroying them. Finally, the sperm must possess the capability of converting to a form that can penetrate the cell membrane of the egg (capacitation).

Following ejaculation, the semen forms a gel which provides protection for the sperm from the acidic environment of the vagina. The gel is liquefied within 20-30 minutes by enzymes from the prostate gland. This liquefaction is important to free the sperm so transportation may occur. The seminal plasma is left in the vagina. The protected sperm with the greatest motility travel through the layers of cervical mucus that guard the entrance to the uterus. During ovulation, this barrier becomes thinner and changes its acidity creating a friendlier environment for the sperm. The cervical mucus acts as a reservoir for extended sperm survival. Once the sperm have entered the uterus, contractions propel the sperm upward into the fallopian tubes. The first sperm enter the tubes minutes after ejaculation. The first sperm, however, are likely not the fertilizing sperm. Motile sperm can survive in the female reproductive tract for up to 5 days. http://coe.ucsf.edu/ivf/conception.html.

 

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TECHNICAL BULLETIN: USING QWIKCHECK TEST STRIPS
Thursday, October 31, 2013

BACKGROUND:
QwikCheck™ Test Strips are for in vitro diagnostic use for the determination of pH and
leukocytes (WBCs) in semen. Test results are determined by comparing the color of the
test patches to the color chart provided on the bottle label.

OVERVEIW:
Normal values for semen pH are generally ≥ 7.2; the pH pad reports a range of 5.0 to
8.5. Normal values for semen Leukocytes are < 1 M/ml; the Leulocyte pad reports semiquantitative results: NEG is <1M/mL and POSITIVE is ≥1 M/mL.

INSTRUCTIONS:
Follow the instructions provided in the package insert for testing and for determining the
results. Because test results can be impacted by drugs or other chemical use, run the pH
and WBC tests on untreated semen and PRIOR to any sample treatment (Chymotrypsin,
enrichment) or dilution (washing, dilution, etc.).

MANUFACTURER’S RECOMMENDATION:
Test the sample PRIOR to any sample treatments or dilutions (chymotrypsin,
enrichment, washing, etc.) as test results may be impacted due to erroneous color
changes.

 

DOWNLOAD THE TECHNICAL BULLETIN HERE

 

Lev Rabinovitch, CTO MEDICAL ELECTRONIC SYSTEMS
Distribution: All SQA Users

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Re-Issue date/Distribution: Tuesday, October 22nd, 2013/ALL SQA-V Users

Subject: It is recommended that twice per year, the SQA-V Gold calibration be checked against the original factory calibration parameters. Although there are acceptable calibration ranges for the SQA-V, the system parameters may be close to the high or low end of the range and proactive maintenance will ensure continued uninterrupted use and optimal clinical performance from the instrument. This is a free service to all SQA-V users.

CALIBRATION CONFIRMATION INSTRUCTIONS

Twice per year, MES recommends sending us the “Service Data Report” from your SQA-V Gold for a calibration confirmation. To print your Service Data Report and return it to MES, please follow these instructions:

• NOTE: The SQA-V internal printer will need to be loaded with paper and printer ribbon. Please see user guide for paper and ribbon loading instructions.

• Navigate to the “Service” menu, once in the “Service” menu select “Print Default Settings” and click “Print Self-Test Data”.

• Tape this report to a piece of blank white paper and fax the report to MES @ 310-670-9069 or scan/e-mail it to service@mes-llc.com. Please include an e-mail address and your contact information with the Self-Test report for follow-up.

• Your SQA-V calibration parameters will be compared to the initial calibration parameters from when the instrument was manufactured and presented back to you in report format.

 

THESE INSTRUCTIONS MAY BE DOWNLOADED HERE

Also, please remember to check the Technical Bulletins section of the website often for updates HERE.

 

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BACKGROUND:

Room temperature is a general term describing common indoor temperatures. It is usually in the range of 20 °C (68 °F or 293 K) to 25 °C (77 °F or 298 K)*

*http://en.wikipedia.org/wiki/Room_temperature

 

OVERVEIW:

The WHO 5th edition manual recommends assessing sperm motility at either room temperature or at 37 °C (with a heated microscope stage). “These conditions should be standardized for each laboratory” (WHO 5th edition manual, p. 22).

 

INSTRUCTIONS:

The SQA-V GOLD is calibrated and room temperature and has been developed to operate at room temperature conditions, so there is no heating stage on the device. When performing a validation of the SQA-V based on comparing the test results to manual results, the manual results should be performed at room temperature as well.

 

MANUFACTURER’S RECOMMENDATION:

Clinical laboratories are air conditioned facilities. It is therefore recommended to maintain the room temperature of the lab in the range of 20 °C (68 °F or 293 K) to 25 °C (77 °F or 298 K).

 

DOWNLOAD THE TECHNICAL BULLETIN HERE

Lev Rabinovitch, CTO MEDICAL ELECTRONIC SYSTEMS
Distribution: All SQA Users


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