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2020 saw the year of the pandemic, unprecedented times and face masks that shaped the world as we know it.Ìý But behind closed doors was a stack of post vasectomy slides, every day the pile getting taller.Ìý The anxiety of wondering if I would ever see the bottom of the pile was growing, knowing the retirement of both my colleagues was swiftly approaching.ÌýThere had to be a way, a faster more efficient way to screen for the presence or absence of spermatozoa.Ìý As a cytologist, we all know that manual methods for semen analysis are time consuming, highly subjective and encounter significantly high error rates despite World Health Organisation (WHO) guidelines.

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Many hours of google searching later, I came across the SQA Vision.Ìý Advertised primarily for fertility testing, it promised to complete a quantitative semi-automated post vasectomy assessment within 5-minutes. Yes 5 minutes!!Ìý Was this going to be the solution to my screening problems? ÌýÌý Ìý

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Fast forward 5 years, and the promise of a result in 5 minutes did not fail to come true. Following the installation of one SQA Vision analyser, there has been no backlog on site.ÌýTypically we receive around 450 post vasectomy samples per year, with the majority of the patient’s first sample received in the post due to the vast geographical area NHS Highland covers, making our work load very unpredictable

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When a sample arrives, it is booked into our laboratory information management system (LIMS) to generate a sample ID number.Ìý All this information is then easily transferred over to the SQA Vision software.Ìý Below are the details required to begin the process, all very straightforward, assuming the patient has completed the request form!

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The WBC concentration and pH are very simple to complete with the use of pH strips.Ìý A simple change in colour, from white to purple, shows a positive WBC count.Ìý The pH is slightly more subjective but a useful colour chart is supplied.ÌýViscosity can either be normal or abnormal, in keeping with the usual subjectivity of the manualÌýassessment.

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To begin the semi-automated test, a testing capillary (below) is filled with the patient sample and then inserted into the analyser.

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Electro-optical signals from moving sperm are detected within 5 minutes.Ìý Great for detection of a failed vasectomy; however for most post vasectomy samples motile spermatozoa are generally not present. So what’s next?Ìý Here is where the semi-automated function takes place.ÌýAround 5 µl of the sample is filled into a fixed depth slide and visualised on a high-definition, touchscreen monitor as shown below.Ìý The user screens the slide from top to bottom, recording the number of motile and non-motile spermatozoa.Ìý Visualisation from left to right cannot occur on the analyser, like it would using a light microscope - one pitfall in the semi-automated test.

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What if no spermatozoa are seen?

If no spermatozoa on the raw sample are seen, the sample is centrifuged.Ìý The pellet is resuspended in a small volume of semen and the second side of the fixed depth slide is filled.Ìý The slide is visualised on the screen and any spermatozoa seen counted.

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The Report

Reports are automatically generated showing motile and non-motile sperm counts which can be interfaced with many LIMS, but at a price!

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Do you perform a daily quality control?

Daily quality control (QC) takes less than 5 minutes to complete and is performed using a known concentration of latex beads, QwikCheck.Ìý Level 1, a high concentration, level 2, a low concentration and a negative solution must all pass before patient testing can commence.Ìý All lot numbers, expiry dates and any corrective actions for failed QC’s are logged on the system.

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Is the maintenance difficult?

Cleaning and maintaining the SQA Vision is quick, simple and hassle free.Ìý A small brush is supplied for daily dusting of the optical chamber while a cleaning solution and foam brush is used for a more thorough weekly clean.Ìý All maintenance tasks are recorded on the SQA Vision, reducing the need for another form to be created.Ìý Testing cannot be started until maintenance tasks have been completed.

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Is there an EQA scheme?

Unfortunately there is not a suitable EQA scheme in the UK, however there is a simple inter-laboratory comparison (ILC) scheme for post vasectomy using Futures NHS designed for participants to assess performance externally.Ìý Every quarter, participants are sent images from positive post vasectomy semen analysis material and the number of spermatozoa seen submitted. Results are compared across participating sites and results emailed.

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Is it UKAS Accredited?

It is unlikely that we will achieve UKAS accreditation due to the complexity of meeting all the standards but we are assured through our IQC and ILC that our results are an acceptable quality standard.

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Would I recommend an SQA Vision?

Yes, for departments losing the skills in standard post vasectomy semen analysis and struggling with demand, the SQA Vision is the answer.ÌýIdentification of spermatozoa is much easier and faster than standard practices, however in terms of consumable costs more expensive.

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This article reflects the author’s experience and opinions. It is intended for informational purposes only.

The author declares no conflict of interest with the manufacturer or distributor of the SQA Vision analyser.

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Images used with kind permission from MES/AB Scientific.