A prospective clinical study of the relationship between the computer-assisted assessment of human semen quality and the achievement of pregnancy in vivo.

The objective of this study was to examine the clinical predictive value for the achievement of pregnancy in vivo of the assessment of human semen quality by computer-assisted semen analysis using the Hamilton-Thorn Motility Analyser (HTM-S), alongside classic World Health Organization (WHO) techniques. A prospective follow-up study of 303 couples attending a regional infertility clinic providing tertiary level services to the population of a single geographical region was undertaken. Couples attending the infertility clinic, in whom the female partner was normal on conventional investigations (history, examination, evidence of ovulation, laparoscopy), were studied. After initial assessment, couples were followed for a median of 15 months and treatment-independent pregnancies observed and related to the results of semen assessment. During the period of follow-up, the treatment-independent pregnancy rate was 52%. Several measures of semen quality, determined both manually and by the HTM-S, were found to be predictive of the achievement of pregnancy and were related to the time taken to conceive. Couples who conceived had higher sperm concentrations and motilities, determined both manually and by the HTM-S, as well as differences in sperm head morphometry and sperm velocity determined by the HTM-S. Using multiple logistic regression, the prognostic accuracy of the HTM-S alone was similar to manual techniques, although data from the computer assisted sperm analysis system were preferred. Using proportional hazards regression, several variables were related to the achievement of pregnancy, particularly morphometry and motility. It was concluded that a strong case can be made for the introduction of automated assessment of human semen in routine service andrology laboratories.

Assessment of the conventional criteria of semen quality by computer-assisted image analysis: evaluation of the Hamilton-Thorn motility analyser in the context of a service andrology laboratory.

A comparative assessment of the conventional criteria of semen quality (sperm concentration, motility and morphology) was undertaken by standard laboratory techniques and by means of a computer-assisted image analysis system (the Hamilton-Thorn HTM-S 2030) in an open prospective study, in the context of a service andrology laboratory. A total of 1435 semen samples submitted by couples in the course of routine infertility investigations were examined by both methods, and the results compared. It was observed that the method did not provide comparable data on semen quality, either in respect of sperm concentration or graded motility, while the morphometric data generated by the HTM-S did not appear to be related to conventional morphology assessment. The clinical value of such systems in the assessment of the classical determinants of semen quality requires formal assessment in properly conducted large scale prospective studies.

Tomlinson: a social policy perspective (Part 2).

This article is the second of two which explore the Tomlinson Report and its implications from a social policy perspective using a "policy as process" model. In this article, the main points of the report and the government's response to it will be analysed with reference to areas of particular interest to nurses and nursing, that is, primary and community health services, the acute sector, nurse education, and research. The impact on nursing and health policy, both in London and the United Kingdom, will also be discussed.