Semenology training programs: 8 years’ experience Daniel R. Franken, Ph.D., a Natalie Aneck-Hahn, D.Tech., b Carl Lombaard, Ph.D., c and ThinusF. Kruger, M.D. a a Department of Obstetrics and Gynaecology, Tygerberg Hospital, University of Stellenbosch, Tygerberg; b Department of Urology, Steve Biko Academic Hospital, University of Pretoria, Pretoria; and c Department of Biostatistics, South African Medical Research Council, Tygerberg, Cape Town, South Africa Objective: To evaluate the immediate effect of hands-on training on the quality of technical skills of laboratory technicians. Design: Retrospective analytical study. Setting: Academic institutions and private infertility clinics. Participants: One hundred and ten laboratory technicians. Intervention(s): None. Main Outcome Measure(s): First, 110 participants from 16 African countries attended 5-day semenology work- shops at Tygerberg Hospital. During these workshops the methodology as described by the World Health Organi- zation manual for the analysis of humansemen, namely, sperm concentration, motility, vitality, and morphology, formed part of the curriculum. Second, two experienced morphology readers from the Tygerberg group presented 23 1-day sperm morphology workshops in nine other countries. Result(s): The semenology workshops indicated a significant improvement in the evaluation of sperm concentra- tion only, whereas pretraining and posttraining results for motility did not differ. Vitality reports did not differ from those of the experienced worker in the first place. Calculation by means of a linear regression model showed a sig- nificant decrease in the mean posttraining scores from the pretraining scores for the sperm morphology courses. Conclusion(s): Training improved technical skills for the evaluation of morphology and sperm concentration. The evaluation of graded sperm motility seems to be more difficult to teach over a short period. (Fertil Steril Ò 2010;94: 2615–9. Ó2010 by American Society for Reproductive Medicine.) Key Words: Semenology, sperm, morphology, training The analysis of human semen remains, especially in developing countries, the cornerstone of male fertility investigations, and there- fore laboratory technician quality assurance should be handled with great responsibility. Although many laboratories claim to use the World Health Organization (WHO) manual for the analysis of hu- man semen as a guideline, a recent survey (1) concluded that only 5% of United Kingdom laboratories adhered to the current WHO rules for the evaluation of sperm morphology. This was also the case for staining, classification, and sampling techniques (1). These reports are possibly partly responsible for the concerns expressed that analysis of human semen has become a neglected test and should be regarded as a technique of the past (2, 3). Except for a few reports, interlaboratory comparisons between andrology laboratories are still lacking (4, 5). Reliable comparisons can be done only in cases where all laboratories use not only comparable or similar techniques but also similar standards for the evaluation of human semen, especially for sperm morphology. Despite the fact that the guidelines set for the analysis of human semen are described in detail in the WHO manual (6), our experience indicated that technicians follow self- made rules or evaluate sperm by hand-down information obtained from senior colleagues. Hands-on training sessions seem to be mandatory to ensure that the trainees understand and follow the correct guidelines set for eval- uating normal spermatozoa. We have demonstrated that, to maintain the reading skills needed to evaluate morphology, the role of hands- on training, as well as refresher courses, is vital (7). The aim of the present report is to evaluate the immediate impact of hands-on training on the morphology reading skills of individuals participating in multiple international morphology workshops; and to record the technical skills of technicians in evaluating semen pa- rameters, that is, sperm morphology, concentration, progressive mo- tility, motility, and vitality, during annual semenology workshops presented at Tygerberg Hospital. The Department of Obstetrics and Gynaecology (University of Stellenbosch) in conjunction with the WHO’s Human Reproductive Programme presented the seme- nology workshops. MATERIALS AND METHODS Semen and Slide Preparation One of the important factors during sperm morphology evaluation is the preparation and staining techniques of the slides. During the current study only precleaned frosted glass slides were used. Semen smears were made according to the WHO’s standards for slide preparation (6). The volume of semen that was used to prepare the slides depended on the sperm concentra- tion in the ejaculate. In cases with a sperm concentration of >20  10 6 cells per milliliter we used 5 mL semen, and if the concentration was <20  10 6 cells per milliliter we used 10 to 20 mL semen. The feathering method was used to prepare the smears (6). The ideal smear will provide 8 to 12 sperm cells per 1,000 magnification. If more cells are present the overlapping of cells usually causes poor morphology scores (4). All the workshop slides were stained by means of the Papanicolaou staining procedure (8). Guidelines for Identifying Normal Sperm Strict sperm morphology is based primarily on the identification of normal sperm. For a spermatozoon to be considered normal the sperm head, neck, Received December 7, 2009; revised April 14, 2010; accepted April 17, 2010; published online May 31, 2010. D.R.F. has nothing to disclose. N.A.-H. has nothing to disclose. C.L. has nothing to disclose. T.F.K. has nothing to disclose. Reprint requests: Daniel R. Franken, Ph.D., Department of Obstetrics and Gynaecology, Tygerberg Hospital, University of Stellenbosch, Tygerberg, South Africa (FAX: 27-21-933-3270; E-mail: drf@sun.ac.za). 0015-0282/$36.00 Fertility and Sterility â Vol. 94, No. 7, December 2010 2615 doi:10.1016/j.fertnstert.2010.04.048 Copyright ª2010 American Society for Reproductive Medicine, Published by Elsevier Inc.