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107. How strict should specimen acceptance or rejection criteria be for diagnostic semen analysis? [Forum/Discussion]
from: Administrator (office@fertaid.com), Australia on 21/10/2014 10:01:57 PM Profession:
Comment: An opinion paper discussing the need for tolerance in rejecting a semen sample for collection violations where the analysis is normal is a timely reminder to Andrology workers.
Submission: In this article Woodward and Tomlinson explore the various reason why samples may be rejected including patient identification, sexual abstinence, Completeness of a sample, collection interval and transport temperature, medication and container. In essence they argue that with the exception of post vasectomy samples and patient identification, if the sample is normal then there needs to be a pragmatic view to reject a sample if say the sample is incomplete or the duration or transport temperature is outside a laboratory guidelines. Since these and other factors may act to diminish the quality of a sample, a normal sample clearly means that these outliers had little or no impact on the quality of the sample or that if there was an effect, the sample can only have been better than reported but it would still have normal. They argue that there are no external influences that can improve the quality of a semen sample so that rejection of a normal sample can only causes the client inappropriate actions and that a sensible compromise is suggested that the samples are not rejected (but the report should contain a comment that the sample breached lab guidelines for acceptance of a sample but was accepted post analysis showing it be normal).
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108. Accreditation needs.
Response to Contribution #107
from: DrJamesStangerPhD (office@fertaid.com), Australia on 21/10/2014 10:23:59 PM Profession:
Comment: The authors appear to have written the opinion piece in response to accreditation guidelines pressures to follow WHO or other standards in accepting or rejecting samples.
Submission: They note that the standards such as WHO are intended to provide framework for andrology staff to develop working rules for processing semen samples and that if a sample does not pass any one of a number of conditions, then the sample should be rejected possibly without even processing it. An example may be if the sample was incomplete. Strict adherence to the WHO manual to meet accreditation assessments may mean that if the sample was normal then in all probability, the sample if complete would have been even more normal (if that makes sense). They cite another example where the container may not be approved containers. Clearly, if the motility was very poor then one cannot rule out toxicity and the sample should be rejected. But if the samples motility was fine then clearly there was little or no toxicity.
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109. Sample acceptance/rejection - policy manual
Response to Contribution #107
from: DrJamesStangerPhD (office@fertaid.com), Australia on 21/10/2014 10:31:31 PM Profession:
Comment: Ultimately, what is in the policy manual largely governs how a laboratory operates. Under the section of sample rejection, perhaps clinics may like to note this paper for normal outliers.
Submission: Accreditation surveyors could be referred to the clinics policy manual where the conditions for accepting/rejecting a sample that falls outside preset limits can be defined. Clinics could quote this paper and use it as a vehicle to process samples that appear to lie within the normal range for all parameters but fail a sample presentation test.
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