South-Asia's first Hands On Workshop On Basic Semen Analysis & Intra Uterine Insemination, 2002

South Asia’s first Hands on Workshop on Basic Semen Analysis under the guidelines of the World Health Organization (WHO) was organized by the Institute of Human Reproduction (IHR) at Guwahati, India from September 23 to September 27, 2002.

The workshop was sponsored by the International Society of Andrology (ISA). The organizing secretary and chairperson of the workshop were Deepak Goenka and M.L.Goenka respectively. The chief faculty of the workshop was Daniel R. Franken from Tygerberg Hospital, South Africa who was assisted by Aneck Hahn from University of Pretoria, South Africa.

An overwhelming response was seen from all parts of India, Bangladesh, Srilanka, and Pakistan to attend the workshop. More than 70 requests were received to attend the workshop, but the participation was restricted to 16 candidates so that individualized training could be given.

The workshop began with a talk by Dr. Deepak Goenka about the recent advances in andrology and the importance of accurate semen analysis in day to day clinical practice. He stressed that semen analysis is the most important clinical laboratory test that is used in the diagnosis of male factor infertility. But it is a ‘neglected test’ because of lack of standardization. Lack of standardization in semen analysis has made it difficult for physicians to compare results among laboratories. It is, therefore, timely that laboratory personnel and physicians should be trained in semen analysis in accordance with the guidelines of the World Health Organisation (WHO).

Prof. Franken briefed the candidates about the workshop format. He introduced the candidates to the latest World Health Organisation (WHO) manual of semen analysis which was published in 1999. The candidates were explained that every day they will be trained in different aspects of semen analysis such as motility, morphology and count etc. A feedback session on the previous day’s training will be conducted the next morning and at the end of the workshop a formal examination will be conducted to determine the improvement in the candidate’s ability in assessing semen.

A pre-training assessment was conducted. Each candidate was given a set of slides to assess the morphology, motility and concentration. The results of the assessment were recorded.

Dr. Hahn talked about laboratory setup, semen collection technique, fructose estimation, pH assessment etc. In her talk she showed a beautiful pre-recorded video cassette, demonstrating how to handle semen from beginning, i.e. immediately after ejaculation, to end, i.e. reporting.

The next four days were filled with didactic lectures on sperm morphology, motility & concentration and hands on training of at least four hours a day. Prof. Franken also discussed about the pros and cons of Computer Assisted Semen Analysis (CASA) and stated that CASA is not important for routine basic semen analysis.

In one of his talks Prof. Franken pointed out the problem of large variation in semen analysis report between laboratories and insufficient training of personnel doing semen analysis. He discussed the various programs that different organizations such as World Health Organization (WHO), International Society of Andrology (ISA), European Society for Human reproduction and Embryology (ESHRE) are conducting to train laboratory personnel and physicians to improve semen analysis reports. He also reviewed the long term continuous quality assessment programs and Tygerberg Hospital’s contribution to standardization of sperm morphology parameters.

Training in intra-uterine insemination (IUI) was also providedduring the workshop. Dr Deepak Goenka talked about the various aspect of Intra Uterine Insemination (IUI) such as patient selection, indications, basic requirement for IUI. He also discussed the minimum number of sperm that should be inseminated, number of inseminations, timing of insemination, complications and success rates of IUI. He gave hands on training on sperm preparation for IUI. Under his guidance the candidates practiced various semen preparation methods such as swim up method and density gradient methods.

Dr. M.L. Goenka spoke in detail about the various ovarian stimulation protocols for Intra Uterine Insemination (IUI). He discussed the various regimens of clomiphene citrate and their pros and cons. He also reviewed the drugs that are used along with clomiphene citrate such as bromocriptine, dexamethasome, and metformin. He further explained the use of human menopausal gonodotropin (HMG), follicular stimulating hormone (FSH), gonadotropin releasing hormone-agonist (GnRH-a) for IUI.

On the last day a theory and practical examination was conducted. The candidates were shown a comparison of their performances before and after training.

Deepak Goenka, India