Importance of papanicolaou staining for sperm morphologic analysis: comparison with an automated sperm quality analyzer.

Without experience or proper training, the evaluation of the morphologic features of sperm can become the most confusing and time-consuming area of semen analysis. This study defined the role of Papanicolaou staining compared with an automated sperm analyzer in the management of infertility. We compared the morphologic features of sperm using Papanicolaou staining and an automated Sperm Quality Analyzer IIC-P (SQA-IIC-P; Medical Electronic Systems, Caesarea, Israel) and evaluated the role of factors affecting these features in semen samples from 201 infertile men. The sensitivity of the SQA-IIC-P was 85.5%, and the specificity was 87.3% compared with Papanicolaou staining. Although the positive predictive value of this instrument was 93.7%, the negative predictive value was only 73.3%. Moreover, sperm indices that are important for in vitro fertilization could be derived only by using the manual method. A strong correlation was seen with smoking and leukocytospermia (P < .001). The SQA-IIC-P can be used as a screening tool to evaluate the morphologic features of sperm. However, Papanicolaou staining to study the cytomorphologic features of sperm and the calculation of sperm indices should be done for quantification of defects.