Rothmann offers Fertility Solutions for semen analysis

Hooked on lab tests. My father was a pediatric surgeon, and I used to go on Sunday rounds with him. From my earliest memories, I recall loving hospitals and the people who work in them. When I was in high school, Dad found me a summer job in the cytogenetics lab, and I became hooked on medical technology. A decade later, I joined the laboratory hematology staff at Cleveland Clinic, founding the Clinic's first bone-marrow transplant lab, where we processed and froze bone- marrow cells. Soon, we were freezing sperm cells, too. From there it was a very short walk to learning semen analysis and related testing. When offered the opportunity to direct this unique laboratory, I was excited about the possibilities of standardizing a poorly performed test and applying good lab practices I learned from hematology and body-fluid analysis.

Proof is in the proficiency. Fertility Solutions opened in 1992 in response to the need for commercial quality-control products after CLIA'88 designated semen analysis as high-complexity. Our goal was to make it easy to comply with the new regulation. Our first quality control products were packaged as proficiency tests. The first really big order we had, I remember looking at our production area seeing 100 boxes with our products and thinking, “Wow, we made these — the first semen-analysis proficiency-test products in the country!”

The test techs love to hate. Overcoming an attitude that semen analysis is not worthy of good quality control and good lab practices is a challenge. Too often we hear, “We know we should perform QC, but …” If blood-gas testing were performed in the sloppy way semen analysis often is, people would die. No training, archaic procedures, and the lack of robust, cost-effective, easy-to-use automation have combined to make semen analysis the test techs love to hate. Eventually, practical automation should be available for semen analysis, but, in the near term, manual microscopy is the most economical method. Lab techs are too busy to waste time on outdated, laborious methods for semen analysis. Disposable counting chambers, streamlined SOP's, decision tools for morphology — these are a few examples of how simple changes can reduce testing time while significantly improving quality.

Go back to high school. We need to get information about laboratory careers to junior and senior high school teachers and guidance teachers. Most of them do not know that careers in laboratory medicine exist. In the high school where I volunteer, most of the kids interested in science get steered toward pharmacy schools. We need to partner with schools to get students excited by our profession, using weekend workshops and internships where they can get hands-on exposure to bench testing and its importance to the practice of medicine.

There's an app for that? There is a critical need for semen-analysis training. We recognize that most labs cannot afford to send techs to training courses, so we developed self-paced programs with universally accepted P.A.C.E. accreditation for CME. We pioneered the use of virtual morphology smears for proficiency testing and training where the classification of specified sperm cells could be performed by hundreds of technologists. Our latest training programs and competency-testing modules incorporate a newly developed morphology classification algorithm, the first clear set of sequential rules for classifying sperm, available soon as both a computer decision tree and an iPad app.