Comparative Assessment of Manual Versus Automated Semen Analysis and the Role of Novel Biomarker Calprotectin in Screening for Male Factor Infertility.

Background & Objective: Although manual semen analysis (MSA) is cost-effective and widely used, it is prone to subjectivity and operator variability, prompting the need for standardized, automated systems such as computer-assisted semen analysis (CASA). This study was conducted to compare semen parameters using manual and automated methods and assess the relationship between calprotectin levels and semen quality. Methods: This prospective cross-sectional study was conducted over a period of 1 year. A total of 200 semen samples from male partners of infertile couples were evaluated by manual as well as automated methods (MES SQA Vision). Calprotectin in seminal plasma was estimated by ELISA. Pearson correlation was used to assess associations, and paired t test was used to compare measurements. Agreement and systematic bias were evaluated using a Bland-Altman plot. Results: A strong correlation was observed between MSA and CASA for total sperm count (r = 0.950), concentration (r = 0.954), motility parameters (rapidly and slowly progressive motility) (r = 0.753 and 0.673), and vitality (r = 0.854), while nonprogressive motility showed a moderate correlation (r = 0.437). Smoking showed weak negative correlations with sperm count (r = -0.0073), concentration (r = -0.01), and motility, and a weak positive correlation with abnormal morphology. Alcohol showed weak positive correlations with count and concentration, but weak negative effects on motility and morphology. Semen calprotectin showed weak negative correlations with sperm count (r = -0.04052), concentration (r = -0.03939), motility (r = -0.16466), and morphology (r = -0.09623) and a weak positive correlation with vitality (r = 0.06115). Conclusion: The computer-assisted sperm analysis (CASA) system represents a significant advancement in reproductive diagnostics by offering precise, objective, and reproducible assessment of key semen parameters, showing agreement with MSA for most of the parameters. Further studies with larger sample sizes are required to clarify the diagnostic significance of calprotectin, an inflammation-related biomarker in seminal plasma.