ABB Andrology common mistakes
ABB Andrology · Understand the traps and how to avoid them.
Reporting sperm concentration from a single chamber count without confirming the replicate count or checking the two counts against the acceptable difference, and reporting the first value obtained.
Candidates memorize the 'count 200 sperm' rule but skip the replicate-and-compare step, or they average two counts that actually exceed the allowable discrepancy (which by WHO criteria should trigger a third count).
What to do instead
State the rule explicitly in practice: load two chambers, count both, and if the difference exceeds the acceptable limit, prepare and count a fresh dilution. Report the mean of counts that agree; never average discrepant counts.
Classifying a sperm as 'rapid progressive' versus 'slow progressive' or 'non-progressive' based on overall impression rather than applying the defined motility grades and velocity threshold.
Motility grading is subjective and candidates under-practice it; the boundary between grade a and grade b depends on a defined speed criterion that is easy to forget under time pressure.
What to do instead
Drill the operational definitions (progressive = moving in a mostly straight line regardless of speed; the rapid/slow split uses the stated velocity criterion). Practice grading a recorded set of fields and compare against a reference grade until agreement is consistent.
Performing morphology assessment on a wet preparation or on a poorly stained/unevenly stained smear and then classifying defects on that inadequate slide.
Candidates conflate the counting-chamber wet prep used for concentration/motility with the stained smear required for morphology, or they accept a smear with staining artifact that mimics defects.
What to do instead
Always assess morphology on a properly fixed, stained smear with adequate staining quality; reject smears with precipitate, uneven thickness, or faded stain and re-prepare. Verify stain quality before grading.
Treating a post-wash sperm recovery as acceptable based only on total motile count while ignoring whether the preparation method (swim-up vs density gradient) was appropriate for the sample's characteristics, and not calculating recovery/yield.
Candidates learn the mechanics of each technique but not the decision logic for selecting a method based on viscosity, debris, or initial quality, nor the yield calculation that flags a failed prep.
What to do instead
For each prep, calculate percent recovery and total motile sperm recovered, and compare against expected yield for that method. Justify method selection by sample characteristics (e.g., density gradient for poor-quality or debris-heavy samples, swim-up for good-quality samples needing clean motile fraction).
Interpreting a single low testosterone value as hypogonadism without confirming it with a repeat morning sample and without pairing it with LH/FSH to localize the defect.
Candidates jump to diagnosis from one number and forget testosterone's diurnal variation and the requirement for confirmatory testing; they also under-use gonadotropins to distinguish primary from secondary failure.
What to do instead
Always confirm an abnormal testosterone on a second early-morning fasting sample. Then interpret LH/FSH: elevated gonadotropins suggest primary testicular failure, low/inappropriately normal gonadotropins suggest central (secondary) failure. State the pattern, not just the single value.
Misattributing an abnormal hormone pattern by ignoring prolactin, thyroid, or the effect of medications and acute illness on the axis, and by not recognizing that a normal total testosterone can coexist with low free testosterone.
Candidates focus narrowly on testosterone and LH/FSH and forget the broader differential and confounders (hyperprolactinemia, thyroid disease, SHBG-altering conditions) that change interpretation.
What to do instead
Build a systematic checklist for every hormone case: repeat morning testosterone, LH/FSH, prolactin, and consider SHBG/free testosterone when total testosterone is borderline. Explicitly note confounders (illness, medications, time of draw) before concluding.
Failing to run and document external quality assessment (proficiency testing) participation and instead relying only on internal daily QC, or accepting EQAS results without investigating an out-of-range result.
Candidates conflate internal QC (daily controls) with external quality assessment (inter-laboratory comparison) and treat a failing EQAS result as something to file rather than investigate.
What to do instead
Separate the two concepts: internal QC monitors daily precision; EQAS/proficiency testing provides external accuracy comparison. For any unacceptable EQAS result, document a root-cause investigation and corrective action, and verify the corrective action's effectiveness.
Using a Levey-Jennings chart or Westgard rules incorrectly - e.g., treating a single 1-2s warning as a rejection, or failing to reject on 2-2s, 1-3s, R-4s, or 4-1s violations.
Candidates memorize rule names but not which rules are warning versus rejection rules, and they misapply multirule logic under exam pressure.
What to do instead
Learn the decision logic: 1-2s is a warning only; 1-3s, 2-2s, R-4s, and 4-1s are rejection rules. Practice reading a control chart and stating which rule fired and whether to accept or reject the run.
Handling and documenting gametes/embryos in the ART lab without verifying identity at every critical step, or describing a procedure without the witnessing/verification checkpoints.
Candidates describe the technical steps of ICSI, cryopreservation, or insemination but omit the identity-verification and witnessing steps that are integral to the procedure in a regulated lab.
What to do instead
For every ART procedure, narrate the identity-verification checkpoints (patient/sample ID match, witnessed critical steps, documentation at each transfer between containers). Treat witnessing as part of the procedure, not an afterthought.
Applying general lab safety or consent/confidentiality rules without addressing andrology-specific requirements - e.g., handling of infectious samples, cryostorage consent, disposition of stored gametes, or reporting of results to the correct party.
Candidates rely on generic biosafety or HIPAA-level knowledge and miss andrology-specific regulatory and ethical obligations around gamete storage, consent for disposition, and quarantine of infectious samples.
What to do instead
Study the andrology-specific regulatory framework: biosafety handling of semen (including infectious-disease screening and storage quarantine), documented consent for cryopreservation and disposition, and confidentiality of gamete/embryo records. For each scenario, name the specific obligation invoked.