Module - Diagnostic and Therapeutic Andrology (SLS323)

STP

Aim of this module

This module will provide the trainees with knowledge and understanding of diagnostic andrology and the process of fertilisation. They will understand and gain experience of insemination methodologies and reporting outcomes from insemination/fertilisation. They will also consider the impact of male infertility on individuals, relationships and society gaining insight into support services available and the importance of providing compassionate, patient-centred care. The impact of culture, equality and diversity on practice will be explored.

Work-based learning outcomes

  1. Recognise and interpret the macroscopic and microscopic appearance of semen, and relate to any pathological process determining the potential implications for conception or child-health.
  2. Advise on and appropriately request additional tests to aid in diagnosis, or implications of observed disease exercising their own professional judgement.
  3. Recognise and diagnose the success or failure of male contraceptive interventions in microscopic specimens, including but not necessarily  limited to post-vasectomy semen analysis.
  4. Recognise and interpret the effects of medical intervention upon semen properties (including but not limited to clearance of pathological organisms; success of vasectomy reversal; recovery from chemo- or radiotherapeutic intervention)
  5. Prepare preliminary reports based on using interpretive and diagnostic skills under supervision.
  6. Work in partnership with other clinical specialisms as part of the systematic diagnosis and review of individual cases.

Work-based Competencies

Learning outcome Title Knowledge
1 1,4, 5, 6

Identify macroscopically the different types of potential disease using a range of semen samples:

  • ejaculatory dysfunction
  • accessory gland dysfunction
  • infection/inflammation
  • Normal macroscopic appearance of semen.
  • Aetiology of common pathologies.
  • Rationale    of    the   techniques   required    to    characterise    and demonstrate the macroscopic properties of semen.
  • Quality Management in an accredited laboratory.
  • The correct principles and applications of disinfectants, methods for sterilisation and decontamination, and for dealing with waste and spillages correctly.
  • Sources of hazard in the workplace, including specimens, raw materials, clinical and special waste and equipment
2 1,4

Using freshly ejaculated samples perform manual assessment of human semen according to or exceeding the requirements.
  • The World Health Organisation current guidelines for investigation of human semen.
  • European and United Kingdom guidance for performance of semen analysis to meet or exceed the above guidelines.
  • Limitations and uncertainty associated with the above.
3 1,2,4

Using fresh ejaculates and pre- recorded video data, perform assessment of human sperm motility that accords to local IQA/EQA data.
  • How to recognise motility and perform assessment according to the four category a/b/c/d assessment.
  • The  biological basis and observation of activated and hyperactivated motility.
  • The aetiology of common and rarer pathologies (including but not limited to:  immotile cilia syndrome; pin-heads; globozoospermia).
  • The rationale of techniques involved including requirements and limitations of manual and computer assisted analyses.
4 1,3,4

Identify markers of normal sperm morphology and Live/Dead cells using representative prepared specimens from a range of ejaculates.
  • The microscopic difference between normal sperm and those with abnormal morphology and the clinical interpretation of these findings.
  • Epidemiology of common pathologies (including but not limited to: pin and tapered heads, globozoospermia).
  • Principles of good fixation and processing.
  • Rationale of the different histological techniques required to demonstrate the different cell types involved in a tissue section.
  • How to score sperm morphology according to the Teratozoospermia Index (TZI) system.
  • Limitations and uncertainty associated with scoring using the Teratozoospermia Index (TZI) system.
  • Assays of whether cells are live/dead including viability / vitality including: different methods for this assessment, differences between methods, associated weaknesses and when a certain assay type may be applicable.
5 1,4

Perform scoring of sperm morphology according to the Teratozoospermia Index (TZI) system.
  • The microscopic difference between normal sperm and those with abnormal morphology and the clinical interpretation of these findings.
  • Epidemiology of common pathologies (including but not limited to: pin and tapered heads, globozoospermia).
  • Principles of good fixation and processing.
  • Rationale of the different histological techniques required to demonstrate the different cell types involved in a tissue section.
  • How to score sperm morphology according to the Teratozoospermia Index (TZI) system.
  • Limitations and uncertainty associated with scoring using the Teratozoospermia Index (TZI) system.
  • Assays of whether cells are live/dead including viability / vitality including: different methods for this assessment, differences between methods, associated weaknesses and when a certain assay type may be applicable.
6 1,4,6

Identify the presence and where possible mechanisms of transmission and clinical manifestations of both acute and chronic infections.
  • The mechanisms involved in the inflammatory process, including the cell types involved and the cascade of inflammatory response.
  • Methods and identification of inflammatory cells in semen.
  • The normal immune situation within the testis, how this may be perturbed and symptoms of this.
  • Principles of infectious diseases and the immune response to infection.
  • General principles of infection control in the management of the patient.
7 3,5,6

Interpret analytical findings in the correct clinical context and considering the current literature and discuss your interpretation with a senior colleague(s).
  • The use of the light microscope and adjustment for brightfield and phase contrast illumination.
  • The relationship between clinical presentation and the diagnosis.
  • The relative merits of differing results when making an informed and accurate diagnosis.
8 6

Work, where appropriate, in partnership with service users.
  • The importance of working, where appropriate, in partnership with service users, other professionals, support staff and others.
9 6

Work, where appropriate, in partnership with colleagues.
  • How to promote patient-centred care.
  • How to work as a member of a multi-disciplinary team.
  • The importance of building and sustaining professional relationships as both an independent practitioner and collaboratively as a member of a team.

Work-based assessment

Complete 2 Case-Based Discussion(s)
Complete 2 of the following DOPS and/or OCEs
Type Title
OCE Discuss provision of a diagnostic semen sample with a patient including requirements before and receipt of the sample. Reflect upon the patient experience and helpful strategies to improve this.
DOPS Perform all aspects of a basic semen analysis according to ESHRE / WHO guidelines including morphology by TZI.
DOPS Perform a laboratory diagnostic for antisperm antibodies
DOPS Correctly identify the support services available to a male patient / couple for infertility, both locally and Nationally.
DOPS Perform and prepare a preliminary report on a post vasectomy semen analysis, recognizing the accuracy of the result and potential for adverse outcome.
DOPS Perform IQC / EQA / Inter-Operator assessment of samples and benchmark your results within the scheme. Discuss potential actions.
DOPS Perform an audit on a process within the laboratory Quality Management Scheme
DOPS Prepare a testicular biopsy specimen through all steps to and including pathological (histological) examination
OCE Discuss the impact of male infertility on the individual and the couple
OCE Present a case in partnership with someone from another clinical specialism as part of the diagnosis and review process
OCE Observe a medical / surgical intervention on a male patient aimed at affecting male fertility, evaluate how this links to this diagnostic pathway.