Standardizing Sperm
On the Regulation of Medical Expert Knowledge
and Biotechnological Classifications
Torsten Wöllmann
IAS-STS, Graz
Department of Sociology, Karl-Franzens-University Graz
Interdisciplinary Research Center „Dynamics of Gender
Constellations“, Technical University of Dortmund
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Introduction
2
Spermatology & Semen Analysis
3
Semen Analysis as Contested Technology
4
The Paradox of Sperm Morphology Assessment
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Further Perspectives
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Infertility as a Sexed and Gendered Concept I
• Medicine concentrated almost exclusively on women for
quite a long time when dealing with diagnosis and
therapy of infertility
• „[...] although doctors acknowledged that it takes both a
woman and a man to make a baby, medical theory and
practice focused almost exclusively on the female body“
Naomi Pfeffer (1993): 30
Infertility as a Sexed and Gendered Concept II
• Since the middle of the 20th century medicine’s attention
for men’s infertility has clearly increased
• Following a study by the World Health Organization male
disorders have to be supposed as causal in half of
infertile couples (WHO 1987)
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Perspectives
• Feminist gender studies &
critical studies on men and masculinities
• Science, technology and medicine studies
• History and sociology of bodies &
social studies on sexual difference
Starting Questions
• How does medicine identify (in)fertility in
human males?
• What processes regulate the technologies
and stocks of knowledge relevant in
identifying male (in)fertility?
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Semen Analysis: What is it?
• Medical test of the ejaculate: microscopic
analysis and some other tests
• Usually accompanied with the inquiry of
the medical history of a patient and his
physical examination
Some Basic Things You Need
to Do Semen Analysis
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Semen Analysis: Why is it done?
• Diagnosis of male infertility
• Prognosis of male fertility
• Testing sperm to be cryopreserved
• Verifying that a vasectomy was successful
Why is that interesting (for me)?
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That‘s Why
• Sperm lab as an arena that participates in the
construction of reproduction and sexuality, body, sex and
gender
• Semen analysis as an element of the biotechnological
production of new concepts of e.g. kinship, family,
fatherhood and masculinity
• The course of the spermatological analysis is object of
different endeavours of standardization and of different
attempts to hegemonise classifications
Formation of Sperm and Spermatology I
• 1677: microscopic visualization of “animalcule”
(drawings)
• 1827: “Animalcule” became “spermatozoa”
• 1841: spermatozoa as product of testes, seen as relevant
in procreation
• 1875: conjugation of egg and sperm
• Late 19th century: photographies of sperm cells &
structure of sperm cells
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Formation of Sperm and Spermatology II
• 1890s: start of sperm cell counting &
first nomenclature to differentiate sperm samples
(normal/abnormal)
• Early 20th century: focus on sperm morphology &
new staining and dyeing techniques
• 1930s: biochemistry, endocrinology and microbiology of
seminal plasma
• 1950s: electron microscope visualizations of sperm cells &
influential publications on morphology, motility and
concentration of sperm cells
• 1960s: genetic research (later: genetic testing)
• Late 1970s: computer-aided sperm analysis (CASA)
How a Normal Human Sperm Cell Looks Like Today
Model:
Electron Microscope Visualization:
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Parameters of Semen Analysis I
• Morphology of sperm cells
• Motility of sperm cells
• Sperm count/ concentration of sperm cells
Parameters of Semen Analysis II
•
•
•
•
•
•
•
Biochemistry of seminal plasma (fructose etc.)
Volume, viscosity, pH and colour of ejaculate
White blood cells
Viability of sperm cells
Antisperm antibodies test
Genetic tests
etc.
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Semen Analysis as Contested Technology
(Some of) the different parameters and the course of semen
analysis are object of endeavours of standardization and of
different attempts to hegemonise classifications:
• The ways of classifying sperm cells is contested, esp.
concerning sperm morphology.
• How to qualify and train laboratory technicians, as semen
analysis requires much experience and skill (e.g. training
programmes, refreshment courses, external quality control
programmes)
• If and how to implement computer-aided sperm analysis
(CASA), which automatises different steps of semen analysis
Contested Classification Systems I
• First classification systems were conceptualized in late 19th
century
• With the rise of semen analysis since the 1950s several
classification systems became dominant in different contexts
• World Health Organization (1980): Laboratory Manual for the
Examination of Human Semen and Semen-Cervical Muscus
Interaction. Singapore (2nd ed. 1987, 3rd ed. 1992, 4th ed.
1999).
• Since the middle of the 1980s the WHO-manual was contested
by a classification system developed by Thinus Kruger and his
colleagues from Tygerberg Hospital in Sout Africa, called
Kruger criteria, Tygerberg criteria or strict criteria.
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Contested Classification Systems II
• Although WHO-criteria and ‚strict‘ criteria
converged in some aspects in the last years there
are still fundamental differences between the two
classification systems
• What is quite different in these two classification
systems is how to deal with sperm morphology:
what is normal concerning to WHO-criteria is
abnormal concerning ‚strict‘ criteria
The Paradox of
Sperm Morphology Assessment
• Sperm morphology is seen to correlate more closely with fertilization
rates than sperm count and motility, i.e. sperm morphology as
predictive parameter to distinguish between fertile and subfertile men
But:
• Problems concerning the reproducibility of sperm morphology
assessments (e.g. morphology evalutation is very much dependent on
the skill of the lab technician and varies widely between and
sometimes even within labs)
• What is least standardized in semen analysis is sperm morphology:
lack of ‚objective‘ measurements of sperm morphology, What is
‚morphological normal‘ is unclear
• Large variety of sperm forms that is difficult to classify
Last but not least:
• Unclearity what morphology means at all
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How to Continue?
I am interested in:
• which classifications and standards are supposed
to determine the local practices of semen
analysis?
• what knowledge is seen as relevant for the
practice of analysing sperm and who decides that
this knowledge counts as relevant?
• which criteria and norms influence the
discussions about this technology? What is made
visible and what is made invisible?
Methods & Data
•
a)
b)
c)
•
a)
b)
c)
Document analysis:
laboratory manuals and recommendations
publications discussing the standardization of semen
analysis
studies on standardization and on quality control
programmes
Expert interviews:
Experts with discursive power in scientific discourses
Experts with organizational decision authority in
hospitals (e.g. heads of department, directors of
institutes)
Experts doing laboratory work in semen analysis (i.e.
lab technicians)
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References
• Kruger,
Kruger Thinus F. et al. (1986): Sperm Morphologic Features as a
Prognosis Factor of In Vitro Fertilization. In: Fertility and Sterility 46:
1118-1123.
• Pfeffer,
Pfeffer Naomi (1993): The Stork and the Syringe. A Political History
of Reproductive Medicine. Cambridge.
• World Health Organization Task Force on the Diagnosis and
Treatment of Infertility (1987): Towards More Objectivity in Diagnosis
and Management of Male Infertility. Results of a World Health
Organization Multicentre Study. In: International Journal of
Andrology, Supplement 7: 1-53.
• World Health Organization (1980): Laboratory Manual for the
Examination of Human Semen and Semen-Cervical Muscus
Interaction. Singapore.
Thank you for listening!
listening!
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