Computer‐Assisted Sperm Analysis (CASA) Versus Manual Evaluation and the Clinical Significance of Sperm Hyperactivated Motility

Background: Semen analysis remains the first-line diagnostic test for male infertility, although it is affected by operator subjectivity. Computer-assisted sperm analysis (CASA) is proposed to improve objectivity; however, its accuracy and clinical relevance remain uncertain. Objectives: We evaluated 424 samples from men attending routine semen analysis and 179 samples from male partners of ICSI couples to compare manual assessment with a CASA system (Ceros II), and to explore whether CASA-derived kinematic parameters, in particular hyperactivated motility (HA), predict ICSI outcomes. Materials and Methods: Manual (according to WHO manual) and CASA assessments were compared using correlation analysis, Passing–Bablok regression, and Bland–Altman plots; kinematic parameters were evaluated in relation to ICSI outcomes. Results: Significant correlations were found between CASA and manual assessment for rapid progressive motility and for sperm count for samples with less than 50 × 106/mL spermatozoa, whereas agreement was lost above this value, unless dilution was performed. Among CASA kinematic parameters, HA measured in whole semen was significantly higher in cycles achieving clinical pregnancy and resulted an independent pregnancy predictor also after adjustment for female age and female factor, showing good discriminative performance. Discussion: These findings suggest that CASA provides objective, reproducible assessment of sperm motility, and that hyperactivated motility may serve as a clinically relevant marker to improve prediction of ICSI outcomes. Conclusions: CASA may provide useful support for routine semen analysis and identify clinically meaningful kinematic parameters. Trial Registration: Not applicable.