Predictive value of sperm morphology and progressively motile sperm count for pregnancy outcomes in intrauterine insemination

Capsule:
In addition to female factors, a low percentage of morphologically normal spermatozoa and moderate number of inseminated motile spermatozoa have a positive predictive value for successful intrauterine insemination, albeit low.

Authors:
Louise Lemmens, M.Sc., Snjezana Kos, Ph.D., Cornelis Beijer, M.Sc., Jacoline W. Brinkman, Ph.D., Frans A.L. van der Horst, Ph.D., Leonie van den Hoven, B.Sc., Dorit C. Kieslinger, M.Sc., Netty J. van Trooyen-van Vrouwerff, B.Sc., Albert Wolthuis, Ph.D., Jan C.M. Hendriks, Ph.D., Alex M.M. Wetzels, Ph.D. for the Semen Section of the Dutch Foundation for Quality Assessment in Medical Laboratories

Volume 105, Issue 6, Pages 1462-1468

Abstract:

Objective:
To investigate the value of sperm parameters to predict an ongoing pregnancy outcome in couples treated with intrauterine insemination (IUI), during a methodologically stable period of time.

Design:
Retrospective, observational study with logistic regression analyses.

Setting:
University hospital.

Patient(s):
A total of 1,166 couples visiting the fertility laboratory for their first IUI episode, including 4,251 IUI cycles.

Intervention(s):
None.

Main Outcome Measure(s):
Sperm morphology, total progressively motile sperm count (TPMSC), and number of inseminated progressively motile spermatozoa (NIPMS); odds ratios (ORs) of the sperm parameters after the first IUI cycle and the first finished IUI episode; discriminatory accuracy of the multivariable model.

Result(s):
None of the sperm parameters was of predictive value for pregnancy after the first IUI cycle. In the first finished IUI episode, a positive relationship was found for ≤4% of morphologically normal spermatozoa (OR 1.39) and a moderate NIPMS (5–10 million; OR 1.73). Low NIPMS showed a negative relation (≤1 million; OR 0.42). The TPMSC had no predictive value. The multivariable model (i.e., sperm morphology, NIPMS, female age, male age, and the number of cycles in the episode) had a moderate discriminatory accuracy (area under the curve 0.73).

Conclusion(s):
Intrauterine insemination is especially be relevant for couples with moderate male factor infertility (sperm morphology ≤4%, NIPMS 5–10 million). In the multivariable model, however, the predictive power of these sperm parameters is rather low.

  • This article from the Netherlands is a large retrospective review of over 1000 couples and 4000 IUI cycles and heir IUI experience with various semen parameters. It further fuels the discussion as to what the minimal parameters are to proceed with IUI attempts and their predictive values. Unless a patient has severe astenozoospermia with a total motile sperm count <1 million, there is a potential chance for pregnancy. What is interesting is that low morphology does not seem to have as negative of an impact as demonstrated in previous studies from other groups. Despite this, the predictive values of either of these variables are still low. Good information to counsel couples with idiopathic male infertility.

  • msamplaski

    This is excellent data to share with patients. I am curious to know if variables associated with poor morphology were accounted for, such as smoking, infections, antioxidant use and varicoceles.

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