Abstract
OBJECTIVE: The clinical relevance of the various parameters measured in routine semen analysis is not well defined. The study objective was to evaluate outcomes of IUI according to sperm concentration, motility, post-wash total motile sperm (TMS), progression and abnormal morphology. DESIGN: Retrospective review. MATERIALS AND METHODS: Records of IUI cycles performed during 2004-09 were reviewed. Inclusion criteria were female age <43 years, diagnosis of unexplained infertility and stimulation using a standard CC/FSH protocol. Analysis was restricted to the first attempt per couple during the review period. HCG (10,000 IU) was administered when there was at least one follicle >17 mm, followed 36 hours later by a single insemination with a 0.3 ml post-wash semen sample. Clinical pregnancy rate (gestational sac) was evaluated according to post-wash semen parameters (concentration, motility, TMS, and progression) of the sample used for insemination by logistic regression. For a subset of couples, percent abnormal morphology from an initial diagnostic semen analysis was also related to pregnancy outcomes by logistic regression. RESULTS: A total of 2410 couples met the inclusion criteria. Pregnancy outcomes were not significantly related to either progression (p=0.64) or sperm morphology abnormalities (p=0.15, n=1326). Pregnancy rates increased significantly with increasing TMS <8 million (p<0.0001). However, there was no apparent relationship between pregnancy and TMS ≥7 million (p=0.28). Among patients with ≥7 million TMS, neither concentration (p=0.59) nor motility (p=0.44) had any apparent effect on pregnancy rates.Tabled 1Total motile sperm<2 million≥2, <4 million≥4, <7 million≥7 millionCycles571042202029Pregnancy (%)09.614.117.4 Open table in a new tab CONCLUSION: Of all the parameters measured in routine semen analysis, the only parameter that was significantly related to IUI pregnancy outcomes was TMS. Outcomes were stable with TMS >7 million, but declined gradually with decreasing counts below 7 million.
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