Sperm morphology by strict criteria does not predict clinical pregnancy rate following intra-uterine insemination

Abstract

ABSTRACT Objective To determine the impact of abnormal sperm morphology of the pre-washed semen sample on the day of intrauterine insemination (IUI) on clinical pregnancy rates (CPR) Design Cross sectional retrospective chart review. Setting Academic fertility center Patient(s) Couples undergoing (IUI) from May 2014 to March 2022. Intervention(s) Sperm morphology, by strict criteria, on the pre-washed IUI sample. Main outcomes Measure(s) To determine the association of sperm morphology with CPR. Result(s) Semen analysis reports, including Kruger strict criteria for morphology from the pre-washed IUI sample, were reviewed for 1,059 cycles, comprising 825 total treated couples. Of the total 1,059 cycles,15.1% resulted in clinical pregnancy. When categorized by strict morphology ≥4% (normal morphology), (3%–2%) [mild-moderate teratozoospermia (TZS)], and ≤1% (severe TZS), the CPR was 16%, 13%, and 10%, respectively (p value 0.30). Early spontaneous miscarriage rate was 4% and when stratified by morphology ≥4% (3%–2%), and ≤1%, was 3%, 1%, and 0%, respectively (p value 0.20). In couples with isolated TZS, the pregnancy rate was 16% in the normal morphology group, 14% in the mild–moderate group, and 8% in the severe group. (p value 0.30). In the multivariate logistic regression, sperm morphology, mild/moderate TZS vs normal forms (OR = 0.99, 95% CI [0.94–1.1]), severe TZS vs normal forms (OR = 0.98, 95% CI [0.0.83–1.1]), was not a predictor of CPR. The Pre-wash TMSC (OR = 1.0, 95% CI [0.996–1.00]) was also not predictive of CPR. The only predictive factor of CPR in IUI was the PWTMSC (OR = 1.03, 95%CI [1.00–1.06). Conclusion(s) The morphology of the pre-washed sample on the day of IUI did not find a difference in CPR, neither in miscarriage rate following IUI, in couples with normal or abnormal sperm morphology, including severe TZS. Mild, moderate, or severe TZS in the semen sample should not exclude couples to attempt an IUI procedure.