Total Normal Motile Sperm Count Plays no Role in Clinical pregnancy Rate After Intrauterine Insemination

Abstract

OBJECTIVE: The objective of this study was to determine if evaluation of sperm morphology, in addition to the total motile sperm count, is helpful in predicting a more accurate pregnancy rate. DESIGN: This was a retrospective study examining 73 patients from May 2008 to October 2010 who underwent intrauterine insemination (IUI) after ovulation from a natural cycle versus ovarian stimulation via selective estrogen receptor modulator (clomiphene citrate) or gonadotropins. MATERIALS AND METHOD(S): Semen analysis was performed prior to insemination using the Kruger criteria. The total normal motile sperm (TNMS) count was defined by total motile sperm (TMS) count (defined as volume x count x % motility) x % normal morphology. Pregnancy rate was stratified by TNMS value. Odds ratio (OR) was calculated to evaluate the impact of TNMS value on the success of IUI. P < 0.05 was considered statistically significant. RESULT(S): A total of 136 IUI cycles in 73 patients were evaluated, with a cumulative pregnancy rate of 19.9%. Mean female age was 36.7±5.1 years. The post-wash mean TMS was 23.9±15.7, mean morphology was 16.3±7.7%, and mean TNMS was 4.2±3.8. TNMS scores were stratified at a variety of different levels. Though there was a trend toward improved pregnancy rate with increasing values (with greatest odds ratio of pregnancy with a TNMS >5), none of the thresholds achieved statistical significance. CONCLUSION(S): Higher TNMS scores are not indicative of an improved rate of conception in patients receiving IUI. Further testing on the subject matter is necessary. SUPPORT: NoneTabled 1TNMSPregnancy Rate (%)Odds Ratio95% Confidence IntervalP value≥ 120.31.180.40–3.440.5≥ 321.81.270.55–2.950.37≥ 526.61.840.83–3.160.12≥ 7231.310.58–2.640.37≥ 1015.80.730.26–2.330.46 Open table in a new tab KEY WORDS: intrauterine insemination (IUI), total motile sperm count (TMS), total normal motile sperm count (TNMS).