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

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 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.

Keywords: IUI; Intrauterine insemination; prognostic value; semen analysis.