Abstract
Purpose:This study sought (i) to investigate the relationship between postwash total motile sperm count and postwash percentage motile sperm in predicting successful intrauterine insemination and (ii) to determine the minimal postwash total motile sperm count required to achieve pregnancy with intrauterine insemination.
Methods:Five hundred four women, who underwent 1636 intrauterine insemination cycles with their partner's sperm for infertility treatment from 1993 through 1995, were included in this retrospective study. All patient charts were reviewed for age, infertility etiology, ovarian stimulation regimens, semen characteristics, and treatment outcome. To determine the relationship between total motile sperm count and intrauterine insemination outcome, patients were grouped as (1) less than 0.5 million, (2) 0.5 to 1 million, (3) 1 to 5 million, (4) greater than 5 million, and (5) greater than 20 million.
Results:Similar live birth rates (per cycle) were seen among the postwash total motile sperm count groups: group 1, 3.5%; group 2, 2.4%; group 3, 7.0%; group 4, 6.9%; and group 5, 7.0% (P = 0.37). However, regardless of the postwash total motile sperm count, the postwash motility predicted intrauterine insemination success at a cutoff value of 40%.
Conclusions:The percentage of postwash sperm motility, and not the postwash total motile sperm count, can predict successful intrauterine insemination outcome. Such information can be useful in counseling patients regarding their chance of success with intrauterine insemination and in determining when alternate methods of assisted reproduction may be a better approach.
Keywords: male infertility, intrauterine insemination, sperm, sperm motility, total motile sperm count
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REFERENCES
- 1.Campana A, Sakkas D, Stalberg A, Bianchi PG, Comte I, Pache T, Walker D. Intrauterine insemination: Evaluation of the results according to the women's age, sperm quality, total sperm count insemination and life table analysis. Hum Reprod. 1996;11:732–736. doi: 10.1093/oxfordjournals.humrep.a019244. [DOI] [PubMed] [Google Scholar]
- 2.Burr RW, Sieberg R, Flaherty SP, Wang X, Matthews CD. The influence of sperm morphology and the number of motile sperm inseminated on the outcome of intrauterine insemination combined with mild ovarian stimulation. Fertil Steril. 1996;65:127–132. doi: 10.1016/s0015-0282(16)58039-x. [DOI] [PubMed] [Google Scholar]
- 3.Berg U, Brucker C, Berg FD. Effect of motile sperm count after swing-up on outcome of intrauterine insemination. Fertil Steril. 1997;67:747–750. doi: 10.1016/s0015-0282(97)81377-5. [DOI] [PubMed] [Google Scholar]
- 4.Van der Westerlaken LA, Naaktgeboren N, Helmerhorst FM. Evaluation of pregnancy rates after intrauterine insemination according to indication, age, and sperm parameters. J Assist Reprod Genet. 1998;15:359–364. doi: 10.1023/A:1022576831691. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Horvath PM, Bohrer M, Shelden RM, Kemmann E. The relationship of sperm parameters to cycle fecundity in superovulated women undergoing intrauterine insemination. Fertil Steril. 1989;52:2880–294. doi: 10.1016/s0015-0282(16)60857-9. [DOI] [PubMed] [Google Scholar]
- 6.Dodson WC, Haney AF. Controlled ovarian hyperstimulation and intrauterine insemination for treatment of infertility. Fertil Steril. 1991;55:457–467. doi: 10.1016/s0015-0282(16)54168-5. [DOI] [PubMed] [Google Scholar]
- 7.Ho P, So W, Chan Y, Yeung WS. Intrauterine insemination after ovarian stimulation as a treatment for subfertility because of subnormal semen: A prospective randomized trial. Fertil Steril. 1992;58:995–999. doi: 10.1016/s0015-0282(16)55449-1. [DOI] [PubMed] [Google Scholar]
- 8.Brasch JG, Rawlins R, Tarchala S, Radwanska E. The relationship between total motile sperm count and the success of intrauterine insemination. Fertil Steril. 1994;62:150–154. doi: 10.1016/s0015-0282(16)56831-9. [DOI] [PubMed] [Google Scholar]
- 9.Huang H, Lee C, Lai Y, Chang M, Wang H, Chang S, Soong Y. The impact of the total motile sperm count on the success of intrauterine insemination with husband's spermatozoa. J Assist Reprod Genet. 1996;13:56–63. doi: 10.1007/BF02068871. [DOI] [PubMed] [Google Scholar]
- 10.DiMarzo SJ, Kennedy JF, Young PE, Hebert SA, Rosenberg DC, Villanueva B. Effect of controlled ovarian hyperstimulation on pregnancy rates after intrauterine insemination. Am J Obstet Gynecol. 1992;166:1607–1613. doi: 10.1016/0002-9378(92)91549-p. [DOI] [PubMed] [Google Scholar]
- 11.Ombelet W, Cox A, Janssen M, Vandeput H, Bosmans E. Artificial insemination 2: using the husband's sperm. Human spermatozoa in assisted reproduction. In: Acosta A, Kruger TF, editors. Human Spermatozoa in Assisted Reproduction. New York: Parthenon; 1996. pp. 399–412. [Google Scholar]
- 12.Cressman BE, Pace-Owens S, Pliego JF, Wincek TJ, Kuehl TJ. Effect of sperm dose on pregnancy rate from intrauterine insemination: A retrospective analysis. Tex Med. 1996;92:74–79. [PubMed] [Google Scholar]
- 13.Tomlinson MJ, Amissah-Arthur JB, Thompson KA, Kasraie JL, Bentick B. Prognostic indications for intrauterine insemination (IUI): Statistical model for IUI success. Hum Reprod. 1996;11:1892–1896. doi: 10.1093/oxfordjournals.humrep.a019513. [DOI] [PubMed] [Google Scholar]
- 14.Comhaire F, Milingos S, Liapi A, Gordts S, Campo R, Depypere, Dhont M, Schoonjans F. The effective cumulative pregnancy rate of different modes of treatment of male infertility. Andrologia. 1995;27:217–221. doi: 10.1111/j.1439-0272.1995.tb01096.x. [DOI] [PubMed] [Google Scholar]
- 15.Dodson WC. Is superovulation and intrauterine insemination really an alternative to assisted reproductive technology? Semin Reprod Endocrinol. 1995;13:85–89. [Google Scholar]
- 16.Keck C, Gerber-Schafer C, Wilhelm C, Vogelgesang D, Breckwoldt M. Intrauterine insemination for treatment of male infertility. Int J Androl. 1997;20:55–64. [PubMed] [Google Scholar]
- 17.Shekarriz M, Sharma RK, Thomas AJ, Jr, Agarwal A. Positive myeloperoxidase staining (Endtz test) as indicator of excessive reactive oxygen species formation in semen. J Assist Reprod Genet. 1995;12:70–74. doi: 10.1007/BF02211372. [DOI] [PubMed] [Google Scholar]
- 18.Mortimer D, Templeton AA. Sperm transport in the human female reproductive tract in relation to semen analysis characteristics and time of ovulation. J Reprod Fert. 1982;64:401–408. doi: 10.1530/jrf.0.0640401. [DOI] [PubMed] [Google Scholar]
- 19.Shulman A, Hauser R, Lipitz S, Frenkel Y, Dor J, Bider D, Mashiach S, Yogev L, Yavetz H. Sperm motility is a major determinant of pregnancy outcome following intrauterine insemination. J Assist Reprod Genet. 1998;15:381–385. doi: 10.1023/A:1022585000740. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Kerin J, Byrd W. Supracervical placement of spermatozoa: utility of intrauterine and tubal insemination. In: Soules MR, editor. Controversies in Reproductive Endocrinology and Infertility. New York: Elsevier; 1989. pp. 183–204. [Google Scholar]
- 21.Tucker MJ, Wong CJY, Chang YM, Leong KH, Leung CKM. Intrauterine insemination as frontline treatment for non-tubal infertility. Asia Oceania. J Obstet Gynecol. 1990;16:137–143. doi: 10.1111/j.1447-0756.1990.tb00016.x. [DOI] [PubMed] [Google Scholar]
- 22.Byrd W. Processing human semen for insemination: Comparison of methods. In: Centola GM, Ginsburg KA, editors. Evaluation and Treatment of the Infertile Male. New York: Cambridge University Press; 1996. pp. 39–107. [Google Scholar]
- 23.Centola GM. Successful treatment of severe oligozoospermia with sperm washing and intrauterine insemination. J Androl. 1997;18:448–453. [PubMed] [Google Scholar]
- 24.Arny M, Quagliarello J. Semen quality before and after processing by a swim-up method: Relationship to outcome of intrauterine insemination. Fertil Steril. 1987;48:643–648. doi: 10.1016/s0015-0282(16)59479-5. [DOI] [PubMed] [Google Scholar]
- 25.Dickey RP, Olar TT, Taylor SN, Curole DN, Rye PH, Matulich EM. Relationship of follicle number, serum estradiol, and other factors bo birth rate and multiparity in human menopausal gonadotropin-induced intrauterine insemination cycles. Fertil Steril. 1991;56:89–92. doi: 10.1016/s0015-0282(16)54423-9. [DOI] [PubMed] [Google Scholar]
- 26.Ombelet W, Puttemans P, Bosmans E. Intrauterine insemination: A first-step procedure in the algorithm of male subfertility treatment. Hum Reprod. 1995;10:1090–1102. doi: 10.1093/humrep/10.suppl_1.90. [DOI] [PubMed] [Google Scholar]
- 27.Aitken RJ, Clarkson JS. Cellular basis of defective sperm function and its association with the genesis of reactive oxygen species by human spermatozoa. J Reprod Fert. 1987;81:459–469. doi: 10.1530/jrf.0.0810459. [DOI] [PubMed] [Google Scholar]
- 28.Sharma RK, Agarwal A. Role of reactive oxygen species in male infertility. Urology. 1996;48:835–850. doi: 10.1016/s0090-4295(96)00313-5. [DOI] [PubMed] [Google Scholar]
- 29.Yovich JM, Edirisinghie WR, Cummins JM, Yovich JL. Influence of pentoxifylline in severe male factor infertility. Fertil Steril. 1990;53:715–732. doi: 10.1016/s0015-0282(16)53470-0. [DOI] [PubMed] [Google Scholar]
- 30.Brennan AP, Holden CA. Pentoxifylline-supplemented cryoprotectant improves human sperm motility after cryopreservation. Hum Reprod. 1995;10:2308–2312. doi: 10.1093/oxfordjournals.humrep.a136291. [DOI] [PubMed] [Google Scholar]
- 31.Sandro CE, Sharma RK, Thomas AJ, Agarwal A. Cryopreservation of human spermatozoa with pentoxifylline improves the post-thaw agonist-induced acrosome reaction rate. Hum Reprod. 1998;13:3384–3389. doi: 10.1093/humrep/13.12.3384. [DOI] [PubMed] [Google Scholar]
- 32.Ombelet W, Vandeput H, Putte GV, Cox A, Janssen M, Jacobs P, Bosmans E, Steeno O, Kruger T. Intrauterine insemination after ovarian stimulation with clomiphene citrate: Predictive potential of inseminating motile count and sperm morphology. Hum Reprod. 1997;12:1458–1463. doi: 10.1093/humrep/12.7.1458. [DOI] [PubMed] [Google Scholar]
- 33.Francavilla F, Romano R, Santucci R, Poccia G. Effect of sperm morphology and motile sperm count on outcome of intrauterine insemination in oligozoospemia and/or asthenozoospermia. Fertil Steril. 1990;53:892–897. [PubMed] [Google Scholar]