Effect of sperm morphology&

number on success of IUI

Aboubakr Elnashar

Ahmed Badawy

Mohamed Eltotongy elnashar53@hotmail.com

Aboubakr Elnashar

Introduction

IUI Widely used

simple, inexpensive, acceptable ART (Zhao et al, 2004).

Indications: many

poor male factor

cervical hostility

unexplained infertility.

Attempted

before proceeding to more expensive& invasive ART

such as ICSI.

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Pregnancy rates:

Patient selection criteria

Presence of various infertility factors

Methods of ovarian stimulation

Number of cycles performed

Technique of preparation.

Sperm parameters:

number of motile sperm

normal morphology.

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Sperm parameters 1. Raw samples

do not correlate with cycle fecundity as do prepared

specimens (Wainer et al, 1996).

2. Post-swim-up semen

can provide useful prognostic information

{processing techniques modify sperm characteristics

vary from laboratory to laboratory

Vary from patient to patient}

(Van Waart et al, 2001)

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Aim of our study

To assess the likelihood of IUI success as a function of

the sperm count and morphology, assessed after sperm

preparation.

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Materials and methods

Design:

A prospective observational study.

Patients:

393 couples who underwent 714 IUI cycles.

Infertility for at least 1 y

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Before IUI

•HSG:

•D21 serum P: documenting ovulation

•TVS: evaluating the pelvic anatomy

•Laparoscopy: when there was a possibility of pelvic

adhesions or endometriosis in the HSG or TVS

•At least 2 semen analyses& microbiological tests

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Normal semen: WHO (1993)

Concentration: 20x106/mL

Total count: 40x106

Progressive motility: 50%

Typical morphology: 30%.

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Semen processing

•Motile sperm were selected by a swim-up procedure.

•Motile sperm fraction was washed twice by

centrifugation

sperm pellet was suspended in 0.35 mL of Earle’s

balanced salt solution

•Sperm were then counted& progressive motility

assessed.

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Ovarian superovulation

CC 50 mg twice daily for 5 d from D2 of the cycle

One hMG ampule 75 IU IM daily from D5 of the cycle.

Monitoring:

TVS.

IUI was performed 36±4 h after hCG

Main Outcome Measures:

Clinical pregnancy.

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Results

The mean age:

31.3±3.2 y

79 (11.06%) Clinical pregnancy/cycle

(79 (20.1% Clinical pregnancy/couple

13 (16.4%) Miscarriage

6 (7.6%) Twin pregnancy

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•Number of motile sperm <5 x106.

No statistically significant difference in PR/cycle between

subgroups

28 pregnancies were reported in 504 cycles accounting

for a 5.55% PR/cycle.

•Number of motile sperm >5 x106

PR/cycle was 24.28% (P<.001). Aboubakr Elnashar

•Below the age 25 y:

with number of motile sperm >5x106: PR/cycle was

28.2%, which is significantly higher than that of other

age groups.

•Above the age of 35y:

with number of motile sperm <5x106: No pregnancies

with number of motile sperm >5x106: PR was very low

0.84% Aboubakr Elnashar

•Normal sperm morphology<30%:

PR was significantly higher when the number of motile

sperm was >5x106 than when it was <5x106 (9.45% vs.

4.62%)

•Normal sperm morphology>30%

PR was significantly higher when the number of motile

sperm was >5x106(20.77%).

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Conclusion

IUI used for treating male factor infertility seems to

have little chance of success when

the woman is older than 35 y of age

number of motile sperm inseminated is <5x106, or

normal sperm morphology is <30%.

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Thank s

Aboubakr Elnashar