Clinical and Experimental Reproductive Medicine

The Korean Society for Reproductive Medicine (대한생식의학회)
권호 표지
DOI QR코드

DOI QR Code

Predictive value of sperm motility before and after preparation for the pregnancy outcomes of intrauterine insemination

  • Jeong, Mina (Seoul Rachel Fertility Center) ;
  • Kim, Seul Ki (Department of Obstetrics and Gynecology, Seoul National University College of Medicine) ;
  • Kim, Hoon (Department of Obstetrics and Gynecology, Seoul National University College of Medicine) ;
  • Lee, Jung Ryeol (Department of Obstetrics and Gynecology, Seoul National University College of Medicine) ;
  • Jee, Byung Chul (Department of Obstetrics and Gynecology, Seoul National University College of Medicine) ;
  • Kim, Seok Hyun (Department of Obstetrics and Gynecology, Seoul National University College of Medicine)
  • Received : 2021.02.23
  • Accepted : 2021.04.06
  • Published : 2021.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: This study aimed to investigate sperm motility and its changes after preparation as predictors of pregnancy in intrauterine insemination (IUI) cycles. Methods: In total, 297 IUI cycles from January 2012 to December 2017 at a single tertiary hospital were retrospectively analyzed. Patient and cycle characteristics, and sperm motility characteristics before and after processing were compared according to clinical pregnancy or live birth as outcomes. Results: The overall clinical pregnancy rate per cycle was 14.5% (43/297) and the live birth rate was 10.4% (30/289). Patient and cycle characteristics were similar between pregnant and non-pregnant groups. Sperm motility after preparation and the total motile sperm count before and after processing were comparable in terms of pregnancy outcomes. Pre-preparation sperm motility was significantly higher in groups with clinical pregnancy and live birth than in cycles not resulting in pregnancy (71.4%±10.9% vs. 67.2%±11.7%, p=0.020 and 71.6% ±12.6% vs. 67.3%±11.7%, p=0.030, respectively). The change in sperm motility after processing was significantly fewer in the non-pregnant cycles, both when the comparison was conducted by subtraction (post-pre) and division (post/pre). These relationships remained significant after adjusting for the female partner's age, anti-Müllerian hormone level, and number of pre-ovulatory follicles. According to a receiver operating characteristic curve analysis, an initial sperm motility of ≥72.5% was the optimal threshold value for predicting live birth after IUI. Conclusion: Initial sperm motility, rather than the motility of processed sperm or the degree of change after preparation, predicted live birth after IUI procedures.

Keywords

Acknowledgement

The authors would like to thank the staff of the Laboratory of Reproductive Medicine, Seoul National University Hospital, Seoul, Korea.

References

  1. Ombelet W, Dhont N, Thijssen A, Bosmans E, Kruger T. Semen quality and prediction of IUI success in male subfertility: a systematic review. Reprod Biomed Online 2014;28:300-9. https://doi.org/10.1016/j.rbmo.2013.10.023
  2. ESHRE Capri Workshop Group. Intrauterine insemination. Hum Reprod Update 2009;15:265-77. https://doi.org/10.1093/humupd/dmp003
  3. Starosta A, Gordon CE, Hornstein MD. Predictive factors for intrauterine insemination outcomes: a review. Fertil Res Pract 2020;6:23. https://doi.org/10.1186/s40738-020-00092-1
  4. Hansen KR, He AL, Styer AK, Wild RA, Butts S, Engmann L, et al. Predictors of pregnancy and live-birth in couples with unexplained infertility after ovarian stimulation-intrauterine insemination. Fertil Steril 2016;105:1575-83.e2. https://doi.org/10.1016/j.fertnstert.2016.02.020
  5. Merviel P, Heraud MH, Grenier N, Lourdel E, Sanguinet P, Copin H. Predictive factors for pregnancy after intrauterine insemination (IUI): an analysis of 1038 cycles and a review of the literature. Fertil Steril 2010;93:79-88. https://doi.org/10.1016/j.fertnstert.2008.09.058
  6. Erdem M, Erdem A, Mutlu MF, Ozisik S, Yildiz S, Guler I, et al. The impact of sperm morphology on the outcome of intrauterine insemination cycles with gonadotropins in unexplained and male subfertility. Eur J Obstet Gynecol Reprod Biol 2016;197:120-4. https://doi.org/10.1016/j.ejogrb.2015.12.014
  7. Nikbakht R, Saharkhiz N. The influence of sperm morphology, total motile sperm count of semen and the number of motile sperm inseminated in sperm samples on the success of intrauterine insemination. Int J Fertil Steril 2011;5:168-73.
  8. Demir B, Dilbaz B, Cinar O, Karadag B, Tasci Y, Kocak M, et al. Factors affecting pregnancy outcome of intrauterine insemination cycles in couples with favourable female characteristics. J Obstet Gynaecol 2011;31:420-3. https://doi.org/10.3109/01443615.2011.569780
  9. Ombelet W, Deblaere K, Bosmans E, Cox A, Jacobs P, Janssen M, et al. Semen quality and intrauterine insemination. Reprod Biomed Online 2003;7:485-92. https://doi.org/10.1016/S1472-6483(10)61894-9
  10. Van Voorhis BJ, Barnett M, Sparks AE, Syrop CH, Rosenthal G, Dawson J. Effect of the total motile sperm count on the efficacy and cost-effectiveness of intrauterine insemination and in vitro fertilization. Fertil Steril 2001;75:661-8. https://doi.org/10.1016/s0015-0282(00)01783-0
  11. Lemmens L, Kos S, Beijer C, Brinkman JW, van der Horst FA, van den Hoven L, et al. Predictive value of sperm morphology and progressively motile sperm count for pregnancy outcomes in intrauterine insemination. Fertil Steril 2016;105:1462-8. https://doi.org/10.1016/j.fertnstert.2016.02.012
  12. Badawy A, Elnashar A, Eltotongy M. Effect of sperm morphology and number on success of intrauterine insemination. Fertil Steril 2009;91:777-81. https://doi.org/10.1016/j.fertnstert.2007.12.010
  13. van Weert JM, Repping S, Van Voorhis BJ, van der Veen F, Bossuyt PM, Mol BW. Performance of the postwash total motile sperm count as a predictor of pregnancy at the time of intrauterine insemination: a meta-analysis. Fertil Steril 2004;82:612-20. https://doi.org/10.1016/j.fertnstert.2004.01.042
  14. Findeklee S, Radosa JC, Radosa MP, Hammadeh ME. Correlation between total sperm count and sperm motility and pregnancy rate in couples undergoing intrauterine insemination. Sci Rep 2020;10:7555. https://doi.org/10.1038/s41598-020-64578-0
  15. Freour T, Jean M, Mirallie S, Dubourdieu S, Barriere P. Computer-assisted sperm analysis (CASA) parameters and their evolution during preparation as predictors of pregnancy in intrauterine insemination with frozen-thawed donor semen cycles. Eur J Obstet Gynecol Reprod Biol 2010;149:186-9. https://doi.org/10.1016/j.ejogrb.2009.12.029
  16. Boomsma CM, Cohlen BJ, Farquhar C. Semen preparation techniques for intrauterine insemination. Cochrane Database Syst Rev 2019;10:CD004507.
  17. World Health Organization. WHO laboratory manual for the examination and processing of human semen. 5th ed. Geneva: World Health Organization; 2010.
  18. Goldenberg M, Rabinovici J, Bider D, Lunenfeld B, Blankstein J, Weissenberg R. Intra-uterine insemination with prepared sperm vs. unprepared first split ejaculates: a randomized study. Andrologia 1992;24:135-40. https://doi.org/10.1111/j.1439-0272.1992.tb02626.x
  19. Zhao Y, Vlahos N, Wyncott D, Petrella C, Garcia J, Zacur H, et al. Impact of semen characteristics on the success of intrauterine insemination. J Assist Reprod Genet 2004;21:143-8. https://doi.org/10.1023/B:JARG.0000031246.76666.f6
  20. Youn JS, Cha SH, Park CW, Yang KM, Kim JY, Koong MK, et al. Predictive value of sperm motility characteristics assessed by computer-assisted sperm analysis in intrauterine insemination with superovulation in couples with unexplained infertility. Clin Exp Reprod Med 2011;38:47-52. https://doi.org/10.5653/cerm.2011.38.1.47
  21. Yalti S, Gurbuz B, Sezer H, Celik S. Effects of semen characteristics on IUI combined with mild ovarian stimulation. Arch Androl 2004;50:239-46. https://doi.org/10.1080/01485010490448435
  22. Lee VM, Wong JS, Loh SK, Leong NK. Sperm motility in the semen analysis affects the outcome of superovulation intrauterine insemination in the treatment of infertile Asian couples with male factor infertility. BJOG 2002;109:115-20. https://doi.org/10.1111/j.1471-0528.2002.01034.x
  23. Hansen KR, Peck JD, Coward RM, Wild RA, Trussell JC, Krawetz SA, et al. Intrauterine insemination performance characteristics and post-processing total motile sperm count in relation to live birth for couples with unexplained infertility in a randomised, multicentre clinical trial. Hum Reprod 2020;35:1296-305. https://doi.org/10.1093/humrep/deaa027
  24. Hendin BN, Falcone T, Hallak J, Nelson DR, Vemullapalli S, Goldberg J, et al. The effect of patient and semen characteristics on live birth rates following intrauterine insemination: a retrospective study. J Assist Reprod Genet 2000;17:245-52. https://doi.org/10.1023/A:1009402214820
  25. Stone BA, Vargyas JM, Ringler GE, Stein AL, Marrs RP. Determinants of the outcome of intrauterine insemination: analysis of outcomes of 9963 consecutive cycles. Am J Obstet Gynecol 1999;180(6 Pt 1):1522-34. https://doi.org/10.1016/S0002-9378(99)70048-7
  26. Suarez SS. Control of hyperactivation in sperm. Hum Reprod Update 2008;14:647-57. https://doi.org/10.1093/humupd/dmn029
  27. Berker B, Sukur YE, Kahraman K, Atabekoglu CS, Sonmezer M, Ozmen B, et al. Absence of rapid and linear progressive motile spermatozoa "grade A" in semen specimens: does it change intrauterine insemination outcomes? Urology 2012;80:1262-6. https://doi.org/10.1016/j.urology.2012.07.004
  28. Freour T, Jean M, Mirallie S, Langlois ML, Dubourdieu S, Barriere P. Predictive value of CASA parameters in IUI with frozen donor sperm. Int J Androl 2009;32:498-504. https://doi.org/10.1111/j.1365-2605.2008.00886.x