The Effect of Processed Total Motile Sperm Counts and Twenty Four Hour Sperm Survival on the Efficacy of Intrauterine Insemination in Male Infertility

Objective: To compare the effectiveness of IUI, based on Pre-treatment Semen analysis results, in treating male factor infertility.Design: A retrospective cohort design of 1,768 infertile couples undergoing 5,219 IUI cycles, who had pretreatment advanced semen analysis were evaluated. An advanced semen analysis consists of a basic semen analysis and processed total motile sperm counts through a density gradient sperm prep and recording 24 hours sperm survival of these sperm culture media in an incubator. Logistic regression analysis was used to assess the significance of prognostic factors in sperm parameters to predict the pregnancy rates with IUI.Results: No basic semen analysis parameter accurately predicted IUI success. Clinical pregnancy rate for first cycle of IUI was 15.6% when >10 × 106 processed total motile sperm was available and 13.7% in all cycles. This group contained 1264/1768 (71.5%) of couples in the study. The pregnancy rate in the first cycle was 18.2% if their 24 hour survival was >70% and 15.9% in all cycles and 1008/1264 (57%) of couples were in this group. No pregnancy was achieved for processed total motile sperm counts <5 × 106 (168/1768) or 9.5% of couples and 3.6% for those with 24 hour survivals <30% in first cycle and 2.0% for all cycles for 601/1768 (34%) of the couples. Strong positive correlations between processed total motile sperm counts and PR (r=0.83; p<0.001) and between 24 hours survival and PR (r=0.79; p<0.001) were seen by linear regression analysis. High correlations were also noted between processed total motile sperm counts (r=0.71; p<0.001) and 24 hours survivals (r=0.76; p<001) in the advanced semen analysis and those in the IUI samples.Conclusion: Both processed total motile sperm counts and 24 hour survival are useful predictors of whether a couple should be treated with levels below threshold levels have a very poor prognosis with IUIs.