İntrauterin inseminasyonda insemine edilen progresif motil sperm sayısı için bir eşik değer var mı? 564 siklusluk retrospektif kohort çalışması

Abstract

Amaç: İntrauterin inseminasyon (IUI) sonrası insemine edilen progresif motil sperm sayısı (IPMSC) ile gebelik testi pozitifliği arasındaki ilişkiyi incelemek ve kullanılabilir bir eşik değer belirlemektir. Gereç ve yöntem: Bu retrospektif kohort çalışmasına Ocak 2025 ile Temmuz 2026 arasında tedavi edilen 364 kadına ait 564 IUI siklusu dahil edildi. Semen örnekleri dansite gradyan santrifügasyonu ve ardından swim-up yöntemiyle hazırlandı ve 0,5 mL süspansiyon insemine edildi. IPMSC, yıkama sonrası sperm konsantrasyonu ve inseminasyon hacmi kullanılarak hesaplandı. IPMSC kategorik ve sürekli olarak incelendi ve yıkama öncesi sperm sayılarıyla karşılaştırıldı. İlişkiler, hasta kimliğinin kümeleme değişkeni olduğu genelleştirilmiş tahmin denklemi modeliyle değerlendirildi. Bulgular: Gebelik testi pozitifliği siklus başına %12,2 ve kadın başına %19,0 idi. Yıkama öncesi sperm parametreleri pozitif ve negatif sikluslar arasında farklı değildi. Medyan IPMSC pozitif sikluslarda daha yüksekti (15,0’a karşı 10,0×10⁶; p=0,012). IPMSC değeri 2×10⁶’nın altında olan 76 siklusun yalnızca birinde pozitif test saptanırken (%1,3), bu oran 2×10⁶ ve üzerindeki sikluslarda %13,9 idi (p<0,001). Kadın yaşı, vücut kitle indeksi, anti-Müllerian hormon, IUI deneme sayısı ve infertilite nedenine göre düzeltme sonrasında, IPMSC’nin en az 2×10⁶ olması pozitif testle ilişkiliydi (OR 9,85; %95 GA 1,37–70,68; p=0,023). Kadın yaşı da sonlanımla bağımsız olarak ilişkiliydi (yıl başına OR 0,93; p=0,011). Sonuç: IPMSC pozitif gebelik testiyle ilişkiliyken yıkama öncesi sperm sayıları ilişkili değildi. IPMSC yaklaşık 2×10⁶’nın altında olduğunda pozitif test nadir olarak izlendi, ancak gebelik yine de mümkündü. IPMSC hasta danışmanlığında yardımcı olabilir, ancak IUI tedavisi için kesin bir eşik olarak kullanılmamalıdır.

Keywords

• İntrauterin inseminasyon
• sperm sayısı
• sperm motilitesi
• erkek infertilitesi
• gebelik oranı

Supporting Institution

Bu çalışma için herhangi bir destek alınmamıştır.

Ethical Statement

Yazarlar herhangi bir çıkar çatışması olmadığını beyan etmişlerdir. Çalışma için Pamukkale Üniversitesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu’ndan onay alınmıştır (onay tarihi: 12.08.2026, karar no: 915989).

Is there a threshold for the inseminated progressive motile sperm count in intrauterine insemination? A retrospective cohort study of 564 cycles

Abstract

Purpose: To examine the association between inseminated progressive motile sperm count (IPMSC) and pregnancy test positivity after intrauterine insemination (IUI), and to identify a useful threshold. Materials and methods: This retrospective cohort study included 564 IUI cycles in 364 women treated between January 2025 and July 2026. Semen samples were prepared by density-gradient centrifugation followed by swim-up, and 0.5 mL was inseminated. IPMSC was calculated from post-wash concentration and insemination volume. IPMSC was analysed categorically and continuously and compared with pre-wash counts. Associations were assessed using generalized estimating equations, with patient identity as the clustering variable. Results: Pregnancy test positivity was 12.2% per cycle and 19.0% per woman. Pre-wash sperm parameters did not differ between positive and negative cycles. Median IPMSC was higher in positive cycles (15.0 vs 10.0×10⁶, p=0.012). One of 76 cycles with an IPMSC below 2×10⁶ had a positive test (1.3%), compared with 13.9% at or above this level (p<0.001). After adjustment for female age, body mass index, anti-Müllerian hormone, IUI attempt number, and infertility cause, an IPMSC of at least 2×10⁶ remained associated with a positive test (OR 9.85, 95% CI 1.37–70.68; p=0.023). Female age was also independently associated with the outcome (OR 0.93 per year; p=0.011). Conclusion: IPMSC was related to a positive pregnancy test, while pre-wash sperm counts were not. Positive tests were uncommon below approximately 2×10⁶, but pregnancy was still possible. IPMSC may help in counselling patients but should not be used as a strict cut-off for IUI treatment.

Keywords

• Artificial insemination
• sperm count
• sperm motility
• male infertility
• pregnancy rate

Supporting Institution

No funding was received for this study.

Ethical Statement

No conflict of interest was declared by the authors. Permission was obtained from Pamukkale University Non-Interventional Clinical Research Ethics Committee for the study (permission date 12.08.2026, decision number 915989).

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