PREDICTIVE VALUE OF SPERM PARAMETERS FOR PREDICTING SUCCESS AFTER INTRAUTERİNE INSEMINATION: THE EXPERIENCE OF A TERTIARY REFERRAL CENTER

Öz

Aim: Intrauterine inseminations IUI are commonly used in the treatment of infertile couples. The effectiveness of IUI depends on many factors, including sperm quality. Normal semen quality is usually verified with the use of the World Health Organization WHO criteria, but these criteria have little prognostic value in IUI, as pregnancy rates after IUI are acceptable even below the WHO thresholds for normal semen quality. Materials and Method: In this study we retrospectively evaluated 379 couples with idiopatic or male factor infertility, who had been treated with IUI after controlled ovarian hyperstimulation in infertility department of Dr. Zekai Tahir Burak Hospital during the time period between January 2002 and June 2004. Results: A total of 379 women underwent 631 cycles of IUI during a 29-months period. Mean age was 27.5 ± 5.37 years and mean infertility duration was 4.28 ± 3.02 years. Fifty nine 93.7% out of 63 pregnancies were obtained in the first three treatment cycles. Pregnancy rate per cycle was 9.98%, and pregnancy rate per couple was 16.62%. A younger age of the female partner, shorter duration of infertility, and the presence of secondary infertility were significantly associated with enhanced success rates with IUI, but the method of ovulation induction did not have an impact on the likelihood of pregnancy. Patients with total motile sperm count TMSC

Anahtar Kelimeler

• Infertility,intrauterine insemination,total motile sperm count

İNTRAUTERİN İNSEMİNASYON SONRASI BAŞARIYI BELİRLEMEDE SPERM PARAMETRELERİNİN PREDİKTİF DEĞERİ: BİR TERSİYER MERKEZ DENEYİMİ

Öz

Amaç: İntrauterin inseminasyon IUI , infertil çiftlerin tedavisinde yıllardır yaygın olarak kullanılan bir yöntemdir. IUI tedavisinin başarısı semen kalitesini de içeren birçok faktöre bağlı olarak değişmektedir. Normal semen kalitesi, Dünya Sağlık Örgütü tarafından belirlenen kriterler kullanılarak tanımlanır, fakat bu kriterlerin IUI’daki başarıyı belirlemedeki prognostik değeri azdı. Çünkü WHO’nun normal olarak önerdiği değerlerin altında bile IUI sonrası elde edilen gebelik oranları kabul edilebilir seviyelerdedir Gereçler ve Yöntem: Bu çalışmada, Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesi İnfertilite Polikliniği’ne Ocak 2002 ve Haziran 2004 tarihleri arasında müracaat eden, açıklanamayan infertilite veya erkek faktörüne bağlı infertilite nedeniyle kontrollü ovaryan hiperstimülasyon sonrasında IUI tedavisi uygulanmış 379 hasta retrospektif olarak incelendi. Bulgular: Yirmidokuz aylık bir süreçte 379 hastaya toplam 631 IUI siklusu uygulanmıştı. Ortalama hasta yaşı 27.5 ± 5.37 ve ortalama infertilite süresi 4.28 ± 3.02 yıl idi. Gebelikle sonuçlanan 63 IUI işleminin 59’unun %93,7 üç siklus sonunda elde edildiği saptandı. . Çalışmaya alınan hastalarda siklus başına düşen gebe- lik oranı %9.98, hasta başına düşen gebelik oranı ise %16.62 idi. Kadının yaşının genç olması, kısa infertilite süresi ve sekonder infertlite nedenlerinden birinin mevcut olması IUI başarısını pozitif etkilemekteydi. Ancak ovulasyon yöntemi gebelik üzerinde anlamlı bir etkiye sahip değildi. Total motil sperm sayısı TMSS

Anahtar Kelimeler

• İnfertilite,intrauterine insemi- nasyon,total motil sperm sayısı

Kaynakça

1. 1. Ombelet W, Bosmans E, Hinoul P, Nijs M Pros and cons of IUI in male subfertility treatment. Reprod Biomed Online 2003; 7(comp 1): 66–72.
2. 2. Goverde AJ, McDonnell J, Vermeiden JP, Schats R, Rutten FF, Schoemaker J. Intrauterine insemination or in-vitro fertilisation in idiopathic subfertility and male subfertility: a randomised trial and cost-effectiveness analysis. Lancet 2000; 355:13-8.
3. 3. Keck C, Gerber-Schafer C, Breckwoldt M. Intrauterine insemination as a first line treatment of unexplained and male factor infertility. Eur J Obstet Gynecol Reprod Biol 1998;79:193-7.
4. 4. Rowe PJ, Comhaire FH, Hargreave TB, Mahmoud A. WHO Manuel for the standardized investigation, diagnosis and management of the infertile male. Cambridge University Press, Cambridge, 2000.
5. 5. Kruger TF, Acosta AA, Simmons KF, Swanson RJ, Matta JF, Oehninger S. Predictive value of abnormal sperm morphology in in vitro fertilization. Fertil Steril 1988; 49: 112-7.
6. 6. Kruger TF, Acosta AA, Simmons KF, et al. New method of evaluating sperm morphology with predictive value for human in vitro fertilization. Urology 1987; 30:248-51.
7. 7. Goverde AJ, McDonnell J, Vermeiden JP, Schats R, Rutten FF, Schoemaker J. Intrauterine insemination or in-vitro fertilisation in idiopathic subfertility and male subfertility: a randomised trial and cost-effectiveness analysis. Lancet 2000; 355: 13-8.
8. 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: 150-4.

9. 9. Allen NC, Herbert CM 3rd, Maxson WS, Rogers BJ, Diamond MP, Wentz AC. Intrauterine insemination: a critical review. Fertil Steril 1985; 44: 569-80.
10. 10. Duran HE, Morshedi M, Kruger T, Oehninger S. Intrauterine insemination: a systematic review on determinants of success. Hum Reprod Update 2002; 8: 373-84.
11. 11. Steures P, van der Steeg JW, Mol BW, et al. Prediction of an ongoing pregnancy after intrauterine insemination. Fertil Steril 2004; 82: 45-51.
12. 12. Montanaro Gauci M, Kruger TF, Coetzee K, et al. Stepwise regression analysis to study male and female factors impacting on pregnancy rate in an intrauterine insemination programme. Andrologia 2001; 33: 135-41.
13. 13. Sahakyan M, Harlow BL, Hornstein MD. Influence of age, diagnosis, and cycle number on pregnancy rates with gonadotropininduced controlled ovarian hyperstimulation and intrauterine insemination Fertil Steril 1999; 72: 500-4.
14. 14. Frederick JL, Denker MS, Rojas A, et al. Is there a role for ovarian stimulation and intra-uterine insemination after age 4 0? Hum Reprod 1994; 9: 2284-6.
15. 15. Tomlinson MJ, Amissah-Arthur JB, Thompson KA, Kasraie JL, Bentick B. Prognostic indicators for intrauterine insemination (IUI): statistical model for IUI success. Hum Reprod 1996; 11: 1892-96.
16. 16. Stovall DW, Toma SK, Hammond MG, Talbert LM. The effect of age on female fecundity. Obstet Gynecol 1991; 77: 33-6.
17. 17. Nuojua-Huttunen S, Tomas C, Bloigu R, Tuomivaara L, Martikainen H. Intrauterine insemination treatment in subfertility: an analysis of factors affecting outcome. Hum Reprod 1999; 14: 698-703.
18. 18. Houmard BS, Juang MP, Soules MR, Fujimoto V. Factors influencing pregnancy rates with a combined clomiphene citrate/gonadotropin protocol for non-assisted reproductive technology fertility treatment. Fertil Steril 2002; 77: 384-6.
19. 19. Branigan EF, Estes MA, Muller CH. Advanced semen analysis: a simple screening test to predict intrauterine insemination success. Fertil Steril 1999; 71: 547-51.
20. 20. 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.
21. 21. Dickey RP, Pyrzak R, Lu PY, Taylor SN, Rye PH. Comparison of the sperm quality necessary for successful intrauterine insemination with World Health Organization threshold values for normal sperm. Fertil Steril 1999; 71: 684-9.
22. 22. Lee RK, Hou JW, Ho HY, Hwu YM, et al. Sperm morphology analysis using strict criteria as a prognostic factor in intrauterine insemination. Int J Androl 2002; 25: 277-80.
23. 23. Van Waart J, Kruger TF, Lombard CJ, Ombelet W. Predictive value of normal sperm morphology in intrauterine insemination (IUI): a structured literature review. Hum Reprod Update 2001; 7: 495- 500.
24. 24. Karabinus DS, Gelety TJ. The impact of sperm morphology evaluated by strict criteria on intrauterine insemination success. Fertil Steril 1997; 67: 536-541.
25. 25. Matorras R, Corcostegui B, Perez C, Mandiola M, Mendoza R, Rodriguez-Escudero FJ. Sperm morphology analysis (strict criteria) in male infertility is not a prognostic factor in intrauterine insemination with husband's sperm. Fertil Steril 1995; 63: 608-11.
26. 26. Hauser R, Yogev L, Botchan A, Lessing JB, Paz G, Yavetz H. Intrauterine insemination in male factor subfertility: significance of sperm motility and morphology assessed by strict criteria. Andrologia 2001; 33: 13-7.
27. 27. Wainer R, Albert M, Dorion A, et al. Influence of the number of motile spermatozoa inseminated and of their morphology on the success of intrauterine insemination. Hum Reprod 2004; 19: 2060- 5.
28. 28. Miller DC, Hollenbeck BK, Smith GD, et al. Processed total motile sperm count correlates with pregnancy outcome after intrauterine insemination. Urology 2002; 60: 497-501.
29. 29. 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.