SPERM PARAMETERS' PREDICTIVE VALUE IN INTRAUTERINE INSEMINATION SUCCESS: A SINGLE-CENTER EXPERIENCE

Year 2023, Volume: 9 Issue: 2, 104 - 112, 29.12.2023

Muhamet Afşin , Ayşe Feyda Nursal , Serap Mutlu Özçelik Otcu , Dilek Yavuz , Serhat Ege

https://doi.org/10.51477/mejs.1367866

Abstract

Although intrauterine insemination is a widely used assisted reproductive technique there is no consensus on sperm parameters that affect the probability of pregnancy. Therefore, the purpose of this study was to determine whether semen parameters affect intrauterine insemination success. A total of 403 couples (345 negative pregnancies, and 58 positive pregnancy) that underwent 549 intrauterine insemination treatment cycles for heterogenous indications were included in the study. Clomiphen citrate, letrazole and/or gonadotropins were used for ovarian stimulation in women in this study. The spermiogram tests of the spouse of receiving IUI tretment were examined. Clinical pregnancy occurred in 58 of 549 intrauterine insemination (10.56%). Unexplained infertility, polycystic ovary syndrome, and cervical-tubal factors were higher in positive pregnancy group compared to negative pregnancy group while male factor was more prevalant in negative pregnancy group comparison to positive pregnancy group (p=0.03). There was no statistical difference between women with positive and negative pregnancy in terms of age (≤ 35 and > 35), body mass index, infertility type, infertility time, endometrial thickness on HCG day, stimulation protocol, cycle numbers, number of insemination, estradiol, prolactin, LH, FSH, and TSH levels (p>0.05). The sperm characteristics in males [ejaculate volum, sperm concentration, total sperm count, motility, immotility, and total progressive motile sperm count] did not significantly differed between positive and negative pregnancy groups (p>0.05).
Briefly, the present study found that the conception probability of intrauterine insemination did not correlate with the spermiogram parameters.

Keywords

intrauterine insemination, infertility, sperm parameters

Ethical Statement

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References

• De Sutter, P., ‘’Rational diagnosis and treatment in infertility’’, Best Practice Res Clin Obstet Gynaecol, 20, 647-4, 2006. https://doi.org/10.1016/j.bpobgyn.2006.04.005.
• Hum ESHRE, Capri Workshop Group. Intrauterine insemination. ESHRE Capri Workshop Group. Intrauterine insemination. Hum Reprod Update, 15, 265-77, 2009. https://doi.org/10.1093/humupd/dmp003.
• Stone, B.A., Vargyas, J.M., Ringler, G.E., Stein, A.L., Marrs, R.P., ‘’Determinants of the outcome of intrauterine insemination: analysis of outcomes of 9963 consecutive cycles’’ Am J Obstet Gynecol, 180(6 Pt 1), 1522-34, 1999. https://doi.org/10.1016/S0002-9378(99)70048-7.
• van der Westerlaken, L.A., Naaktgeboren, N., Helmerhorst, F.M., ‘’Evaluation of pregnancy rates after intrauterine insemination according to indication, age, and sperm parameters’’, J Assist Reprod Genet,15, 359-64, 1998.
• World Health Organization., ‘’WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction. 5th ed. Cambridge’’, Cambridge University 2010.
• 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, 28, 300-9, 2014. https://doi.org/10.1016/j.rbmo.2013.10.023.
• Bensdorp, A.J., et al., ‘’Prevention of multiple pregnancies in couples with unexplained or mild male subfertility: randomised controlled trial of in vitro fertilisation with single embryo transfer or in vitro fertilisation in the modified natural cycle compared with intrauterine insemination with controlled ovarian hyperstimulation’’, BMJ, 350, g7771, 2015. DOI: 10.1136/bmj.g7771. doi: https://doi.org/10.1136/bmj.g7771
• Sakar, M.N., Oglak, S.C., ‘’Letrozole is superior to clomiphene citrate in ovulation induction in patients with polycystic ovary syndrome’’, J Med Sci, 36(7), 1460-1465, 2020. doi: https://doi.org/10.12669/pjms.36.7.3345.
• Oğlak, S.C., Sakar, M.N., Ege, S., “Comparison of the efficacy of letrozole and gonadotropin combination versus gonadotropin alone in intrauterine insemination cycles in patients with unexplained infertility”, Eastern J Med, 25(3), 427-433, 2020. DOI: 10.5505/ejm.2020.24993.
• Sakar, M.N., Oğlak, S.C., ‘’Comparison of the efficacy of letrozole stair-step protocol with clomiphene citrate stair-step protocol in the management of clomiphene citrate-resistant polycystic ovary syndrome patients’’, J Obstet Gynaecol Res, 47(11), 3875-3882, 2021. https://doi.org/10.1111/jog.14936.
• Allahbadia, G.N., ‘’Intrauterine Insemination: Fundamentals’’ Revisited.J Obstet Gynaecol India, 67: 385-92, 2017. DOI 10.1007/s13224-017-1060-x.
• Deveneau, N.E., et al., ‘’Impact of sperm morphology on the likelihood of pregnancy after intrauterine insemination’’, Fertil Steril, 102, 1584-90, 2014. https://doi.org/10.1016/j.fertnstert.2014.09.016.
• Mankus, E.B., et al., ‘’Prewash total motile count is a poor predictor of live birth in intrauterine insemination cycles’’ Fertil Steril, 111, 708-13, 2019. https://doi.org/10.1016/j.fertnstert.2018.12.025
• Miller, D.C., et al., ‘’Processed total motile sperm count correlates with pregnancy outcome after intrauterine insemination’’ Urology, 60, 497-501, 2002. https://doi.org/10.1016/S0090-4295(02)01773-9
• Van Voorhis, B.J., Barnett, M., Sparks, A.E., Syrop, C.H., 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, 75, 661-68, 2001. https://doi.org/10.1016/S0015-0282(00)01783-0
• Akanji Tijani, H., Bhattacharya, S., ‘’The role of intrauterine insemination in male infertility’’, Hum Fertil (Camb), 13, 226-32, 2010. https://doi.org/10.3109/14647273.2010.533811.
• Dorjpurev, U., et al., ‘’Effect of semen characteristics on pregnancy rate following intrauterine insemination’', J Med Invest, 58, 127-33, 2011. https://doi.org/10.2152/jmi.58.127
• 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, 5, 168-73, 2011.
• Merviel, P., Heraud, M.H., 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, 93, 79-88, 2010. https://doi.org/10.1016/j.fertnstert.2008.09.058.
• Hamilton, J.A., et al., ‘’Total motile sperm count: a better indicator for the severity of male factor infertility than the WHO sperm classification system’’, Hum Reprod, 30, 1110-21, 2015. doi:10.1093/humrep/dev058.
• Ates, E., Akdag, A., Kol, A., Turan, O.D., Erol, H., ‘’Intrauterine insemination experience of a university hospital: Pregnancy rate and associated factors’’, Androl Bul, 23(2), 82-86, 2021. https://doi.org/10.24898/tandro.2021.85619.
• Yalti, S., Gürbüz, B., Sezer, H., Celik, S., ‘’Effects of semen characteristics on IUI combined with mild ovarian stimulation’’, Arch Androl, 50, 239-246, 2004. https://doi.org/10.1080/01485010490448435.
• Tasın, C., Ozaksit, G., ‘’The relationship between sperm parameters and pregnancy outcomes in patients with intrauterine insemination’’, Türk Kadın Sağlığı ve Neonatoloji Dergisi, 3(3), 60-66. 2021. DOI: 10.46969/ezh.962608.
• Bensdorp, A.J., Cohlen, B.J., Heineman, M.J., Vandekerckhove, P., ‘’Intra‐uterine insemination for male subfertility’’ Cochrane Database Syst Rev, (3), CD000360, 2007. https://doi.org/10.1002/14651858.CD000360.
• Lemmens, L., et al., ‘’Semen Section of the Dutch Foundation for Quality Assessment in Medical Predictive value of sperm morphology and progressively motile sperm count for pregnancy outcomes in intrauterine insemination’’, Fertil Steril, 105, 1462-68, 2016. https://doi.org/10.1016/j.fertnstert.2016.02.012.
• Kohn, T.P., Kohn, J.R., Ramasamy, R., ‘’Effect of Sperm Morphology on Pregnancy Success via Intrauterine Insemination’’, A Systematic Review and Meta-Analysis. J Urol, 199, 812-22, 2018. https://doi.org/10.1016/j.juro.2017.11.045