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.
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SUBMITTER: Hansen KR
PROVIDER: S-EPMC7316499 | biostudies-literature | 2020 Jun
REPOSITORIES: biostudies-literature
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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.
Hansen Karl R KR Peck Jennifer D JD Coward R Matthew RM Wild Robert A RA Trussell J C JC Krawetz Stephen A SA Diamond Michael P MP Legro Richard S RS Coutifaris Christos C Alvero Ruben R Robinson Randal D RD Casson Peter P Christman Gregory M GM Santoro Nanette N Zhang Heping H
Human reproduction (Oxford, England) 20200601 6
<h4>Study question</h4>Are intrauterine insemination (IUI) performance characteristics and post-processing total motile sperm count (TMC) related to live birth rate in couples with unexplained infertility?<h4>Summary answer</h4>Patient discomfort with IUI and lower inseminate TMC were associated with a reduced live birth rate, while time from hCG injection to IUI, sperm preparation method and ultrasound guidance for IUI were not associated with live birth success.<h4>What is already known</h4>We ...[more]
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Project description:The objective of this study was to determine the relationship between strict morphology as assessed on the initial semen analysis during fertility workup and pregnancy rates after intrauterine insemination. This is a retrospective study of couples undergoing intrauterine insemination from 2007 to 2012. Couple characteristics and semen analysis parameters were recorded and evaluated. Risk ratios (RR) and 95% confidence intervals (95% CI) were calculated, accounting for within-couple (cluster) correlation among repeated intrauterine insemination cycles. Four hundred thirty-five women (average ± standard deviation age 31.7 ± 4.8) undergoing 1,287 intrauterine insemination cycles were analyzed. Fecundability was not statistically different when low strict morphology (≤1% and 2-4%) was compared to the reference range of morphology > 14% [RR 0.99 (0.41-2.40) and 0.90 (0.48-1.70)]. Results were unchanged when adjusted for female characteristics, medication, and inseminating total motile sperm count [aRR 1.22 (0.51-2.93) and 1.00 (0.53-1.91)]. Evaluating combined effects of morphology with inseminating total motile sperm count, pregnancy rates among cycles with total motile count < 5 million and strict morphology ≤ 4% normal were reduced when compared to cycles with total motile count > 20 million and morphology > 4% normal (RR 0.37, 95% CI 0.17-0.82). These relationships remained when evaluating live birth/ongoing pregnancy per cycle. In intrauterine insemination cycles, initial strict morphology was associated with subsequent fecundability only when inseminating total motile count was below 5 million. For cycles with total motile count above this threshold, no impact of low morphology on success rates with intrauterine insemination was observed.
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Project description:Background/aimsA large proportion of men with normal sperm results as analyzed using conventional techniques have fragmented DNA in their spermatozoa. We performed a prospective study to examine the incidence of DNA fragmentation in sperm in cases of couples with previously unexplained infertility and treated with intrauterine insemination. We evaluated whether there was any predictive value of DNA fragmentation for pregnancy outcome in such couples.MethodsThe percentage of DNA fragmentation and all classical variables to evaluate sperm before and after sperm treatment were determined. We studied the probable association between these results and pregnancy outcome in terms of clinical and ongoing pregnancy rate per started first cycle. We also assessed the optimal threshold level to diagnose DNA fragmentation in our center.ResultsWhen using threshold levels of 20, 25, and 30%, the occurrence of DNA fragmentation was 42.9, 33.3, and 28.6%, respectively. Receiver operating characteristic (ROC) analysis of all cases revealed an area under the curve of 80% to predict the clinical pregnancy rate per cycle from testing the sperm motility (a + b) before treatment. We failed to generate an ROC curve to estimate pregnancy outcome from the amount of DNA fragmentation before treatment. However, when selecting only those men with a pretreatment DNA fragmentation of at least 20%, the pretreatment result was statistically different between couples who achieved a clinical pregnancy and those who did not.ConclusionDNA fragmentation is often diagnosed in couples with unexplained infertility. Each center should evaluate the type of test it uses to detect DNA fragmentation in sperm and determine its own threshold values.
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