Effect of sperm morphology&
number on success of IUI
Aboubakr Elnashar
Ahmed Badawy
Mohamed Eltotongy [email protected]
Aboubakr Elnashar
Introduction
IUI Widely used
simple, inexpensive, acceptable ART (Zhao et al, 2004).
Indications: many
poor male factor
cervical hostility
unexplained infertility.
Attempted
before proceeding to more expensive& invasive ART
such as ICSI.
Aboubakr Elnashar
Pregnancy rates:
Patient selection criteria
Presence of various infertility factors
Methods of ovarian stimulation
Number of cycles performed
Technique of preparation.
Sperm parameters:
number of motile sperm
normal morphology.
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Sperm parameters 1. Raw samples
do not correlate with cycle fecundity as do prepared
specimens (Wainer et al, 1996).
2. Post-swim-up semen
can provide useful prognostic information
{processing techniques modify sperm characteristics
vary from laboratory to laboratory
Vary from patient to patient}
(Van Waart et al, 2001)
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Aim of our study
To assess the likelihood of IUI success as a function of
the sperm count and morphology, assessed after sperm
preparation.
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Materials and methods
Design:
A prospective observational study.
Patients:
393 couples who underwent 714 IUI cycles.
Infertility for at least 1 y
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Before IUI
•HSG:
•D21 serum P: documenting ovulation
•TVS: evaluating the pelvic anatomy
•Laparoscopy: when there was a possibility of pelvic
adhesions or endometriosis in the HSG or TVS
•At least 2 semen analyses& microbiological tests
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Normal semen: WHO (1993)
Concentration: 20x106/mL
Total count: 40x106
Progressive motility: 50%
Typical morphology: 30%.
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Semen processing
•Motile sperm were selected by a swim-up procedure.
•Motile sperm fraction was washed twice by
centrifugation
sperm pellet was suspended in 0.35 mL of Earle’s
balanced salt solution
•Sperm were then counted& progressive motility
assessed.
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Ovarian superovulation
CC 50 mg twice daily for 5 d from D2 of the cycle
One hMG ampule 75 IU IM daily from D5 of the cycle.
Monitoring:
TVS.
IUI was performed 36±4 h after hCG
Main Outcome Measures:
Clinical pregnancy.
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Results
The mean age:
31.3±3.2 y
79 (11.06%) Clinical pregnancy/cycle
(79 (20.1% Clinical pregnancy/couple
13 (16.4%) Miscarriage
6 (7.6%) Twin pregnancy
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•Number of motile sperm <5 x106.
No statistically significant difference in PR/cycle between
subgroups
28 pregnancies were reported in 504 cycles accounting
for a 5.55% PR/cycle.
•Number of motile sperm >5 x106
PR/cycle was 24.28% (P<.001). Aboubakr Elnashar
•Below the age 25 y:
with number of motile sperm >5x106: PR/cycle was
28.2%, which is significantly higher than that of other
age groups.
•Above the age of 35y:
with number of motile sperm <5x106: No pregnancies
with number of motile sperm >5x106: PR was very low
0.84% Aboubakr Elnashar
•Normal sperm morphology<30%:
PR was significantly higher when the number of motile
sperm was >5x106 than when it was <5x106 (9.45% vs.
4.62%)
•Normal sperm morphology>30%
PR was significantly higher when the number of motile
sperm was >5x106(20.77%).
Aboubakr Elnashar
Conclusion
IUI used for treating male factor infertility seems to
have little chance of success when
the woman is older than 35 y of age
number of motile sperm inseminated is <5x106, or
normal sperm morphology is <30%.
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Thank s
Aboubakr Elnashar