Value of sperm morphology assessed by strict criteria for prediction of the outcome of artificial (intrauterine) insemination.

The purpose of this study was to investigate the relationship between sperm parameters and the outcome of artificial (intrauterine) insemination (IUI). One hundred and twenty-six patients undergoing 395 consecutive IUI cycles in a 1-year period in our institution were studied. In all cases, controlled ovarian stimulation and hCG-timed IUI were performed, followed by progesterone supplementation of the luteal phase. In 86 patients, (243 cycles) the husband's sperm was utilized, whereas in 40 couples (152 cycles), donor sperm was used due to severe male factor infertility. Among the sperm parameters of the original ejaculate, % normal morphology (assessed by strict criteria) was the most significant predictor of pregnancy (stepwise regression analysis, P = 0.003). Using logistic regression, morphology was the best predictor of pregnancy (r = 0.12); linearity of movement significantly enhanced the predictive value of morphology alone (r = 0.17, P = 0.004). Overall, the pregnancy rates were significantly higher (P = 0.01) in cases with > or = 14% normal morphology (15% per cycle) compared to cases with < 14% normal morphology (7% per cycle). This threshold level for morphology is in agreement with previously published IVF results. These results underscore the significance of sperm morphology assessed by strict criteria as a predictor of pregnancy outcome in the IUI setting.

Impact of cryopreservation on spermatozoa from infertile men: implications for artificial insemination.

The objective of this study was to evaluate the effect of cryopreservation-thawing on the quality of sperm from men with subfertile semen parameters. Twenty-seven patients with teratozoospermia, six of whom also had asthenozoospermia, were studied and their sperm parameters were compared to those of fertile donors (n = 71) in their fresh, post-thaw, and washed samples. After thawing, the percentage decrease in motility was significantly greater in patients than in donors, but the motility yield (post-thaw motility/prethaw motility) reached an average of 58% in the patient group vs. 68% in the donors (p = .02). No single characteristic of the fresh samples from patients or donors could significantly predict post-thaw outcome. For the patient group, however, multiple regression analysis provided a cutoff sperm concentration (50 x 10(6)/mL) and motility (40%) below which a very poor post-thaw recovery was obtained. The frozen-thawed-washed specimens had significantly higher velocity than the frozen-thawed samples, both in patients and donors. The results suggest that some patients with teratoasthenozoospermia yield acceptable sperm parameters after freezing-thawing-washing, and therefore these ejaculates could be used individually (or pooled) in artificial insemination.