The relationship of total progressive motile sperm count with the outcome of IUI? An analysis of 5171 cycles

Abstract

Background: The role of motile sperm count in intrauterine insemination (IUI) success rate is controversial. This retrospective cohort study performed among unselected infertile couples undergoing IUI was to explore the association between the total progressive motile sperm count (TPMSC) and the live birth rate (LBR) following IUI.

Methods: The total cohort of 5363 cycles, 2666 infertile couples between January 2015 and December 2018 and finally 5171 cycles, 2647 couples were included for analysis in Sun Yat-sen memorial hospital of Sun Yat-sen University. The primary outcome was LBR per cycle. And the secondary outcome measure was clinical pregnancy rate (CPR) per cycle.

Results: From the receiver operating characteristic (ROC) analysis of female age predicting live birth, female age cutoff was defined as 28 years. With a female age of ≤28 years, the CPRs were 11.5%, 14.9%, 16.1%, and 15.8% in quartile groups of pre-wash TPMSC, respectively. For the LBRs the values were 9.4%, 12.9%, 14.4%, and 11.3%, and there were also no significant differences in quartile groups of pre-wash TPMSC with ≤24 million (M), [24M–50M], [50M–97M], >97M. No statistically significant differences in the CPRs (p = .051) and LBRs (p = .088) were also observed in the quartiles groups of post-wash TPMSC. With a female age of >28 years, the CPR in couples with post-wash TPMSC ≤22.32 M was significantly lower than with post-wash TPMSC >81.0 M (p = .007). There was an obvious trend in which CPRs and LBRs increased with the post-wash TPMSC during the <81 M interval in women >28 years.

Conclusions: The optimal female age cutoff for live birth was 28 years in IUI cycles. Pre-wash and post-wash TPMSC were not significantly associated with CPR and LBR per cycle. When female age >28 years, there was a better outcome with post-wash TPMSC >22.32 million.

摘要

背景

前向运动精子数对于宫腔内人工授精(IUI)成功率的作用存在争议。这项回顾性队列研究在未经选择的接受IUI不孕夫妇中进行, 旨在探索IUI后前向运动精子总数(TPMSCc)与活产率(LBR)之间的关系。

方法

2015年1月至2018年12月间, 在中山大学孙中山纪念医院就诊的5363个周期, 2666对不孕夫妇, 最终纳入5171个周期, 2647对夫妇进行分析。主要结局为每周期LBR。次要结局为每周期临床妊娠率(CPR)。

结果

从受试者工作特征(ROC)分析女性年龄预测活产的能力, 女性年龄截断值为28岁。当女性年龄≤28岁时, 洗涤前TPMSC四分位组的CPRs分别为11.5%、14.9%、16.1%和15.8%。LBR值分别为9.4%、12.9%、14.4%和11.3%, 洗涤前TPMSC≤2.4千万(M)、[24M-50M]、[50M-97M]、>97M四分位组差异也不显著。洗涤后TPMSC四分位组的CPRs (p = .051)和LBR (p = .088)也无统计学差异。女性年龄>28岁, 洗涤后TPMSC夫妇CPR≤22.32M明显低于洗涤后TPMSC >81.0 M (p = .007)。在<81 M的区间内, >28年女性的CPRs和LBRs随洗涤后TPMSC的增加而明显增加。

结论

在IUI周期中活产的女性最佳年龄截断值为28岁。洗涤前和洗涤后TPMSC与每周期CPR和LBR无显著相关性。女性>年龄28岁时, 洗涤后TPMSC > 22.32M, 效果较好。

关键词:

• 宫腔内人工授精
• 前向运动精子总数(TPMSC)
• 活产率
• 临床妊娠率(CPR)

Keywords:

• Intrauterine insemination (IUI)
• total progressive motile sperm count (TPMSC)
• live birth rate (LBR)
• clinical pregnancy rate (CPR)

Authors’ contributions

Haiyan Lin and Yu Li planned, designed and drafted the study, Songbang Ou was responsible for the data collection. Xuedan Jiao conducted the main part of the analysis, Wenjun Wang, Qingxue Zhang contributed to the interpretation of the analysis. Peter Humaidan and Thor Haahr revised the manuscript. All authors approved the final version.

Consent for publication

All the authors have consented for publication.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical approval

The study was approved by the ethics committee of Sun Yat-sen Memorial Hospital (No. SYSEC-KY-KS-2019-162).

Additional information

Funding

This study was funded by Guangdong Province Natural Science Funding (No. 2020A1515010101).