Taylor P Kohn1, Jaden R Kohn1, Ranjith Ramasamy2. 1. Baylor College of Medicine, Houston, Texas; Department of Urology, University of Miami Miller School of Medicine, Miami, Florida. 2. Baylor College of Medicine, Houston, Texas; Department of Urology, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: ramasamy@miami.edu.
Abstract
PURPOSE: Men with abnormal sperm morphology are often counseled that natural conception and intrauterine insemination are ineffective, and in vitro fertilization is the only option. Our objective was to determine the effect of sperm morphology on the pregnancy success of intrauterine insemination. MATERIALS AND METHODS: We systematically searched for studies published prior to January 2017 that 1) reported ultrasound verified clinical pregnancies per intrauterine insemination cycle, 2) assessed sperm morphology using the Kruger strict criteria and 3) described morphology at the greater than 4% and 4% or less and/or the 1% or greater and less than 1% thresholds. In all studies mean female age was between 25 and 40 years and mean total motile sperm count was greater than 10 million. Estimates were pooled using random effects meta-analysis. RESULTS: Data were extracted from 20 observational studies involving a total of 41,018 cycles. When comparing men at the greater than 4% and 4% or less thresholds, the rate of ultrasound verified pregnancy per intrauterine insemination cycle was not statistically or clinically different (14.2% vs 12.1%, p = 0.06) and the risk difference was 3.0% (95% CI 1.4-4.6), indicating 3.0 additional pregnancies per 100 intrauterine insemination cycles. When comparing men at the 1% or greater and the less than 1% thresholds, there were no statistical or clinical differences in the rate of ultrasound verified pregnancy per cycle of intrauterine insemination (14.0% vs 13.9%, p = 0.97) or in the risk difference (1.6%, 95% CI -4.5-7.6). CONCLUSIONS: There appears to be no clinical difference in intrauterine insemination pregnancy success among men with normal and abnormal sperm morphology when accounting for total motile sperm count and female age. Abnormal sperm morphology alone should not exclude couples from attempting intrauterine insemination.
PURPOSE:Men with abnormal sperm morphology are often counseled that natural conception and intrauterine insemination are ineffective, and in vitro fertilization is the only option. Our objective was to determine the effect of sperm morphology on the pregnancy success of intrauterine insemination. MATERIALS AND METHODS: We systematically searched for studies published prior to January 2017 that 1) reported ultrasound verified clinical pregnancies per intrauterine insemination cycle, 2) assessed sperm morphology using the Kruger strict criteria and 3) described morphology at the greater than 4% and 4% or less and/or the 1% or greater and less than 1% thresholds. In all studies mean female age was between 25 and 40 years and mean total motile sperm count was greater than 10 million. Estimates were pooled using random effects meta-analysis. RESULTS: Data were extracted from 20 observational studies involving a total of 41,018 cycles. When comparing men at the greater than 4% and 4% or less thresholds, the rate of ultrasound verified pregnancy per intrauterine insemination cycle was not statistically or clinically different (14.2% vs 12.1%, p = 0.06) and the risk difference was 3.0% (95% CI 1.4-4.6), indicating 3.0 additional pregnancies per 100 intrauterine insemination cycles. When comparing men at the 1% or greater and the less than 1% thresholds, there were no statistical or clinical differences in the rate of ultrasound verified pregnancy per cycle of intrauterine insemination (14.0% vs 13.9%, p = 0.97) or in the risk difference (1.6%, 95% CI -4.5-7.6). CONCLUSIONS: There appears to be no clinical difference in intrauterine insemination pregnancy success among men with normal and abnormal sperm morphology when accounting for total motile sperm count and female age. Abnormal sperm morphology alone should not exclude couples from attempting intrauterine insemination.
Authors: Marah C Hehemann; Omer A Raheem; Saneal Rajanahally; Sarah Holt; Tony Chen; Judy N Fustok; Kelly Song; Heather Rylander; Emma Chow; Kevin A Ostrowski; Charles H Muller; Thomas J Walsh Journal: Ther Adv Urol Date: 2021-07-20
Authors: Ashok Agarwal; Rakesh Sharma; Sajal Gupta; Renata Finelli; Neel Parekh; Manesh Kumar Panner Selvam; Ralf Henkel; Damayanthi Durairajanayagam; Camila Pompeu; Sarah Madani; Andrea Belo; Neha Singh; Simryn Covarrubias; Sara Darbandi; Raha Sadeghi; Mahsa Darbandi; Paraskevi Vogiatzi; Florence Boitrelle; Mara Simopoulou; Ramadan Saleh; Mohamed Arafa; Ahmad Majzoub; Hussein Kandil; Armand Zini; Edmund Ko; Juan G Alvarez; Marlon Martinez; Jonathan Ramsay; Sunil Jindal; Gian Maria Busetto; Hassan Sallam; Israel Maldonado; Christina Anagnostopoulou; Marco G Alves; Pallav Sengupta; Kambiz Gilany; Donald P Evenson; Sheena E M Lewis; Jaime Gosalvez; Rafael F Ambar; Rupin Shah Journal: World J Mens Health Date: 2021-06-17 Impact factor: 6.494
Authors: Jamie Stanhiser; Jennifer E Mersereau; Daquan Dock; Caitlin Boylan; Hunter Caprell; R Matthew Coward; Dara S Berger; Marc Fritz Journal: F S Rep Date: 2020-12-09