Semen Analysis of Total Motile Sperm Count Based on the 1999 and 2010 WHO Criteria

Abstract Study question Is the performance of the postwash total motile sperm count a predictor of pregnancy at the time of intrauterine insemination? Summary answer The number of motile spermatozoa inseminated (NMSI) in IUI can be used to define clear range of pre /postwash sperm parameters. What is known already There is no consensus about the optimal number of motile spermatozoa inseminated (NMSI) required for a reasonable chance of pregnancy after IUI. A meta-analysis of 16 studies assessing NMSI and IUI outcomes, concluded that at cut-off levels between 0.8 and 5 million, defined as the ability to predict failure to become pregnant. The purpose of this study is to determine the range of NMSI as a predictor of success in IUI. Study design, size, duration This prospective study includes 60 patients who underwent semen analysis at an academic infertility centre (SRIHER) during the month of December 2020 and January 2021. Participants/materials, setting, methods A total of 60 infertile couples who underwent IUI at our academic centre were enrolled in our study. A detailed history and infertility work up was done before proceeding for IUI, as per the department protocol. The semen was prepared by discontinuous 2 layered density gradient method. The results were analyzed by patient factors including age, BMI, semen parameters, NMSI. The NMSI were divided into 4 groups: A (<1), B (1–4), C (5–9), D (>10). Main results and the role of chance The mean age of the infertile couples who underwent IUI was (28.2 ± 3.8) in females and (31.8 ± 3.8) in males respectively. The sperm parameters such as concentration (21.8 ± 14.8), motility (53.15 ± 13.22), morphology (2.43 ± 1.33) respectively. When the NMSI was group C (5–9 x 10 6) the pregnancy rate was 38.5% whereas the pregnancy rate was 37.5% in group D ( >10 x 10 6). In the other sub groups such as group A(<1 x 10 6) and group C (1–4 x 10 6) the pregnancy rate was 14.2% and 12.5% respectively. Limitations, reasons for caution Infertile men with Azoospermia, Men with Retrograde ejaculation, Testicular samples, Epididymal samples, Infected samples. All of the above samples were avoided. It cannot be used for counselling during the initial infertility workup, but only during/after the IUI procedure. Wider implications of the findings: The results suggest that NMSI can be a predictor of success in IUI in patients who are < 30 years of age & ≥35 years, NMSI does not appear to be a useful. The effect of NMSI on pregnancy rate needs to evaluated on a larger scale . Trial registration number Not applicable

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Post-wash total motile sperm count a useful predictor in the decision to perform IVF/ICSI in patients with non-male factor infertility

Journal of Shifa Tameer-e-Millat University ◽

10.32593/jstmu/vol3.iss2.108 ◽

2020 ◽

Vol 3 (2) ◽

pp. 99-106

Author(s):

Sara Mahmood Qureshi ◽

Salma Kafeel ◽

Riffat Bibi ◽

Jawad Mohmand

Keyword(s):

Sperm Quality ◽

Sperm Count ◽

Adverse Outcomes ◽

Male Factor Infertility ◽

Motile Sperm ◽

Operating Characteristics ◽

Male Factor ◽

Vitro Fertilization ◽

Total Motile Sperm Count

Introduction: The unrestricted use of intracytoplasmic sperm injection (ICSI) for non-male factor infertility is associated with adverse outcomes. Post-wash total motile sperm count (PW-TMSC) offers prognostic value to assess sperm quality and aid in the decision to perform in vitro fertilization (IVF) or ICSI. Objectives: The aim of this study was to identify the effect of PW-TMSC on fertilization rates in patients undergoing IVF cycles exclusively with non-male factor infertility. It also aimed to identify whether unnecessary ICSI could be avoided in such cases, thus maximizing optimal outcomes. Materials & Methods: We retrospectively analyzed age, semen volume, prewash TMSC, and PW-TMSC in 68 conventional IVF cycles of infertile couples with non-male factor infertility. Clinical characteristics including female age, number of follicles, level of estradiol on trigger day, mature cumulus-oocyte complexes (COCs) collected, were also included. Results: Incidence of <30% fertilization was significantly higher in the 4-<10 Million group compared with the ≥20 Million post-wash TMSC group (P<0.001). Furthermore, Receiver operating characteristics (ROC) analysis revealed post-wash TMSC as a significant predictor (P<0.05) of total failed fertilization (TFF) and of ≥30% fertilization (P<0.05) with area under curve (AUC) of 0. 79 and 0.77, respectively, with a deemed cutoff of 10.89 Million. Conclusion: Post-wash TMSC is a good predictor of fertilization; it can help in avoiding potentially low or even total fertilization failure (TFF). A cut-off point of 10.89 Million or less should warrant the use of ICSI.

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