The impact of sperm morphology evaluated by strict criteria on intrauterine insemination success.

OBJECTIVE

To determine the relationship between IUI success and the level of morphologically normal sperm, evaluated using strict criteria, in the raw semen.

DESIGN

Evaluation of semen quality characteristics and pregnancy results for 538 stimulated IUI cycles.

SETTING

University medical center infertility clinic.

PATIENT(S): Women undergoing IUI with their partner's semen as treatment for infertility (n = 193).

INTERVENTION(S): Ovulation induction using clomiphene citrate, hMG, or both; preparation of raw semen using wash and swim-up or Percoll; deposition of prepared semen at the uterine fundus.

MAIN OUTCOME MEASURE(S): Pregnancy status after IUI. Percentage morphologically normal sperm in raw semen, evaluated using strict criteria. Sperm concentration and percentage motile sperm in raw and prepared semen.

RESULT(S): Pregnancy rates (PRs) per cycle were not different when the percentage of morphologically normal sperm in raw semen was < 5%, 5% to 9%, 10% to 19%, 20% to 29%, and > or = 30% (6.5% +/- 3.9%, 13.6% +/- 3.2%, 8.8% +/- 2.4%, 7.1% +/- 2.5%, and 9.7% +/- 3.3%, respectively). Pregnancy rates did not differ among age groups, infertility diagnoses, ovarian stimulation protocols, or semen preparation methods.

CONCLUSION(S): The percentage of morphologically normal sperm in the raw semen, as judged by strict criteria, did not affect IUI PR. Intrauterine insemination appears to be a successful treatment modality for male factor infertility, even when the percentage of morphologically normal sperm in raw semen is very low.