Absence of rapid and linear progressive motile spermatozoa "grade A" in semen specimens: does it change intrauterine insemination outcomes?

OBJECTIVE

To evaluate the predictive value of the absence of rapid and linear progressive motile spermatozoa "grade A" on the intrauterine insemination success rates.

METHODS

The present retrospective case-control study included 338 couples in their first intrauterine insemination cycles. All intrauterine insemination cycles were preceded by ovarian stimulation with recombinant follicle-stimulating hormone starting on cycle day 3 with a standard protocol. A single intrauterine insemination was performed 36-40 hours after human chorionic gonadotropin administration. Multivariate analysis was performed to define the independent predictors of intrauterine insemination success. The main outcome measure, the clinical pregnancy rate per cycle, was assessed in 3 different categories, according to the total motile sperm count (TMSC).

RESULTS

Multivariate logistic regression analysis identified a 2.7 times increased chance of clinical pregnancy in the presence of grade A spermatozoa, after adjustment for female and male age (P = .023, 95% confidence interval 1.149-6.359). The influence of the absence of grade A spermatozoa on the clinical pregnancy rate was significant when the TMSC was 5-10 × 10(6) (0% vs 9.2%, respectively, P = .033).

CONCLUSION

The absence of grade A spermatozoa decreased the intrauterine insemination success rates in couples with male factor subfertility, especially when the TMSC was <10 × 10(6). In vitro fertilization, instead of intrauterine insemination, might be a more effective treatment option for couples with a TMSC <10 × 10(6) and no grade A spermatozoa.