Effect of sperm morphology& number on success of IUI Aboubakr Elnashar Ahmed Badawy Mohamed Eltotongy elnashar53@hotmail.com Aboubakr Elnashar

Introduction IUI Widely used simple, inexpensive, acceptable ART (Zhao et al, 2004). Indications: many poor male factor cervical hostility unexplained infertility. Attempted before proceeding to more expensive& invasive ART such as ICSI. Aboubakr Elnashar

Pregnancy rates: Patient selection criteria Presence of various infertility factors Methods of ovarian stimulation Number of cycles performed Technique of preparation. Sperm parameters: number of motile sperm normal morphology. Aboubakr Elnashar

Sperm parameters 1. Raw samples do not correlate with cycle fecundity as do prepared specimens (Wainer et al, 1996). 2. Post-swim-up semen can provide useful prognostic information {processing techniques modify sperm characteristics vary from laboratory to laboratory Vary from patient to patient} (VanWaart et al, 2001) Aboubakr Elnashar

Aim of our study To assess the likelihood of IUI success as a function of the sperm count and morphology, assessed after sperm preparation. Aboubakr Elnashar

Materials and methods Design: A prospective observational study. Patients: 393 couples who underwent 714 IUI cycles. Infertility for at least 1 y Aboubakr Elnashar

Before IUI HSG: D21 serum P: documenting ovulation TVS: evaluating the pelvic anatomy Laparoscopy: when there was a possibility of pelvic adhesions or endometriosis in the HSG or TVS At least 2 semen analyses& microbiological tests Aboubakr Elnashar

Normal semen: WHO (1993) Concentration: 20x106/mL Total count: 40x106 Progressive motility: 50% Typical morphology: 30%. Aboubakr Elnashar

Semen processing Motile sperm were selected by a swim-up procedure. Motile sperm fraction was washed twice by centrifugation sperm pellet was suspended in 0.35 mL of Earles balanced salt solution Sperm were then counted& progressive motility assessed. Aboubakr Elnashar

Ovarian superovulation CC 50 mg twice daily for 5 d from D2 of the cycle One hMG ampule 75 IU IM daily from D5 of the cycle. Monitoring: TVS. IUI was performed 364 h after hCG Main Outcome Measures: Clinical pregnancy. Aboubakr Elnashar

Results The mean age: 31.33.2 y 79 (11.06%)Clinical pregnancy/cycle (79 (20.1%Clinical pregnancy/couple 13 (16.4%)Miscarriage 6 (7.6%)Twin pregnancy Aboubakr Elnashar

Number of motile sperm 5 x106 PR/cycle was 24.28% (P5x106: PR/cycle was 28.2%, which is significantly higher than that of other age groups. Above the age of 35y: with number of motile sperm 5x106: PR was very low 0.84% Aboubakr Elnashar

Normal sperm morphology5x106 than when it was 30% PR was significantly higher when the number of motile sperm was >5x106(20.77%). Aboubakr Elnashar

Conclusion IUI used for treating male factor infertility seems to have little chance of success when the woman is older than 35 y of age number of motile sperm inseminated is