Effect of sperm morphology& number on success of IUI


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Effect of sperm morphology& number on success of IUI

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Effect of sperm morphology& number on success of IUI

  1. 1. Effect of sperm morphology& number on success of IUI Aboubakr Elnashar Ahmed Badawy Mohamed Eltotongy elnashar53@hotmail.com Aboubakr Elnashar
  2. 2. 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
  3. 3. 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
  4. 4. 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
  5. 5. 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
  6. 6. Materials and methods Design: A prospective observational study. Patients: 393 couples who underwent 714 IUI cycles. Infertility for at least 1 y Aboubakr Elnashar
  7. 7. 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
  8. 8. Normal semen: WHO (1993) Concentration: 20x106/mL Total count: 40x106 Progressive motility: 50% Typical morphology: 30%. Aboubakr Elnashar
  9. 9. 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 Earle’s balanced salt solution •Sperm were then counted& progressive motility assessed. Aboubakr Elnashar
  10. 10. 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 36±4 h after hCG Main Outcome Measures: Clinical pregnancy. Aboubakr Elnashar
  11. 11. Results The mean age: 31.3±3.2 y 79 (11.06%)Clinical pregnancy/cycle (79 (20.1%Clinical pregnancy/couple 13 (16.4%)Miscarriage 6 (7.6%)Twin pregnancy Aboubakr Elnashar
  12. 12. •Number of motile sperm <5 x106. No statistically significant difference in PR/cycle between subgroups 28 pregnancies were reported in 504 cycles accounting for a 5.55% PR/cycle. •Number of motile sperm >5 x106 PR/cycle was 24.28% (P<.001). Aboubakr Elnashar
  13. 13. •Below the age 25 y: with number of motile sperm >5x106: 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: No pregnancies with number of motile sperm >5x106: PR was very low 0.84% Aboubakr Elnashar
  14. 14. •Normal sperm morphology<30%: PR was significantly higher when the number of motile sperm was >5x106 than when it was <5x106 (9.45% vs. 4.62%) •Normal sperm morphology>30% PR was significantly higher when the number of motile sperm was >5x106(20.77%). Aboubakr Elnashar
  15. 15. 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 <5x106, or normal sperm morphology is <30%. Aboubakr Elnashar
  16. 16. Thank s Aboubakr Elnashar