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Semen quality and prediction of IUI success in male subfertility: a systematic review.
Reprod Biomed Online 2014; 28(3):300-9RB

Abstract

Many variables may influence success rates after intrauterine insemination (IUI), including sperm quality in the native and washed semen sample. A literature search was performed to investigate the threshold levels of sperm parameters above which IUI pregnancy outcome is significantly improved and/or the cut-off values reaching substantial discriminative performance in an IUI programme. A search of MEDLINE, EMBASE and Cochrane Library revealed a total of 983 papers. Only 55 studies (5.6%) fulfilled the inclusion criteria and these papers were analysed. Sperm parameters most frequently examined were: (i) inseminating motile count after washing: cut-off value between 0.8 and 5 million; (ii) sperm morphology using strict criteria: cut-off value ⩾5% normal morphology; (iii) total motile sperm count in the native sperm sample: cut-off value of 5-10 million; and (iv) total motility in the native sperm sample: threshold value of 30%. The results indicate a lack of prospective studies, a lack of standardization in semen testing methodology and a huge heterogeneity of patient groups and IUI treatment strategies. More prospective cohort trials and prospective randomized trials investigating the predictive value of semen parameters on IUI outcome are urgently needed. It is generally believed that intrauterine insemination (IUI) with homologous semen should be a first-choice treatment to more invasive and expensive techniques of assisted reproduction in cases of cervical, unexplained and moderate male factor subfertility. The rationale for the use of artificial insemination is to increase gamete density at the site of fertilization. Scientific validation of this strategy is difficult because literature is rather confusing and inconclusive. Many variables may influence success rates after IUI treatment procedures. It seems logical that sperm quality has to be one of the main determinants to predict IUI success. Clinical practice would benefit from the establishment of threshold levels for sperm parameters above which IUI pregnancy outcome is significantly improved and below which a successful outcome is unlikely. We performed a literature search to investigate if such threshold levels are known. Most striking were the lack of standardization in semen-testing methodology and the huge heterogeneity of patient groups and IUI treatment strategies. The four sperm parameters most frequently examined were: (i) inseminating motile count after washing: cut-off value between 0.8 and 5 million; (ii) sperm morphology using strict criteria: cut-off value >4% normal morphology; (iii) total motile sperm count in native sperm sample: cut-off value of 5-10 million; and (iv) total motility in native sperm sample: threshold value of 30%. This review identified an urgent need for more and better prospective cohort trials investigating the predictive value of semen parameters on IUI pregnancy rate.

Authors+Show Affiliations

Genk Institute for Fertility Technology, Department of Obstetrics and Gynaecology, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, Hasselt, Belgium. Electronic address: willem.ombelet@telenet.be.Genk Institute for Fertility Technology, Department of Obstetrics and Gynaecology, Genk, Belgium.Genk Institute for Fertility Technology, Department of Obstetrics and Gynaecology, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, Hasselt, Belgium.Genk Institute for Fertility Technology, Department of Obstetrics and Gynaecology, Genk, Belgium.Reproductive Biology Unit, Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Hospital, Tygerberg, South Africa.

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

24456701

Citation

Ombelet, Willem, et al. "Semen Quality and Prediction of IUI Success in Male Subfertility: a Systematic Review." Reproductive Biomedicine Online, vol. 28, no. 3, 2014, pp. 300-9.
Ombelet W, Dhont N, Thijssen A, et al. Semen quality and prediction of IUI success in male subfertility: a systematic review. Reprod Biomed Online. 2014;28(3):300-9.
Ombelet, W., Dhont, N., Thijssen, A., Bosmans, E., & Kruger, T. (2014). Semen quality and prediction of IUI success in male subfertility: a systematic review. Reproductive Biomedicine Online, 28(3), pp. 300-9. doi:10.1016/j.rbmo.2013.10.023.
Ombelet W, et al. Semen Quality and Prediction of IUI Success in Male Subfertility: a Systematic Review. Reprod Biomed Online. 2014;28(3):300-9. PubMed PMID: 24456701.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Semen quality and prediction of IUI success in male subfertility: a systematic review. AU - Ombelet,Willem, AU - Dhont,Nathalie, AU - Thijssen,Annelies, AU - Bosmans,Eugene, AU - Kruger,Thinus, Y1 - 2013/11/15/ PY - 2013/06/26/received PY - 2013/10/25/revised PY - 2013/10/31/accepted PY - 2014/1/25/entrez PY - 2014/1/25/pubmed PY - 2014/11/11/medline KW - assisted reproduction KW - intrauterine insemination KW - predictive value KW - pregnancy rate KW - semen KW - sperm quality SP - 300 EP - 9 JF - Reproductive biomedicine online JO - Reprod. Biomed. Online VL - 28 IS - 3 N2 - Many variables may influence success rates after intrauterine insemination (IUI), including sperm quality in the native and washed semen sample. A literature search was performed to investigate the threshold levels of sperm parameters above which IUI pregnancy outcome is significantly improved and/or the cut-off values reaching substantial discriminative performance in an IUI programme. A search of MEDLINE, EMBASE and Cochrane Library revealed a total of 983 papers. Only 55 studies (5.6%) fulfilled the inclusion criteria and these papers were analysed. Sperm parameters most frequently examined were: (i) inseminating motile count after washing: cut-off value between 0.8 and 5 million; (ii) sperm morphology using strict criteria: cut-off value ⩾5% normal morphology; (iii) total motile sperm count in the native sperm sample: cut-off value of 5-10 million; and (iv) total motility in the native sperm sample: threshold value of 30%. The results indicate a lack of prospective studies, a lack of standardization in semen testing methodology and a huge heterogeneity of patient groups and IUI treatment strategies. More prospective cohort trials and prospective randomized trials investigating the predictive value of semen parameters on IUI outcome are urgently needed. It is generally believed that intrauterine insemination (IUI) with homologous semen should be a first-choice treatment to more invasive and expensive techniques of assisted reproduction in cases of cervical, unexplained and moderate male factor subfertility. The rationale for the use of artificial insemination is to increase gamete density at the site of fertilization. Scientific validation of this strategy is difficult because literature is rather confusing and inconclusive. Many variables may influence success rates after IUI treatment procedures. It seems logical that sperm quality has to be one of the main determinants to predict IUI success. Clinical practice would benefit from the establishment of threshold levels for sperm parameters above which IUI pregnancy outcome is significantly improved and below which a successful outcome is unlikely. We performed a literature search to investigate if such threshold levels are known. Most striking were the lack of standardization in semen-testing methodology and the huge heterogeneity of patient groups and IUI treatment strategies. The four sperm parameters most frequently examined were: (i) inseminating motile count after washing: cut-off value between 0.8 and 5 million; (ii) sperm morphology using strict criteria: cut-off value >4% normal morphology; (iii) total motile sperm count in native sperm sample: cut-off value of 5-10 million; and (iv) total motility in native sperm sample: threshold value of 30%. This review identified an urgent need for more and better prospective cohort trials investigating the predictive value of semen parameters on IUI pregnancy rate. SN - 1472-6491 UR - https://www.unboundmedicine.com/medline/citation/24456701/Semen_quality_and_prediction_of_IUI_success_in_male_subfertility:_a_systematic_review_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1472-6483(13)00576-2 DB - PRIME DP - Unbound Medicine ER -