Human Reproduction, Vol 12, 1458-1463, Copyright © 1997 by Oxford University Press
W Ombelet, H Vandeput, G Van de Putte, A Cox, M Janssen, P Jacobs, E Bosmans, O Steeno and T Kruger
This retrospective study aimed to evaluate the prognostic value of the
inseminating motile count (IMC) and sperm morphology (using strict
criteria) on success rates after homologous intrauterine insemination (IUI)
combined with clomiphene citrate (CC) stimulation. A total of 373 couples
underwent 792 IUI cycles in a predominantly (87.4%) male subfertility
group. The overall cycle fecundity (CF) and baby take-home rate (BTH) was
14.6 and 9.9% respectively. The cumulative CF and BTH (per couple) after
three cycles were 30.6 and 21.1% respectively. Overall, sperm morphology
and IMC were of no prognostic value using receiver operating characteristic
(ROC) curve analysis, but after classifying the study population into
different subgroups according to IMC, sperm morphology turned out to be a
valuable prognostic parameter in subgroup 1, i.e. IMC <1 x 10(6). In
this subgroup, no pregnancies were seen when the morphology score was
<4% and the mean value of sperm morphology was significantly different
in the pregnant (8.3%) versus non-pregnant group (5.0%; P <0.05). The
cumulative CF and BTH after three IUI cycles were comparable for all
couples with the exception of those cases in which the IMC was <1 x
10(6) with a morphology score of <4% normal forms. We recorded only two
twin pregnancies (2.5%) and no moderate or severe ovarian hyperstimulation
syndrome. We conclude that in a selected group of patients without CC
resistance and normal ovarian response following CC stimulation [maximum of
three follicles with a diameter of >16 mm at the time of administration
of human chorionic gonadotrophin (HCG)], IUI combined with CC-HCG can be
offered as a very safe and non-expensive first-line treatment, at least
with an IMC of >1 x 10(6) spermatozoa. In cases with <1 x 10(6)
spermatozoa, CC- IUI remains important as a first-choice therapy provided
the morphology score is > or =4%.
ARTICLES
Intrauterine insemination after ovarian stimulation with clomiphene citrate: predictive potential of inseminating motile count and sperm morphology
Genk Institute for Fertility Technology, Z.O.L. Campus St Jan, Belgium.
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