title: Evaluation of the effect of the absence of sperm with rapid and linear progressive motility on subsequent pregnancy rates following intrauterine insemination or in vitro fertilization.
abstract: The objective of this study was to investigate the association of rapid and linear progressive motility in seminal and Percoll-separated sperm with the outcome of intrauterine insemination (IUI) and in vitro fertilization (IVF) cycles. Motility was graded using the qualitative system proposed by the World Health Organization: grade A, rapid and linear, grade B, slow or nonlinear; grade C, non-progressive; or grade D, nonmotile. Absence of rapid and linear motility was defined as grade A sperm absent. Nine-hundred-fifty IVF and 1,448 IUI cycles were analyzed. In 7.9% (75) of the IVF cycles, grade A sperm were absent in the semen. Although the mean fertilization rate was lower in the absence of grade A sperm in the semen (44.5% vs. 63.4%, P < 0.05), the pregnancy rates were similar irrespective of their presence or absence (18.7% vs. 17.8%). In the cycles in which grade A sperm were absent following Percoll separation (26/950; 2.7%), the fertilization rate (29% vs. 62.8%) and the clinical pregnancy rate/retrieval were significantly lower (3.8% vs. 18.3%, P < 0.05). In 26.4% (382) of the IUI cycles, grade A sperm were absent in the semen and conception occurred in 30 (7.9%), compared to a pregnancy rate of 10.4% in the group with grade A sperm present in the semen. Following Percoll separation, only a 2.5% (2/80) pregnancy rate was observed in the group with no grade A sperm, compared to 10.2% in the group with grade A sperm (P < 0.05). The absence of rapid and linear motile sperm in the Percoll-separated sperm significantly reduced fertilization rates in vitro and pregnancy rates in both IUI and IVF cycles. The use of the total number of grade A sperm was also effective in predicting reduced fertilization in IVF and reduced pregnancy rates in IUI, but no better than the use of the mere presence/absence of grade A sperm. In a clinical situation, the simpler test is preferable. This type of evaluation is available to all centers as opposed to the more expensive computer-assisted semen analysis.
authors.affiliation: University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden, Cooper Hospital/University Medical Center, Department of Obstetrics and Gynecology, USA.
authors.forename: A
authors.initials: A
authors.lastname: Bollendorf
authors.forename: J H
authors.initials: JH
authors.lastname: Check
authors.forename: D
authors.initials: D
authors.lastname: Lurie
mesh_terms: D000328:Adult; D002469:Cell Separation; D002499:Centrifugation, Density Gradient; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007317:Insemination, Artificial, Homologous; D008297:Male; D011247:Pregnancy; D011446:Prospective Studies; D012661:Semen / Q000166:cytology; D013076:Sperm Count; D013081:Sperm Motility / Q000502:physiology*; D013094:Spermatozoa / Q000502:physiology*