The significance of the ionophore-challenged acrosome reaction in the prediction of successful outcome of controlled ovarian stimulation and intrauterine insemination.
BACKGROUND
This prospective study compared the acrosome reaction following ionophore challenge (ARIC) versus conventional sperm parameters and sperm velocities in predicting successful outcome following ovarian stimulation and intrauterine insemination.


METHODS
All patients were offered a maximum of three treatment cycles. Conventional semen analysis was performed and sperm velocities were measured using computer-aided sperm analysis. Acrosome-reacted sperm were stained using chlortetracycline after ionophore challenge. Multiple logistic regression analysis and the receiver-operator characteristic curve analysis were applied to determine the best predictive variables and their cut-off values.


RESULTS
ARIC score was the most significant variable in predicting pregnancy, followed by the percentage of induced acrosome-reacted sperm, serum estradiol levels on the day of hCG and sperm morphology by strict criteria. Higher spontaneous acrosome reaction had a negative relationship with pregnancy. ARIC score of 10% had a sensitivity of 85.3% and a specificity of 85.5%. The positive and negative predictive values were 64.2 and 96.6% respectively and the false positive and negative rates were 14.7 and 14.5% respectively.


CONCLUSIONS
ARIC score was a better predictor of pregnancy than conventional sperm parameters and sperm velocities.
Makkar
Guneet
G
Department of Obstetrics & Gynecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, People's Republic of China.
Ng
Ernest Hung Yu
EH
Yeung
William Shu Biu
WS
Ho
Pak Chung
PC
D020101:Acrosome Reaction / Q000187:drug effects*; D000328:Adult; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D004958:Estradiol / Q000097:blood; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D007317:Insemination, Artificial, Homologous; D007476:Ionophores / Q000494:pharmacology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010062:Ovulation Induction; D011237:Predictive Value of Tests; D011247:Pregnancy; D018873:Pregnancy Rate; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D013081:Sperm Motility; D013094:Spermatozoa / Q000166:cytology; D016896:Treatment Outcome
D006063:Chorionic Gonadotropin; D007476:Ionophores; D004958:Estradiol