title: Performance of the postwash total motile sperm count as a predictor of pregnancy at the time of intrauterine insemination: a meta-analysis.
abstract: OBJECTIVE
  To assess the performance and clinical value of the postwash total motile sperm count (postwash TMC) as a test to predict intrauterine insemination (IUI) outcome.
  
  
  METHODS
  Meta-analysis of diagnostic tests.
  
  
  METHODS
  Tertiary fertility center.
  
  
  METHODS
  Patients undergoing IUI.
  
  
  METHODS
  None.
  
  
  RESULTS
  We detected 16 studies that reported on postwash TMC at insemination and IUI outcome. Summary receiver operating characteristics (ROC) curves indicated a reasonable predictive performance toward IUI outcome, and, at cut-off levels between 0.8 to 5 million motile spermatozoa, the postwash TMC provided a substantial discriminative performance. At these cut-off levels, the specificity of the postwash TMC, defined as the ability to predict failure to become pregnant, was as high as 100%; the sensitivity of the test, defined as the ability to predict pregnancy, was limited.
  
  
  CONCLUSIONS
  The postwash TMC at insemination could potentially be used in counseling patients for either IUI or IVF. However, to enable patient counseling before the start of treatment, further studies are needed to establish the accuracy of a postwash TMC during the fertility workup rather than at insemination.
authors.affiliation: Center for Reproductive Medicine, Division of Obstetrics and Gynecology, Academic Medical Center, Meibergdreef 9, 1100 AZ Amsterdam, The Netherlands. j.m.vanweert@amc.uva.nl
authors.forename: Janne-Meije
authors.initials: JM
authors.lastname: van Weert
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Repping
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Van Voorhis
authors.forename: Fulco
authors.initials: F
authors.lastname: van der Veen
authors.forename: Patrick M M
authors.initials: PM
authors.lastname: Bossuyt
authors.forename: Ben W J
authors.initials: BW
authors.lastname: Mol
mesh_terms: D005260:Female; D006801:Humans; D007315:Insemination, Artificial / Q000379:methods*; D016239:MEDLINE; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D013081:Sperm Motility; D016896:Treatment Outcome