title: The impact of sperm morphology on the outcome of intrauterine insemination cycles with gonadotropins in unexplained and male subfertility.
abstract: OBJECTIVE
  To determine the impact of sperm morphology on success of intrauterine insemination (IUI) in unexplained and male subfertility.
  
  
  METHODS
  Basal and post-wash normal percentage of sperm with normal morphology was assessed prospectively in 412 couples with 530 IUI cycles who underwent ovarian hyperstimulation with gonadotropins. The primary outcome was live birth per cycle. Receiver operating characteristics (ROC) curves were used to determine the effectiveness of sperm morphology to predict live birth in IUI cycles.
  
  
  RESULTS
  Normal sperm morphology (%) after preparation was higher in patients with live birth (5.4 ± 4.5 vs 4.3 ± 4.1; respectively, p<.05) in study population. In male subfertile group, normal sperm morphology before and after sperm preparation was higher in patients with live birth (1.3 ± 1.4 vs 0.6 ± 0.9; p<0.001 and 4.6 ± 4.4 vs 1.9 ± 2.2; p<0.01, respectively). However, both basal and post-wash normal sperm morphology (%) were similar in patients with and without live birth in unexplained group. The best cut-off value for normal sperm morphology (%) to predict live birth was 4.5% in male subfertile group with a sensitivity of 50.6% and specificity of 61.7%.
  
  
  CONCLUSIONS
  Morphological evaluation is not a reliable parameter alone for predicting pregnancy outcome in unexplained infertility. In male subfertility, post-wash normal sperm morphology percentage higher than 4.5 increases the probability of live birth.
authors.affiliation: Department of Obstetrics & Gynecology, Gazi University Faculty of Medicine, Ankara, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Erdem
authors.affiliation: Department of Obstetrics & Gynecology, Gazi University Faculty of Medicine, Ankara, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Erdem
authors.affiliation: Department of Obstetrics & Gynecology, Yüksek Ihtisas University, Ankara, Turkey. Electronic address: firatmutlu78@hotmail.com.
authors.forename: Mehmet Firat
authors.initials: MF
authors.lastname: Mutlu
authors.affiliation: Department of Obstetrics & Gynecology, Gazi University Faculty of Medicine, Ankara, Turkey.
authors.forename: Seckin
authors.initials: S
authors.lastname: Ozisik
authors.affiliation: Department of Obstetrics & Gynecology, Gazi University Faculty of Medicine, Ankara, Turkey.
authors.forename: Sule
authors.initials: S
authors.lastname: Yildiz
authors.affiliation: Department of Obstetrics & Gynecology, Gazi University Faculty of Medicine, Ankara, Turkey.
authors.forename: Ismail
authors.initials: I
authors.lastname: Guler
authors.affiliation: Department of Obstetrics & Gynecology, Gazi University Faculty of Medicine, Ankara, Turkey.
authors.forename: Cengiz
authors.initials: C
authors.lastname: Karakaya
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D043373:Follicle Stimulating Hormone, Human / Q000627:therapeutic use; D006801:Humans; D007246:Infertility / Q000628:therapy; D007248:Infertility, Male / Q000628:therapy*; D007315:Insemination, Artificial; D050498:Live Birth / Q000453:epidemiology*; D008297:Male; D008596:Menotropins / Q000627:therapeutic use; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D018873:Pregnancy Rate; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D011994:Recombinant Proteins / Q000627:therapeutic use; D013094:Spermatozoa / Q000166:cytology / Q000473:pathology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005300:Fertility Agents, Female; D043373:Follicle Stimulating Hormone, Human; D011994:Recombinant Proteins; C571801:follitropin alfa; D008596:Menotropins
keywords: Intrauterine insemination; Sperm morphology; Unexplained infertility