title: The Effects of Total Motile Sperm Count on Spontaneous Pregnancy Rate and Pregnancy After IUI Treatment in Couples with Male Factor and Unexplained Infertility.
abstract: BACKGROUND
  Male infertility factor is defined if the total number of motile spermatozoa (TMSC) < 20 × 10(6)/ejaculated, and unexplained infertility if spermiogram is normal with normal female factor.
  
  
  OBJECTIVE
  of this study was to determine the predictive value of TMSC for spontaneous pregnancy (ST) and pregnancy after treatment with intrauterine insemination (IUI) in couples with male factor and unexplained infertility.
  
  
  BACKGROUND
  According to the WHO qualification system abnormal spermiogram can be diagnosed as oligozoospermia (O), asthenozoospermia (A), teratozoospermia (T) or combination (O+A+T) and azoospermia (A). Although this classification indicates the accuracy of findings its relevance for prognosis in infertile couple and the choice of treatment is questionable.
  
  
  METHODS
  The study included 98 couples with male infertility factor (bad spermiogram) and couples with normospermia and normal female factor (unexplained infertility). Testing group is randomized at: group (A) with TMSC> 3,10(6) / ejaculate and a spontaneous pregnancy, group (B) with TMSCl <3 x 10(6) / ejaculate and pregnancy after IUI, plus couples who have not achieved SP with TMSC> 3 x 10(6) / ejaculate and couples who have not achieved pregnancy.
  
  
  RESULTS
  From a total of 98 pairs of men's and unexplained infertility, 42 of them (42.8%) achieved spontaneous pregnancy, while 56 (57.2%) pairs did not achieve spontaneous pregnancy. TMSC was significantly higher (42.4 ± 28.4 vs. 26.2 ± 24, p <0.05) in the group A compared to group B. Couples with TMSC 1-5 × 10(6) ejaculate had significantly lower (9.8% vs. 22.2%, p <0.0001) rate of spontaneous pregnancy in comparison to couples after IUI treatment. Couples with unexplained infertility had significantly higher (56.8% vs. 29.9%, p <0.01) spontaneous pregnancy rate compared to couples after IUI treatment. Infertile couples had significant pregnancy rate with TMSC 5-10 x 10(6) / ejaculate (OR = 1.45, 95% CI:1.26-1.78, <0.01); with TMSC 10-20 x 10(6) / ejaculate (OR = 1.36, 95% CI: 1:12 to 1:46, <0.0001) with TMSC> 20 x 10(6) / ejaculate (RR = 1.7, 95% CI: 1.56-1.82, <0.001) after treatment with IUI compared to spontaneous pregnancy.
  Based on these results we can conclude that couples with the TMSC> 5 x 10(6) / ejaculate are indicated for treatment with IUI. TMSC can be used as the method of choice for diagnosis and treatment of male infertility.
authors.affiliation: Department of Endocrinology, Internal Clinic, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
authors.forename: Mithad
authors.initials: M
authors.lastname: Hajder
authors.affiliation: PZU Institute of Human Reproduction, Obstetrics and Perinatal Medicine, "Dr. Hajder" Tuzla, Bosnia and Herzegovina.
authors.forename: Elmira
authors.initials: E
authors.lastname: Hajder
authors.affiliation: PZU Institute of Human Reproduction, Obstetrics and Perinatal Medicine, "Dr. Hajder" Tuzla, Bosnia and Herzegovina.
authors.forename: Amela
authors.initials: A
authors.lastname: Husic
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000628:therapy*; D007317:Insemination, Artificial, Homologous; D008297:Male; D011247:Pregnancy; D018873:Pregnancy Rate; D011379:Prognosis; D013076:Sperm Count / Q000379:methods; D013081:Sperm Motility; D013094:Spermatozoa; D016896:Treatment Outcome
keywords: Intrauterine insemination; Male infertility; Spontaneous ongoing pregnancy rate; Total motile sperm count; Unexplained infertility