Use of semen quality scores to predict pregnancy rates in couples undergoing intrauterine insemination with donor sperm

A low total motile sperm count in donor sperm obtained from commercial banks does not affect pregnancy rates from intrauterine insemination

Objective

Women are often concerned about the absolute quantity and quality of sperm in a thawed donor sample at the time of intrauterine insemination (IUI). The aim of this study was to determine how the total motile sperm count (TMSC) of donor sperm obtained from commercial sperm banks affects the pregnancy rate after IUI.

Study design

We performed a retrospective cohort study including single women and women in same-sex relationships undergoing IUI at a single academic fertility center between January 2011 and March 2018. Our primary outcome was pregnancy rates per IUI cycle, stratified by post-washed TMSC. The data was analyzed according to TMSC and included three different groups: samples with a TMSC less than 5 million; TMSC of 5-10 million; and a TMSC greater than 10 million. Pregnancies were defined by a serum Beta-human chorionic gonadotropin (Beta-HCG) of greater than 5 mIU/mL. Chi-squared analyses and correlation coefficients were performed.

Results

Overall, 9341 IUIs were conducted during the study period. Of these, 1080 (11.56%) were performed for single women and women in a same-sex relationship using commercially available donor sperm. We found that there were no differences in the pregnancy rates per insemination based on TMSC. The pregnancy rates per cycle were 15/114 (13.3%) for the group with a TMSC of less than 5 million; 34/351(9.5%) with a TMSC of 5-10 million; and 61/609 (10.0%) for samples with a TMSC greater than 10 million (p = 0.52). We found an insignificant correlation (r = -0.072) between donor sperm TMSC and pregnancy after IUI (p = 0.46). Furthermore, a reassuring beta-HCG level (>100IU/L) drawn 16 days after IUI was unrelated to TMSC (r = 0.0071, p = 0.94).

Conclusion

The pregnancy rate following IUI is unaffected by the TMSC of commercially available donor sperm. This result is useful in reassuring patients when freshly thawed donor sperm is found to have a lower TMSC. Frozen sperm samples from commercial banks typically represent just a portion of an ejaculate produced by a donor who meets the banks' standards for age, health and sperm quality. As such, exaggerated sperm death caused by freezing does not result in worse outcomes with donor sperm.

Predictive factors influencing pregnancy rates after intrauterine insemination with frozen donor semen: a prospective cohort study

The extent to which certain parameters can influence pregnancy rates after intrauterine insemination with frozen donor semen was examined prospectively. Between July 2011 and September 2015, 402 women received 1264 IUI cycles with frozen donor semen in a tertiary referral infertility centre. A case report form was used to collect data prospectively. The primary outcome measure was clinical pregnancy rate (CPR), confirmed by detection of a gestational sac and fetal heartbeat using ultrasonography at 7-8 weeks of gestation. Statistical analysis was carried out using generalized estimating equations (GEE) to account for the correlation between observations from the same patient. Overall, CPR per cycle was 17.2%. Multivariate GEE analysis revealed the following parameters as predictive for a successful pregnancy outcome: female age (P = 0.0003), non-smoking or smoking fewer than 15 cigarettes a day (P = 0.0470 and P = 0.0235, respectively), secondary infertility (P = 0.0062), low progesterone levels at day zero of the cycle (P = 0.0164) and use of ovarian stimulation with HMG and recombinant FSH compared with clomiphene citrate and natural cycle (P = 0.0006 and P = 0.0004, respectively). These parameters were the most important factors influencing the success rate in a sperm donation programme.

Post-laparoscopy predictive factors of achieving pregnancy in patients treated for infertility

Introduction

Laparoscopy is a long-established diagnostic and therapeutic method for treating women suffering from infertility. The application of this method of treatment can help achieve pregnancy only if there is correct classification of patients and evaluation of their partner’s reproductive capacity. The main predictors of achieving pregnancy in a couple treated for infertility are the woman’s age, her ovarian reserve, tubal patency, the presence of endometriosis and quality of sperm parameters.

Aim

To evaluate the effect of endometriosis, ovarian reserve and selected parameters of semen on the effect of achieving pregnancy in patients undergoing laparoscopy.

Material and methods

The most significant predictor of pregnancy in patients undergoing laparoscopy due to infertility was found to be anti-Mullerian hormone (AMH) level after laparoscopy, and the main parameters of semen partners were density, motility and morphology. The number of achieved pregnancies after the laparoscopic treatment of infertility was lower in patients diagnosed with endometriosis, and depended on the severity of the condition.

Results

As a result of laparoscopic treatment of endometriosis, we found a decrease in ovarian reserve measured by means of AMH.

Conclusions

The most important predictors of pregnancy in patients who underwent laparoscopy due to infertility are post-laparoscopy AMH levels and the main parameters of the partner’s semen: density, motility and morphology. The number of pregnancies after laparoscopic treatment is lower in patients diagnosed with endometriosis, and depends on the severity of the conditio.

The impact of semen quality, occupational exposure to environmental factors and lifestyle on recurrent pregnancy loss

PURPOSE

This study aimed to investigate the effect of male semen quality, occupational exposure, and lifestyle on recurrent pregnancy loss (RPL).

METHODS

Information on couples' occupational exposure and lifestyle was collected using a detailed questionnaire from 68 RPL couples and 63 randomly selected healthy controls. Semen parameters were estimated by computer-assisted sperm analysis, and sperm nuclear status was detected with aniline blue (AB) staining.

RESULTS

Patients in the RPL group had significantly lower viability, normal morphology, and total progressive motility of sperm, and a higher mean percentage of AB staining positive sperm compared with those of controls (P < 0.05). There were no differences in sperm concentration, and motility between the groups (P > 0.05). Significant odds ratio (OR) was found when occupational exposure and unhealthy habits were superimposed (OR: 11.965, P = 0.005).

CONCLUSIONS

In addition to standard female factors for evaluating the risk for RPL, the use of male factors should also be taken into consideration. We found that sperm quality, occupational exposure, and lifestyle are factors that affect RPL. Consequently, occupational exposure and lifestyle factors should constitute an important section of questionnaires given to patients, and these factors should be evaluated by a clinician or trained staff.

Sperm gene expression profile is related to pregnancy rate after insemination and is predictive of low fecundity in normozoospermic men

BACKGROUND

Assessment of male fertility is traditionally based on microscopic evaluation of semen. However, the classical semen parameters do not adequately reflect sperm function, and their clinical value in predicting fertility is limited. We hypothesize that the sperm expression profile could reflect the fertilizing quality of spermatozoa and could be more informative for predicting the in vivo reproductive fitness of men with normal semen parameters.

METHODS

Sperm gene expression patterns of 68 normozoospermic donors (43 Phase I and 25 Phase II), used for therapeutic IUI, were analysed via TaqMan Arrays.

RESULTS

Significant differences in the expression of individual genes were observed between groups of donors with the lowest and highest pregnancy rates (PRs) after IUI. Additionally, we have developed a molecular means to classify the fertility status of semen donors for IUI based on the expression signature of four genes. In the Phase I study, this model had 90% sensitivity and 97% specificity for discriminating donors resulting in low PRs (cut-off value: <13.6%), far better than that obtained from the combination of sperm parameters. The translation of the model was validated in Phase II donors resulting in a sensitivity of 71.5% and a specificity of 78%.

CONCLUSIONS

Our findings contribute to the search for the most valuable genetic markers which are potentially useful as tools for predicting pregnancy. Our expression model could complement classical semen analysis in order to identify sperm donors with a less favourable IUI reproductive outcome despite having normal semen parameters. It may also be useful for the study of sperm function in couples with unexplained infertility.

Quality of reporting of test accuracy studies in reproductive medicine: impact of the Standards for Reporting of Diagnostic Accuracy (STARD) initiative

OBJECTIVE

To evaluate the extent to which test accuracy studies published in two leading reproductive medicine journals in the years 1999 and 2004 adhered to the Standards for Reporting of Diagnostic Accuracy (STARD) initiative parameters, and to explore whether the introduction of the STARD statement has led to an improved quality of reporting.

DESIGN

Structured literature search. Articles that reported on the diagnostic performance of a test in comparison with a reference standard were eligible for inclusion. For each article we scored how well the 25 items of the STARD checklist were reported. These items deal with the study question, study participants, study design, test methods, reference standard, statistical methods, reporting of results, and conclusions. We calculated the total number of reported STARD items per article, summary scores for each STARD item, and the average number of reported STARD items per publication year.

SETTING

Not applicable.

PATIENT(S)

Not applicable.

INTERVENTION(S)

Not applicable.

MAIN OUTCOME MEASURE(S)

Quality of reporting.

RESULT(S)

We found 24 studies reporting on test accuracy in reproductive medicine in 1999 and 27 studies in 2004. The mean number of reported STARD items for articles published in 1999 was 12.1 +/- 3.3 (range 6.5-20) and 12.4 +/- 3.2 (range 7-17.5) in 2004, after publication of the STARD statement. Overall, less than half of the studies reported adequately on 50% or more of the STARD items. The reporting of individual items showed a wide variation. There was no significant improvement in mean number of reported items for the articles published after the introduction of the STARD statement.

CONCLUSION(S)

Authors of test accuracy studies in the two leading fertility journals poorly report the design, conduct, methodology, and statistical analysis of their study. Strict adherence to the STARD guidelines should be encouraged.