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Efficacy of sperm motility after processing and incubation to predict pregnancy after intrauterine insemination in normospermic individuals.

de Araújo LF, de Araújo Filho E, Fácio CL, Bossoni MC, Machado-Paula LA, Corrente JE, Cavagna M, Matheus PC, Pontes A - Reprod. Biol. Endocrinol. (2013)

Bottom Line: The analysis of age, duration and causes of infertility did not indicate any statistical significance between pregnancy and no pregnancy groups, similar to the results for total sperm count and morphology analyses, excluding progressive motility (p < 0.0001).The analysis of the progressive motility of the pregnancy group after processing and 24 h after incubation has not shown any motility difference at 24 h after incubation; additionally, in couples who did not obtain pregnancy, there was a statistically significant decrease in progressive motility 24 h after incubation (p < 0.0001).The ROC curve analysis generated a cutoff value of 56.5% for progressive motility at 24 h after incubation and this cutoff value produced 96.1% sensitivity, 92.7% specificity, 84.7% positive predictive value and 98.3% negative predictive value.

View Article: PubMed Central - HTML - PubMed

Affiliation: Center of Human Reproduction of São José do Rio Preto, São José do Rio Preto, SP, Brazil. lfparaujo@yahoo.com.br.

ABSTRACT

Background: Intrauterine insemination (IUI) is widely used to treat infertility, and its adequate indication is important to obtain good pregnancy rates. To assess which couples could benefit from IUI, this study aimed to evaluate whether sperm motility using a discontinuous gradient of different densities and incubation in CO2 in normospermic individuals is able to predict pregnancy.

Methods: A total of 175 couples underwent 175 IUI cycles. The inclusion criteria for women were as follows: 35 years old or younger (age range: from 27 to 35 years) with normal fallopian tubes; endometriosis grades I-II; unexplained infertility; nonhyperandrogenic ovulatory dysfunction. Men with normal seminal parameters were also included. All patients underwent ovarian stimulation with clomiphene citrate and human hMG or r-FSH. When one or (at most) three follicles measuring 18 to 20 mm were observed, hCG (5000 UI) or r-hCG (250 mcg) was administered and IUI performed 36-40 h after hCG. Sperm processing was performed using a discontinuous concentration gradient. A 20 microliters aliquot was incubated for 24 h at 37 degrees C in 5% CO2 following a total progressive motility analysis. The Mann-Whitney and Chi-square tests, as well as a ROC curve were used to determine the cutoff value for motility.

Results: Of the 175 couples, 52 (in 52 IUI cycles) achieved clinical pregnancies (CP rate per cycle: 29.7%). The analysis of age, duration and causes of infertility did not indicate any statistical significance between pregnancy and no pregnancy groups, similar to the results for total sperm count and morphology analyses, excluding progressive motility (p < 0.0001). The comparison of progressive motility after processing and 24 h after incubation between these two groups indicated that progressive motility 24 h after incubation was higher in the pregnancy group. The analysis of the progressive motility of the pregnancy group after processing and 24 h after incubation has not shown any motility difference at 24 h after incubation; additionally, in couples who did not obtain pregnancy, there was a statistically significant decrease in progressive motility 24 h after incubation (p < 0.0001). The ROC curve analysis generated a cutoff value of 56.5% for progressive motility at 24 h after incubation and this cutoff value produced 96.1% sensitivity, 92.7% specificity, 84.7% positive predictive value and 98.3% negative predictive value.

Conclusions: We concluded that the sperm motility of normospermic individuals 24 h after incubation at 37 degrees C in 5% CO2, with a cutoff value of 56.5%, is predictive of IUI success.

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Related in: MedlinePlus

ROC curve. ROC curve analysis for motility after sperm processing (area under the curve: 0.759) and at 24 h after incubation at 37°C in 5% CO2 (area under the curve: 0.965) as a predictive factor to clinical pregnancy after IUI in normospermic individuals. Blue line: conctmabpos = total concentration of progressive motility after sperm processing. Green line: mot24h = motility at 24 h after incubation.
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Figure 1: ROC curve. ROC curve analysis for motility after sperm processing (area under the curve: 0.759) and at 24 h after incubation at 37°C in 5% CO2 (area under the curve: 0.965) as a predictive factor to clinical pregnancy after IUI in normospermic individuals. Blue line: conctmabpos = total concentration of progressive motility after sperm processing. Green line: mot24h = motility at 24 h after incubation.

Mentions: The ROC curve (Figure 1) determined the cutoff value for sperm motility after processing and at 24 h after incubation as the predictive factor for pregnancy in normospermic individuals. The area under the curve was 0.965 for the 56.5% cutoff value, and 0.759 for the 69% cutoff value.


Efficacy of sperm motility after processing and incubation to predict pregnancy after intrauterine insemination in normospermic individuals.

de Araújo LF, de Araújo Filho E, Fácio CL, Bossoni MC, Machado-Paula LA, Corrente JE, Cavagna M, Matheus PC, Pontes A - Reprod. Biol. Endocrinol. (2013)

ROC curve. ROC curve analysis for motility after sperm processing (area under the curve: 0.759) and at 24 h after incubation at 37°C in 5% CO2 (area under the curve: 0.965) as a predictive factor to clinical pregnancy after IUI in normospermic individuals. Blue line: conctmabpos = total concentration of progressive motility after sperm processing. Green line: mot24h = motility at 24 h after incubation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4016529&req=5

Figure 1: ROC curve. ROC curve analysis for motility after sperm processing (area under the curve: 0.759) and at 24 h after incubation at 37°C in 5% CO2 (area under the curve: 0.965) as a predictive factor to clinical pregnancy after IUI in normospermic individuals. Blue line: conctmabpos = total concentration of progressive motility after sperm processing. Green line: mot24h = motility at 24 h after incubation.
Mentions: The ROC curve (Figure 1) determined the cutoff value for sperm motility after processing and at 24 h after incubation as the predictive factor for pregnancy in normospermic individuals. The area under the curve was 0.965 for the 56.5% cutoff value, and 0.759 for the 69% cutoff value.

Bottom Line: The analysis of age, duration and causes of infertility did not indicate any statistical significance between pregnancy and no pregnancy groups, similar to the results for total sperm count and morphology analyses, excluding progressive motility (p < 0.0001).The analysis of the progressive motility of the pregnancy group after processing and 24 h after incubation has not shown any motility difference at 24 h after incubation; additionally, in couples who did not obtain pregnancy, there was a statistically significant decrease in progressive motility 24 h after incubation (p < 0.0001).The ROC curve analysis generated a cutoff value of 56.5% for progressive motility at 24 h after incubation and this cutoff value produced 96.1% sensitivity, 92.7% specificity, 84.7% positive predictive value and 98.3% negative predictive value.

View Article: PubMed Central - HTML - PubMed

Affiliation: Center of Human Reproduction of São José do Rio Preto, São José do Rio Preto, SP, Brazil. lfparaujo@yahoo.com.br.

ABSTRACT

Background: Intrauterine insemination (IUI) is widely used to treat infertility, and its adequate indication is important to obtain good pregnancy rates. To assess which couples could benefit from IUI, this study aimed to evaluate whether sperm motility using a discontinuous gradient of different densities and incubation in CO2 in normospermic individuals is able to predict pregnancy.

Methods: A total of 175 couples underwent 175 IUI cycles. The inclusion criteria for women were as follows: 35 years old or younger (age range: from 27 to 35 years) with normal fallopian tubes; endometriosis grades I-II; unexplained infertility; nonhyperandrogenic ovulatory dysfunction. Men with normal seminal parameters were also included. All patients underwent ovarian stimulation with clomiphene citrate and human hMG or r-FSH. When one or (at most) three follicles measuring 18 to 20 mm were observed, hCG (5000 UI) or r-hCG (250 mcg) was administered and IUI performed 36-40 h after hCG. Sperm processing was performed using a discontinuous concentration gradient. A 20 microliters aliquot was incubated for 24 h at 37 degrees C in 5% CO2 following a total progressive motility analysis. The Mann-Whitney and Chi-square tests, as well as a ROC curve were used to determine the cutoff value for motility.

Results: Of the 175 couples, 52 (in 52 IUI cycles) achieved clinical pregnancies (CP rate per cycle: 29.7%). The analysis of age, duration and causes of infertility did not indicate any statistical significance between pregnancy and no pregnancy groups, similar to the results for total sperm count and morphology analyses, excluding progressive motility (p < 0.0001). The comparison of progressive motility after processing and 24 h after incubation between these two groups indicated that progressive motility 24 h after incubation was higher in the pregnancy group. The analysis of the progressive motility of the pregnancy group after processing and 24 h after incubation has not shown any motility difference at 24 h after incubation; additionally, in couples who did not obtain pregnancy, there was a statistically significant decrease in progressive motility 24 h after incubation (p < 0.0001). The ROC curve analysis generated a cutoff value of 56.5% for progressive motility at 24 h after incubation and this cutoff value produced 96.1% sensitivity, 92.7% specificity, 84.7% positive predictive value and 98.3% negative predictive value.

Conclusions: We concluded that the sperm motility of normospermic individuals 24 h after incubation at 37 degrees C in 5% CO2, with a cutoff value of 56.5%, is predictive of IUI success.

Show MeSH
Related in: MedlinePlus