Effect of Sperm Morphology on Pregnancy Success via Intrauterine Insemination: A Systematic Review and Meta-Analysis

Taylor P. Kohn, Jaden R. Kohn, Ranjith Ramasamy

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose: Men with abnormal sperm morphology are often counseled that natural conception and intrauterine insemination are ineffective, and in vitro fertilization is the only option. Our objective was to determine the effect of sperm morphology on the pregnancy success of intrauterine insemination. Materials and Methods: We systematically searched for studies published prior to January 2017 that 1) reported ultrasound verified clinical pregnancies per intrauterine insemination cycle, 2) assessed sperm morphology using the kruger strict criteria and 3) described morphology at the greater than 4% and 4% or less and/or the 1% or greater and less than 1% thresholds. In all studies mean female age was between 25 and 40 years and mean total motile sperm count was greater than 10 million. Estimates were pooled using random effects meta-analysis. Results: Data were extracted from 20 observational studies involving a total of 41,018 cycles. When comparing men at the greater than 4% and 4% or less thresholds, the rate of ultrasound verified pregnancy per intrauterine insemination cycle was not statistically or clinically different (14.2% vs 12.1%, p = 0.06) and the risk difference was 3.0% (95% CI 1.4-4.6), indicating 3.0 additional pregnancies per 100 intrauterine insemination cycles. When comparing men at the 1% or greater and the less than 1% thresholds, there were no statistical or clinical differences in the rate of ultrasound verified pregnancy per cycle of intrauterine insemination (14.0% vs 13.9%, p = 0.97) or in the risk difference (1.6%, 95% CI -4.5-7.6). Conclusions: There appears to be no clinical difference in intrauterine insemination pregnancy success among men with normal and abnormal sperm morphology when accounting for total motile sperm count and female age. Abnormal sperm morphology alone should not exclude couples from attempting intrauterine insemination.

Original languageEnglish (US)
JournalJournal of Urology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Insemination
Meta-Analysis
Spermatozoa
Pregnancy
Sperm Count
Fertilization in Vitro
Observational Studies

Keywords

  • Artificial
  • Homologous
  • Infertility
  • Insemination
  • Male
  • Semen analysis
  • Spermatozoa
  • Testis

ASJC Scopus subject areas

  • Urology

Cite this

Effect of Sperm Morphology on Pregnancy Success via Intrauterine Insemination : A Systematic Review and Meta-Analysis. / Kohn, Taylor P.; Kohn, Jaden R.; Ramasamy, Ranjith.

In: Journal of Urology, 01.01.2018.

Research output: Contribution to journalArticle

@article{e7252010b0fc48d68fbdd1fdc949974c,
title = "Effect of Sperm Morphology on Pregnancy Success via Intrauterine Insemination: A Systematic Review and Meta-Analysis",
abstract = "Purpose: Men with abnormal sperm morphology are often counseled that natural conception and intrauterine insemination are ineffective, and in vitro fertilization is the only option. Our objective was to determine the effect of sperm morphology on the pregnancy success of intrauterine insemination. Materials and Methods: We systematically searched for studies published prior to January 2017 that 1) reported ultrasound verified clinical pregnancies per intrauterine insemination cycle, 2) assessed sperm morphology using the kruger strict criteria and 3) described morphology at the greater than 4{\%} and 4{\%} or less and/or the 1{\%} or greater and less than 1{\%} thresholds. In all studies mean female age was between 25 and 40 years and mean total motile sperm count was greater than 10 million. Estimates were pooled using random effects meta-analysis. Results: Data were extracted from 20 observational studies involving a total of 41,018 cycles. When comparing men at the greater than 4{\%} and 4{\%} or less thresholds, the rate of ultrasound verified pregnancy per intrauterine insemination cycle was not statistically or clinically different (14.2{\%} vs 12.1{\%}, p = 0.06) and the risk difference was 3.0{\%} (95{\%} CI 1.4-4.6), indicating 3.0 additional pregnancies per 100 intrauterine insemination cycles. When comparing men at the 1{\%} or greater and the less than 1{\%} thresholds, there were no statistical or clinical differences in the rate of ultrasound verified pregnancy per cycle of intrauterine insemination (14.0{\%} vs 13.9{\%}, p = 0.97) or in the risk difference (1.6{\%}, 95{\%} CI -4.5-7.6). Conclusions: There appears to be no clinical difference in intrauterine insemination pregnancy success among men with normal and abnormal sperm morphology when accounting for total motile sperm count and female age. Abnormal sperm morphology alone should not exclude couples from attempting intrauterine insemination.",
keywords = "Artificial, Homologous, Infertility, Insemination, Male, Semen analysis, Spermatozoa, Testis",
author = "Kohn, {Taylor P.} and Kohn, {Jaden R.} and Ranjith Ramasamy",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.juro.2017.11.045",
language = "English (US)",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Effect of Sperm Morphology on Pregnancy Success via Intrauterine Insemination

T2 - A Systematic Review and Meta-Analysis

AU - Kohn, Taylor P.

AU - Kohn, Jaden R.

AU - Ramasamy, Ranjith

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Purpose: Men with abnormal sperm morphology are often counseled that natural conception and intrauterine insemination are ineffective, and in vitro fertilization is the only option. Our objective was to determine the effect of sperm morphology on the pregnancy success of intrauterine insemination. Materials and Methods: We systematically searched for studies published prior to January 2017 that 1) reported ultrasound verified clinical pregnancies per intrauterine insemination cycle, 2) assessed sperm morphology using the kruger strict criteria and 3) described morphology at the greater than 4% and 4% or less and/or the 1% or greater and less than 1% thresholds. In all studies mean female age was between 25 and 40 years and mean total motile sperm count was greater than 10 million. Estimates were pooled using random effects meta-analysis. Results: Data were extracted from 20 observational studies involving a total of 41,018 cycles. When comparing men at the greater than 4% and 4% or less thresholds, the rate of ultrasound verified pregnancy per intrauterine insemination cycle was not statistically or clinically different (14.2% vs 12.1%, p = 0.06) and the risk difference was 3.0% (95% CI 1.4-4.6), indicating 3.0 additional pregnancies per 100 intrauterine insemination cycles. When comparing men at the 1% or greater and the less than 1% thresholds, there were no statistical or clinical differences in the rate of ultrasound verified pregnancy per cycle of intrauterine insemination (14.0% vs 13.9%, p = 0.97) or in the risk difference (1.6%, 95% CI -4.5-7.6). Conclusions: There appears to be no clinical difference in intrauterine insemination pregnancy success among men with normal and abnormal sperm morphology when accounting for total motile sperm count and female age. Abnormal sperm morphology alone should not exclude couples from attempting intrauterine insemination.

AB - Purpose: Men with abnormal sperm morphology are often counseled that natural conception and intrauterine insemination are ineffective, and in vitro fertilization is the only option. Our objective was to determine the effect of sperm morphology on the pregnancy success of intrauterine insemination. Materials and Methods: We systematically searched for studies published prior to January 2017 that 1) reported ultrasound verified clinical pregnancies per intrauterine insemination cycle, 2) assessed sperm morphology using the kruger strict criteria and 3) described morphology at the greater than 4% and 4% or less and/or the 1% or greater and less than 1% thresholds. In all studies mean female age was between 25 and 40 years and mean total motile sperm count was greater than 10 million. Estimates were pooled using random effects meta-analysis. Results: Data were extracted from 20 observational studies involving a total of 41,018 cycles. When comparing men at the greater than 4% and 4% or less thresholds, the rate of ultrasound verified pregnancy per intrauterine insemination cycle was not statistically or clinically different (14.2% vs 12.1%, p = 0.06) and the risk difference was 3.0% (95% CI 1.4-4.6), indicating 3.0 additional pregnancies per 100 intrauterine insemination cycles. When comparing men at the 1% or greater and the less than 1% thresholds, there were no statistical or clinical differences in the rate of ultrasound verified pregnancy per cycle of intrauterine insemination (14.0% vs 13.9%, p = 0.97) or in the risk difference (1.6%, 95% CI -4.5-7.6). Conclusions: There appears to be no clinical difference in intrauterine insemination pregnancy success among men with normal and abnormal sperm morphology when accounting for total motile sperm count and female age. Abnormal sperm morphology alone should not exclude couples from attempting intrauterine insemination.

KW - Artificial

KW - Homologous

KW - Infertility

KW - Insemination

KW - Male

KW - Semen analysis

KW - Spermatozoa

KW - Testis

UR - http://www.scopus.com/inward/record.url?scp=85040640712&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85040640712&partnerID=8YFLogxK

U2 - 10.1016/j.juro.2017.11.045

DO - 10.1016/j.juro.2017.11.045

M3 - Article

C2 - 29129781

AN - SCOPUS:85040640712

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

ER -