Spermatozoa concentration and motility in relation to pregnancy outcomes of assisted reproductive procedures

To determine whether sperm concentration and motility in the initial semen assessment affects overall pregnancy outcome of in vitro fertilization(IVF), intracytoplasmic sperm injection(ICSI), and intrauterine insemination(IUI) cycles. Retrospective chart review study. Patient treatment groups were IUI, IVF, and ICSI cycles. Medications used for ovulation induction in IVF and ICSI cycles were gonadotropins and/or menotropins, whereas in IUI cycles, ovulation was induced by clomiphene, tamoxifen and/or gonadotropins/menotropins. Follicular growth was monitored with estradiol levels and ultrasound examinations. Initial semen volume, sperm count, and motility were reported before processing. Embryos in IVF and ICSI groups were transferred on day 3. Pregnancy outcomes were obtained directly from patients. There were 824 patients in the IUI group, 786 in the IVF group, and 1268 in the ICSI group. Sperm concentrations(0-20;20-99.9;100-150;>150M/ml)affected(P<0.01)clinical pregnancy(40.5;36.1;24.6;15.8%)and delivery rates(34.2;31.2;23.1;5.3%)in the ICSI group. Motility(1-29.9;30-60;>60%)was significant in the respect that as values increased(P<0.04)clinical pregnancy decreased(42.9;37;33.9%)but delivery rates remained unaffected in the ICSI group. In the IVF and IUI groups, clinical pregnancy and delivery outcomes were not influenced by these semen parameters. Our results indicate that high concentrations of sperm in semen may decrease functionality of spermatozoa lowering successful pregnancy rates in ICSI cycles. Results also suggest that as motility increases, pregnancy rates decrease but overall delivery rates are unaffected in the ICSI group. Lack of such an effect in IVF and IUI cases are most likely due to the ability of the cumulus cell to perform natural selection of sperm for oocyte fertilization. Therefore, additional screening test(s) for samples with high sperm concentration and motility have to be established if ICSI is to be considered.