Impacto de la morfología espermática en las tasas de embarazo con inseminación intrauterina / Impact of sperm morphology on pregnancy rates after intrauterine insemination

Introducción y objetivo: La morfología espermática se ha utilizado como factor pronóstico en fertilización in vitro; sin embargo, en inseminación intrauterina (IIU) su rol predictivo es controversial. El objetivo de este estudio fue determinar el impacto que tiene la morfología espermática como parámetro aislado del espermiograma en la probabilidad de embarazo de parejas que son tratadas con IIU. Material y métodos: Estudio retrospectivo de los ciclos de IIU realizados en la Unidad de Medicina Reproductiva de Clínica Las Condes entre enero del 2016 y diciembre del 2018. Regresión logística de las siguientes variables: morfología espermática agrupada en 0-1%, 2-3% y≥4%, recuento total de espermatozoides con motilidad progresiva inseminados, edad de la mujer y del hombre. Resultados: Se incluyeron 385 casos, diagnosticándose embarazo clínico en 85 de ellos. Al separar en grupos de morfología espermática<4% y≥4% la tasa de embarazo fue de 22% en ambos grupos. La edad de la mujer fue el único factor estadísticamente significativo en la regresión logística. El área bajo la curva de ROC de morfología espermática como predictor de embarazo fue de 0,53. Conclusiones: Nuestro estudio concluye que la morfología espermática no debe ser considerada como parámetro único a la hora de decidir si una pareja puede ser tratada o no con IIU, eliminando la teratozoospermia aislada como indicación directa de fertilización in vitro. No fue posible determinar un punto de corte de morfología espermática que sirva como predictor de embarazo. (AU)

Introduction and objective: Sperm morphology has been used as a prognostic factor in in vitro fertilization, however, in intrauterine insemination (IUI) its predictive role is controversial. The aim of this study was to determine the impact of sperm morphology as isolated parameter of the spermiogram has on the probability of pregnancy in couples that are treated with IUI. Material and methods: Retrospective study of IUI cycles performed in the Reproductive Medicine Unit of Clínica Las Condes between January 2016 and December 2018. Logistic regression of the following variables: sperm morphology grouped in 0-1%, 2-3% and≥4%, total progressively motile sperm count inseminated, age of the woman and the man. Results: A total of 385 cases were included and clinical pregnancy was diagnosed in 85 of them. When separating into groups of sperm morphology<4% and≥4%, the pregnancy rate was 22% in both groups. The age of the woman was the only statistically significant factor in the logistic regression. The area under the ROC curve of sperm morphology as a predictor of pregnancy was 0.53. Conclusions: Our study concludes that sperm morphology should not be considered as a single parameter when deciding whether or not a couple can be treated with IUI, eliminating isolated teratozoospermia as a direct indication for in vitro fertilization. It was not possible to determine a cut-off point for sperm morphology that serves as a predictor of pregnancy. (AU)

[Impact of sperm morphology on pregnancy rates after intrauterine insemination]. / Impacto de la morfología espermática en las tasas de embarazo con inseminación intrauterina.

INTRODUCTION AND OBJECTIVE: Sperm morphology has been used as a prognostic factor in in vitro fertilization, however, in intrauterine insemination (IUI) its predictive role is controversial. The aim of this study was to determine the impact of sperm morphology as isolated parameter of the spermiogram has on the probability of pregnancy in couples that are treated with IUI. MATERIAL AND METHODS: Retrospective study of IUI cycles performed in the Reproductive Medicine Unit of Clínica Las Condes between January 2016 and December 2018. Logistic regression of the following variables: sperm morphology grouped in 0-1%, 2-3% and≥4%, total progressively motile sperm count inseminated, age of the woman and the man. RESULTS: A total of 385 cases were included and clinical pregnancy was diagnosed in 85 of them. When separating into groups of sperm morphology<4% and≥4%, the pregnancy rate was 22% in both groups. The age of the woman was the only statistically significant factor in the logistic regression. The area under the ROC curve of sperm morphology as a predictor of pregnancy was 0.53. CONCLUSIONS: Our study concludes that sperm morphology should not be considered as a single parameter when deciding whether or not a couple can be treated with IUI, eliminating isolated teratozoospermia as a direct indication for in vitro fertilization. It was not possible to determine a cut-off point for sperm morphology that serves as a predictor of pregnancy.