Predictive value of sperm morphology and progressively motile sperm count for pregnancy outcomes in intrauterine insemination
Open accessAbstract
Objective To investigate the value of sperm parameters to predict an ongoing pregnancy outcome in couples treated with intrauterine insemination (IUI), during a methodologically stable period of time. Design Retrospective, observational study with logistic regression analyses. Setting University hospital. Patient(s) A total of 1,166 couples visiting the fertility laboratory for their first IUI episode, including 4,251 IUI cycles. Intervention(s) None. Main outcome measure(s) Sperm morphology, total progressively motile sperm count (TPMSC), and number of inseminated progressively motile spermatozoa (NIPMS); odds ratios (ORs) of the sperm parameters after the first IUI cycle and the first finished IUI episode; discriminatory accuracy of the multivariable model. Result(s) None of the sperm parameters was of predictive value for pregnancy after the first IUI cycle. In the first finished IUI episode, a positive relationship was found for ≤4% of morphologically normal spermatozoa (OR 1.39) and a moderate NIPMS (5-10 million; OR 1.73). Low NIPMS showed a negative relation (≤1 million; OR 0.42). The TPMSC had no predictive value. The multivariable model (i.e., sperm morphology, NIPMS, female age, male age, and the number of cycles in the episode) had a moderate discriminatory accuracy (area under the curve 0.73). Conclusion(s) Intrauterine insemination is especially relevant for couples with moderate male factor infertility (sperm morphology ≤4%, NIPMS 5-10 million). In the multivari…
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In a multivariate analysis including more than 4200 cycles, sperm morphology had no impact on pregnancy rates after IUI.
“In a multivariate analysis including more than 4200 cycles, Lemmens et al. [74] highlight sperm morphology had no impact on pregnancy rates after IUI.”
From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [74]
Publications examining the impact of morphology on spontaneous pregnancy, intrauterine insemination, and in vitro fertilization reach varying conclusions.
“Despite efforts to standardize methodology for grading sperm morphology, publications examining the impact morphology on spontaneous pregnancy, intrauterine insemination, and in vitro fertilization reach varying conclusions (2, 3, 4, 5, 6, 7, 8, 9, 10).”
From Poor reproducibility of percentage of normally shaped sperm using the World Health Organization Fifth Edition strict grading criteria (2022) · cites this paper as [6]
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Isolated abnormal strict morphology is not a contraindication for intrauterine insemination
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- Authors
- Lemmens, L., Kos, S., Beijer, C., Brinkman, J. W., van der Horst, F. A. L., van den Hoven, L., Kieslinger, D. C., van Trooyen-van Vrouwerff, N. J., Wolthuis, A., Hendriks, J. C. M., Wetzels, A. M. M., Kos, S., Beijer, C., Brinkman, J. W., van der Horst, F. A. L., van den Hoven, L., Kieslinger, D. C., van Trooyen-van Vrouwerff, N. J., Wolthuis, A., & Wetzels, A. M. M.
- Affiliations
- Radboud University Medical Center (NL)
- Corresponding author
- Lemmens, Louise
- ORCID
- Hendriks, Jan C.M.
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 2016-06
- Volume
- 105
- Issue
- 6
- Pages
- 1462-1468
- ISSN
- 0015-0282 (ISSN-L)
- OpenAlex
- W2278084710
- Cited by
- 91
- References
- 4
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 8 · 2023: 6 · 2022: 10 · 2021: 21 · 2020: 12 · 2019: 9 · 2018: 9 · 2017: 5 · 2016: 3
- FWCI
- 11.47
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Sperm and Testicular Function
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Health Sciences › Health Professions › General Health Professions › Male Reproductive Health Studies
- Keywords
- intrauterine insemination, sperm morphology, pregnancy outcome prediction, male factor infertility, semen parameters
- MeSH terms
- Adult, Aged, Female, Humans, Infertility, Male, Insemination, Artificial, Male, Middle Aged, Predictive Value of Tests, Pregnancy, Pregnancy Outcome, Retrospective Studies, Sperm Count, Sperm Motility, Spermatozoa, Young Adult
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