Prediction of pregnancy by intrauterine insemination using CASA estimates and strict criteria in patients with male factor infertility
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Summary: This study was performed to predict pregnancy by intrauterine insemination (IUI) using computer‐aided sperm analysis (CASA) estimates and strict criteria in patients with male factor infertility. IUI was performed in 682 cycles on 160 male factor infertile patients. Semen examinations were carried out by CASA and strict criteria before and after sperm preparation using continuous‐step density gradient centrifugation. Receiver operating characteristics (ROC) curves were constructed for assessment of the effectiveness of each individual parameter in predicting pregnancy by IUI. A clinically acceptable threshold was calculated when sensitivity plus specificity were maximum. The average cycle of IUI performed was 4.3 ± 2.4. Pregnancy rate per cycle and per patient were 7.2% (49/682) and 28.1% (45/160), respectively. Using ROC curve, it was shown that normal sperm morphology assessed by the strict criteria before sperm separation and five parameters after sperm separation including rapid, progressive motility, average path velocity (VAP), curvilinear velocity (VCL), and straight line velocity (VSL) were able to predict pregnancy by IUI. Correlation between sperm parameters and pregnancy outcome was examined by the logistic regression model. In a multivariate analysis normal morphology before sperm separation ≥15.5% [odds ratio (OR) = 2.2, p = 0.02], rapid after sperm separation ≥25.5% [OR = 3.9, p = 0.029], and VCL after sperm separation ≥102.65 μm/sec [OR = 3.2, p = 0.002] were the parameters of predictive value for pregnancy outcome. Adjustment of the model for female age, female infertility factors, and the methods of ovulation induction did not change this finding, and the final model still had the same covariates. Pregnancy rates per cycle according to the number (0, 1, 2 and 3) of variables satisfied with the three parameters were 0% (0/110), 1.6% (3/183), 9.7% (21/217) and 15.1% (23/151), respectively. Three semen parameters including normal morphology before sperm separation, rapid and VCL after sperm separation were identified as predictors of pregnancy by IUI. These variables would be helpful when counselling patients before they make the decision to proceed with in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI)‐ET.
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Other smaller studies observed that sperm morphology affected the outcome of IUI.
“Other studies of smaller series also observed that sperm morphology affected the outcome of IUI [86, 87, 88, 89, 90, 91, 92, 93].”
From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [91]
The Results of IUI treatment report that normal sperm morphology predicted pregnancy after IUI, supporting the main point. The Discussion describes this study as a “large series of 682 consecutive IUI”; our copy does not establish that it was a smaller series relative to the citing study. (LLM, conf=0.83)
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Isolated abnormal strict morphology is not a contraindication for intrauterine insemination
Lockwood, G. M., Deveneau, N. E., Shridharani, A. N., Strawn, E. Y., & Sandlow, J. I. (2015) · Andrology · doi:10.1111/andr.12098 · Cited by 34 · see citing works
Gatimel, N., Barbotin, A., Mery, L., Beauvillard, D., Bendayan, M., Boursier, A., Boueilh, T., Pereira, B., Chammas, J., Jacquet, J., et al. (2026) · Andrology · doi:10.1111/andr.70134 · Cited by 2 · see citing works
- Authors
- Shibahara, H., Obara, H., Ayustawati, Hirano, Y., Suzuki, T., Ohno, A., Takamizawa, S., & Suzuki, M.
- Affiliations
- Jichi Medical University (JP)
- Corresponding author
- Shibahara, Hiroaki
- Venue
- International Journal of Andrology
- Publisher
- Wiley
- Published
- 2004-03-05
- Volume
- 27
- Issue
- 2
- Pages
- 63-68
- ISSN
- 0105-6263 (ISSN-L)
- 1365-2605
- OpenAlex
- W2017922757
- Cited by
- 92
- References
- 1
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 5 · 2023: 5 · 2022: 2 · 2021: 1 · 2020: 1 · 2019: 5 · 2018: 8 · 2017: 4 · 2016: 4 · 2015: 5 · 2014: 7 · 2013: 9 · 2012: 5
- FWCI
- 3.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Journal of Andrology (publishedVersion)
- PubMed (publishedVersion)
- 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, male factor infertility, computer-assisted sperm analysis, sperm motility, sperm morphology, sperm preparation, density gradient centrifugation, pregnancy prediction, curvilinear velocity, ovulation induction, patient counseling, logistic regression
- MeSH terms
- Adult, Electronic Data Processing, Female, Humans, Infertility, Male, Insemination, Artificial, Homologous, Male, Pregnancy, Prognosis, ROC Curve, Sperm Motility, Spermatozoa, Pregnancy Rate
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