ABNORMAL SPERM MORPHOLOGY IS HIGHLY PREDICTIVE OF PREGNANCY OUTCOME DURING CONTROLLED OVARIAN HYPERSTIMULATION AND INTRAUTERINE INSEMINATION

Purpose: The purpose of this study was to assess the predictive value of a modified form of Kruger's strict criteria for sperm morphology fo r pregnancy outcomes after intrauterine insemination (IUI) and control led ovarian hyperstimulation (COH) in the presence of normal sperm con centration and motility. Materials and Methods: A retrospective review of 42 couples undergoing COH/IUI was stratified by favorable or unfav orable sperm morphology, Endpoints were pregnancy or failure Of treatm ent as defined by four or more cycles of COH/IUI without pregnancy. Re sults: An unfavorable morphology (<4%) was highly predictive of failur e during COH-IUI (94.45%; 17/18). A normal PIF was a sensitive indicat or of those patients who became pregnant (93.8%; 15/16) and had a fair specificity for failure to achieve pregnancy after four cycles of tre atment (65.4%; 17/26). Couples with a favorable sperm morphology were 28.3 rimes as likely to achieve a pregnancy within four cycles of trea tment as those with unfavorable sperm morphology [95% confidence limit s, 3.2 to 250.5; P < 0.001]. Conclusions: Abnormal strict morphologic assessment is both sensitive and specific for pregnancy outcomes in co uples undergoing COH/IUI. Couples with persistently unfavorable sperm morphology should be counseled appropriately and would be better sewed by more aggressive treatment with in vitro fertilization and embryo t ransfer.