SPERM RECOVERY AND SURVIVAL - 2 TESTS THAT PREDICT IN-VITRO FERTILIZATION OUTCOME

Objectives: To determine if human sperm recovery during swim-up and sp erm survival after 24 hours, as obtained from a screening semen specim en, are predictive of subsequent IVF and clinical pregnancy rates (PRs ) and to determine if these techniques can identify men with normal se men analysis parameters and poor TVF success. Design: Historical prosp ective study. Setting: All semen evaluations and IVF cycles were perfo rmed at the University of Pittsburgh, Magee-Womens Hospital, Pittsburg h, Pennsylvania. Patients, Participants: Couples undergoing IVF at Mag ee-Womens Hospital from August 1988 through June 1993. Interventions: A screening semen analysis and swim-up procedure were performed on all couples undergoing IVF. The number of spermatozoa recovered after swi m-up and the percentage of motile spermatozoa present after a 24-hour incubation were recorded. Main Outcome Measures: Fertilization and PRs were compared according to the parameters obtained from routine semen analysis, the number of spermatozoa obtained with swim-up, and the pe rcentage of motile spermatozoa at 24 hours. Results: Using X(2) or Fis her's exact test, fertilization rates were significantly different acc ording to the number of spermatozoa recovered after swim-up (less than or equal to 2.0 and >2.0 X 10(6) spermatozoa recovered, 48.3% versus 71.4%) as were PRs (16.9% versus 29.8%). Similarly, the percentage of motile spermatozoa present at 24 hours (<less than or equal to >20% an d >20%) discriminated between fertilization rates (45.9% versus 65.8%) and PRs (16.4% versus 36.5%). Among a subset of men with normal semen analyses and total motile sperm counts greater than or equal to 40 X 10(6), the results from swim-up and survival discriminated between men with high and low fertilization and PRs. Receiver operating character istic analysis revealed that swim-up results better discriminated betw een pregnant and nonpregnant IVF patients than sperm motility, but tha t the percentage of motile spermatozoa present at 24 hours was no bett er in this regard than sperm motility. Conclusions: The number of sper matozoa recovered after swim-up and the percentage of spermatozoa that maintain their motility after 24 hours were both helpful in assessing IVF and PRs and may be helpful in altering physicians to a subset of men having normal semen analysis parameters yet poor IVF success.