Advanced semen analysis: a simple screening test to predict intrauterine insemination success

Objective: To determine if a simple screening test of sperm recovery throug h a density gradient preparation and sperm survival after a 24-hour incubat ion is predictive of IUI success. Design: Prospective nonrandomized descriptive study. Setting: Tertiary assisted reproductive technology center. Patient(s): Four hundred fourteen couples undergoing IUI for male factor an d unexplained infertility. Intervention(s): An advanced semen analysis, which consisted of a basic sem en analysis, sperm processing through a density gradient preparation, and a 24-hour sperm incubation, was performed on all couples before beginning IU Is. Main Outcome Measure(s:): Cumulative and per cycle pregnancy rates (PRs) we re calculated for routine semen parameters, number of sperm processed throu gh density gradient, and percent motile sperm after a 24-hour incubation. Result(s): None of the basic semen analysis parameters accurately predicted IUI success. When the processed total motile sperm available for inseminat ion was greater than or equal to 10 X 10(6) and their 24-hour survival was greater than or equal to 70%, 89% (162 of 182) of couples achieved a pregna ncy with a 21.4% (162 of 757) per cycle PR compared to a 2.8% (11 of 403) p er cycle PR and 4.7% total PR when survival was <70%. With use of these cut off values for the advanced semen analysis, the test had a sensitivity of 9 4% and specificity of 86%. Conclusion(s): The number of motile sperm available for insemination and es pecially their 24-hour survival are highly predictive of IUI success. This advanced semen analysis is an excellent screening test to evaluate couples considering IUI. (Fertil Steril(R) 1999;71:547-51. (C) 1999 by American Soc iety for Reproductive Medicine.)