THE EVALUATION OF THE SPERM MIGRATION TEST AS A PREDICTOR FOR SUCCESSWITH INTRAUTERINE INSEMINATION

Objective-The objective of this study was to prospectively evaluate th e sperm migration test (SMT) as a discriminator in couples undergoing intrauterine insemination (IUI). Patients and Methods-261 couples unde rwent 797 IUI treatment cycles involving gonadotropin stimulation in t he three year period. All had a diagnosis of unexplained infertility. All male partners underwent a repeat standard seminal analysis and SMT prior to the female partner undergoing controlled ovarian stimulation . Results-Despite apparently normal seminal analyses before referral, in 22 samples the sperm concentration, motility or morphology were abn ormal (WHO criteria). Of these, 20 couples underwent 109 cycles and ac hieved 2 pregnancies giving a pregnancy rate of 1.8% per cycle and a c umulative pregnancy rate of 10% per couple. From the remaining couples with normal seminal analyses, 71 had an SMT <5 million/mL and 168 had an SMT >5 million/ml. The suboptimal SMT group underwent 276 cycles ( 3.89 cycles per couple) and achieved 18 pregnancies giving a pregnancy rate of 6.5% per cycle and a cumulative pregnancy rate of 25.4%. The normal SMT group underwent 412 cycles (2.45 cycles per couple) and ach ieved 60 pregnancies giving a pregnancy rate of 14.6% per cycle and a cumulative pregnancy rate of 35.7%. Conclusions-We confirm that abnorm al seminal analysis leads to poor pregnancy rates with IUI. However, a n SMT <5 million/mL despite normal seminal analysis (WHO criteria) als o leads to significantly worse pregnancy rates. We would recommend tha t prior to IUI, couples are screened using the SMT.