INTRAUTERINE INSEMINATION AFTER OVARIAN STIMULATION WITH CLOMIPHENE CITRATE - PREDICTIVE POTENTIAL OF INSEMINATING MOTILE COUNT AND SPERM MORPHOLOGY

This retrospective study aimed to evaluate the prognostic value of the inseminating motile count (IMC) and sperm morphology (using strict cr iteria) on success rates after homologous intrauterine insemination (I UI) combined with clomiphene citrate (CC) stimulation. A total of 373 couples underwent 792 IUI cycles in a predominantly (87.4%) male subfe rtility group. The overall cycle fecundity (CF) and baby take-home rat e (BTH) was 14.6 and 9.9% respectively. The cumulative CF and BTH (per couple) after three cycles were 30.6 and 21.1% respectively. Overall, sperm morphology and IMC were of no prognostic value using receiver o perating characteristic (ROC) curve analysis, but after classifying th e study population into different subgroups according to IMC, sperm mo rphology turned out to be a valuable prognostic parameter in subgroup 1, i.e. IMC <1x10(6). In this subgroup, no pregnancies were seen when the morphology score was <4% and the mean value of sperm morphology wa s significantly different in the pregnant (8.3%) versus non-pregnant g roup (5.0%; P <0.05). The cumulative CF and BTH after three IUI cycles were comparable for all couples with the exception of those cases in which the IMC was <1 x 10(6) with a morphology score of <4% normal for ms. We recorded only two twin pregnancies (2.5%) and no moderate or se vere ovarian hyperstimulation syndrome. We conclude that in a selected group of patients without CC resistance and normal ovarian response f ollowing CC stimulation [maximum of three follicles with a diameter of >16 mm at the time of administration of human chorionic gonadotrophin (HCG)], IUI combined with CC-HCG can be offered as a very safe and no n-expensive first-line treatment, at least with a IMC of >1 x 10(6) sp ermatozoa. In cases with <1 x 10(6) spermatozoa, CC-IUI remains import ant as a first-choice therapy provided the morphology score is greater than or equal to 4%.