Abstract: PD68-10
Sources of Funding: None

Introduction

Multiple studies have demonstrated a higher intrauterine insemination (IUI) pregnancy success in men with >4% normal morphology compared to men with ≤4% normal sperm morphology; other studies have not demonstrated this relationship. We performed a systematic review and meta-analysis to assess the effect of abnormal sperm morphology on pregnancy success for couples undergoing IUI._x000D_

Methods

We performed a systematic search of MEDLINE, EMBASE, and Clinicaltrial.gov for studies evaluating semen morphology using the strict criteria and IUI success rates (measured by clinical pregnancies per cycle of IUI) published through April 2016. Studies were eligible for inclusion if they assessed IUI pregnancy success rate for percent sperm morphology >4% and ≤4% or percent sperm morphology ≥1% and <1%. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using meta-regression._x000D_

Results

Data were extracted from 22 trials involving 25,817 cycles. 19 trials reported sperm morphology >4% and ≤4% and 13 trials reported sperm morphology ≥1% and <1%. Average pregnancy success rates for couples with a normal sperm morphology >4% was 15.29% [95% CI: 12.89% to 18.05%; I2=91.5%]. There was no significantly difference when compared to the pregnancy success rate for couples with normal sperm morphology ≤4%: 13.00% [95% CI: 10.76% to 15.63%; I2=88.9%]; between-group difference, P = 0.205. No significant difference was seen between the average pregnancy success for couples with a sperm morphology ≥1%: 14.06% [95% CI: 12.47% to 15.81%; I2=80.1%] compared to the pregnancy success for couples with sperm morphology <1%: 13.33% [95% CI: 9.93% to 17.68%; I2=28.9%]; between-group difference P = 0.739. Using meta-regression, no within-group confounders were noted for wither 1% threshold and 4% threshold when potential confounders such as female age, average total motile count (TMC), minimum TMC required for IUI, and average year of study (P > 0.05)._x000D_

Conclusions

Neither the threshold of sperm morphology between >4% and ≤4% and ≥1% and <1% was statistically significant nor clinically significant. Thus for couples with abnormal morphology, IUI ought to be trialed prior to proceeding to significantly more expensive in vitro fertilization. We recommend that men with isolated abnormal sperm morphology should not be counseled against trial of IUI even if sperm morphology is <1%. _x000D_

Funding

None