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

Objective: To determine if a simple screening test of sperm recovery through a density gradient preparation and sperm survival after a 24-hour incubation 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 and unexplained infertility. Intervention(s): An advanced semen analysis, which consisted of a basic semen analysis, sperm processing through a density gradient preparation, and a 24-hour sperm incubation, was performed on all couples before beginning IUIs. Main Outcome Measure(s:): Cumulative and per cycle pregnancy rates (PRs) were calculated for routine semen parameters, number of sperm processed through 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 insemination 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 pregnancy with a 21.4% (162 of 757) per cycle PR compared to a 2.8% (11 of 403) per cycle PR and 4.7% total PR when survival was <70%. With use of these cutoff values for the advanced semen analysis, the test had a sensitivity of 94% and specificity of 86%. Conclusion(s): The number of motile sperm available for insemination and especially 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 Society for Reproductive Medicine.)