Comparison of pregnancy rates in pre-treatment male infertility and low total motile sperm count at insemination

In intrauterine insemination (IUI), total motile sperm count (TMSC) is an important predictor of pregnancy. However, the clinical significance of a poor TMSC on the day of IUI in a patient with prior normal semen analysis (SA) is unclear. We performed this study to determine if these patients perform as poorly as those who had male factor infertility diagnosed prior to commencing treatment. 147 males with two abnormal SA based on the 2010 World Health Organization criteria underwent 356 IUI with controlled ovarian hyper-stimulation (COH). Their pregnancy rates were compared to 120 males who had abnormal TMSC at the time of 265 IUI with COH, in a retrospective university-based study. The two groups were comparable in female age (p = 0.11), duration of infertility (p = 0.17), previous pregnancies (p = 0.13), female basal serum FSH level (p = 0.54) and number of mature follicles on the day of ovulation trigger (p = 0.27). Despite better semen parameters on the day of IUI in the pre-treatment male factor infertility group (TMSC mean +/- A SD: 61 +/- A 30 million vs. 3.5 +/- A 2 million, p < 0.001), pregnancy rates were much higher in the group with low TMSC on the day of IUI (5 % vs. 17 %, p < 0.001). A patient with a recent (within 6 months) normal pre-treatment SA but low TMSC on the day of IUI likely has a reasonable chance to achieve pregnancy, and does not perform as poorly as subjects previously diagnosed with male factor infertility. More studies should be performed to confirm these findings.