Abstract
Amaç: İnfertil hastalarda intrauterin inseminasyon yaygın kullanılan bir yöntemdir. Bu hastalardaki gebelik başarısını
etkileyen sperm parametreleri ise hala tartışmalı bir konudur. Bu çalışmamız sperm parametrelerinin intrauterin
inseminasyon sonuçlarına etkisini tayin etmeyi amaçlamaktadır.
Gereç ve Yöntem: Çalışmamız Ocak 2009-Ocak 2011 tarihleri arasında Dr. Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma
Hastanesi infertilite polikliniğinde rekombinant FSH ile ovulasyon indüksiyonu oluşturulup intrauterin inseminasyon
uygulanan 170 infertil hastanın 300 siklusunun incelendiği bir çalışmadır. Yaş, bazal FSH, toplam kullanılan FSH dozu,
tedavi siklus sayısı, sigara kullanımı, varikosel ve semen parametreleri ile tedavi sonuçları karşılaştırıldı. Hastaların semen
parametrelerinde total progresif motil sperm sayısı ≤10 milyon ve >10 milyon , morfoloji ise ≤ % 4 ve >% 4 olarak gruplara
ayrıldı. Total progresif motil sperm sayısı ve morfoloji gruplarının gebelik sonuçlarına bakıldı. Erkek hastalarda sigara
kullanımı ve varikoselin total progresif motil sperm sayısı ve morfolojiye olan etkilerine bakıldı.
Bulgular: Total progresif motil sperm sayısı <10 milyon ve ≥10 milyon grupları arasında ve morfoloji ≤% 4 ve >% 4
grupları arasında klinik gebelik oranları açısından istatiksel olarak anlamlı fark saptanmadı. Erkelerde sigara kullanımının
normal morfolojideki sperm sayısının azalttığı, varikoselin ise hem total progresif motil sperm sayısını hem de normal
morfolojideki sperm sayısının azalttığı bulundu.
Sonuç: İntrauterin inseminasyon sikluslarındaki gebelik oranları ne tek başına morfoloji ne de tek başına total progresif
motil sperm sayısı ile korelasyon göstermektedir. İnfertil erkeklerde sigara kullanımının özellikle morfolojiyi bozarak
gebelik oranlarını azalttığı saptandı. Varikoselin hem morfolojiyi hem de total progresif motil sperm sayısını azalttığı
fakat bunun gebelik sonuçlarını etkilemediği sonucuna ulaşıldı.
References
- Fritz AM, Speroff L. Clinical Gynecologic Endocrinology and Infertility, 2011.
- Tomlinson MJ, Amissah-Arthur JB, Thompson KA, Kasraie JL, Bentick B. Prognostic indicators for intrauterine insemination (IUI): statistical model for IUI success. Hum Reprod 1996; 11:1892-1896.
- Guzick D, Sullivan M, Adamson GD, et al. Efficacy of treatment for unexplained infertility. Fertil Steril 1998; 70:207-213.
- Goverde AJ, McDonnell J, Vermeiden JP, Schats R, Rutten FF, Schoemaker J. IUI or IVF in idiopathic subfertility and male subfertility. Lancet 2000; 355:13-18.
- Kirby CA, Flaherty SP, Godfrey BM, et al. A prospective trial of intrauterine insemination of motile spermatozoa versus timed intercourse. Fertil Steril 1991; 56:102-107.
- Berger T, Marrs RP, Moyer DL. Comparison of techniques for selection of motile spermatozoa. Fertil Steril 1985; 43:268-273.
- DiMarzo SJ, Kennedy JF, Young PE, et al. Effect of controlled ovarian hyperstimulation on pregnancy rates intrauterine insemination. Am J Obstet Gynecol 1992; 166:1607-1612.
- ESHRE Capri Workshop Group. Intrauterine insemination. Hum Reprod Update 2009; 15:265-277.
- Sharpe RM. Environment, lifestyle and male infertility. Baillieres Best Pract Res Clin Endocrinol Metab 2000; 14:489–503.
- Papadimas J, Mantalenakis S. Reproductive Endocrinology in males. Thessaloniki, University Studio Press, 1993.
- Kantartzi P-D. [Update on the role of varicocele in male infertility]. Master degree dissertation. Thessaloniki, 2006.
- Van Noord-Zaadstra BM, Looman CW, Alsbach H, Habbena JDF, teVelde ER, Karbaat J. Delaying child-bearing: effect of age on fecundity and outcome of pregnancy, Br Med J 1991; 302:1361-1365.
- Shenfi eld F, Doyle P, Valentine A, Steele SJ, Tan S-L, Effects of age, gravidity and male infertility status on cumulative conception rates following artificial insemination with cryopreserved donor semen: analysis of 2998 cycles of treatment in one centre over 10 years. Hum Reprod 1993; 8:60-64.
- Demir B, Dilbaz B, Cinar O, et al. Factors affecting pregnancy outcome of intrauterine insemination cycles in couples with favourable female characteristics. J Obstet Gynaecol. 2011; 31:420-423.
- Barroso G, Oehninger S, Monzo A, Kolm P, Gibbons WE, Muasher Sj. High FSH:LH ratio and low LH levels in basal cycle day 3: impact on follicular development and IVF outcome. J Assist Reprod Genet 2001; 18:499-505.
- Burr RW, Siegberg R, Flaherty S, Wang XJ and Matthews CD. The influence of sperm morphology and the number of motile sperm count inseminated on the outcome intrauterine insemination combined with mild ovarian stimulation. Fertil Steril 1996; 65:127-132.
- A Nyboe Andersen, V Goossens, S Bhattacharya, et al. Assisted reproductive technology and intrauterine inseminations in Europe, 2005: results generated from European registers by ESHRE: ESHRE. The European IVF Monitoring Programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE). Hum Reprod 2009; 24:1267-1287.
- Thonneau P, Marchand S, Tallec A, et al. Incidence and main causes of infertility in a resident population (1,850,000) of three French regions (1988–1989). Hum Reprod 1991; 6:811-816.
- Ombelet W, Dhont N, Thijssen A, Bosmans E, Kruger T. Semen quality and prediction of IUI success in male subfertility: a systematic review. Reprod Biomed Online 2014; 28:300-309.
- Wainer R, Merlet F, Bailly M, Lombroso R, Camus E and Bisson JP. Prognosis for intrauterine insemination with partner’s sperm according to the characteristics of the spermatozoa.Contracept Fertil Sex 1996;24:897-903.
- Wainer R, Albert M, Dorion A, Influence of the number of motile spermatozoa inseminated and of their morphology on the success of intrauterine insemination Hum Reprod 2004;19:2060-2065.
- Lindheim SR, Barad DH, Zinger M, et al. Abnormal sperm morphology is highly predictive of pregnancy outcome during COH and IUI. J Assist Reprod Genet 1996; 13:569-572.
- Karabinus DS, Gelety TJ. The impact of sperm morphology evaluated by strict criteria on intrauterine insemination success. Fertil Steril 1997; 67:536-541.
- Check ML, Bollendorf A, Check JH, Katsoff D. et al. Reevaluation of the clinical importance of evaluating sperm morphology using strict criteria. Arch Androl 2002; 48:1-3.
- Lockwood GM, Deveneau NE, Shridharani AN, Strawn EY, Sandlow JI. Isolated abnormal strict morpholohy is not a contraindication for intrauterine insemination. Andrology 2015; 3:1088-1093.
- Van Waart J, Kruger TF, Lombard CJ, Ombelet W. Predictive value of normal sperm morphology in intra uterine insemination (IUI): a structured literature review. Hum Reprod Update 2001; 7:495-500.
- Ghaffari MA, Rostami M. The effect of cigarette smoking on human sperm creatine kinase activity: as an ATP buffering system in sperm. Int J Fertil Steril 2013; 6:258–265.
- İrez T, Ocal P, İdil M, et al. Effects of smoking cigarette on intrauterine insemination outcomes. Basic Clin Sci 2013;2:20–4.
- Harlev A, Agarwal A, Gunes SO, Shetty A, du Plessis SS. Smoking and Male Infertility: An Evidence-Based Review. World J Mens Health 2015; 33:143–160.
- Agarwal A, Majzoub A, Esteves SC, Ko E, Ramasamy R, Zini A. Clinical utility of sperm DNA fragmentation testing: practice recommendations based on clinical scenarios. Transl Androl Urol 2016; 5:935–950.
- Jensen MS, Mabeck LM, Toft G, Thulstrup AM, Bonde JP. Lower sperm counts following prenatal tobacco exposure. Hum Reprod 2005; 20:2559–2566.
- Axelsson J, Rylander L, Rignell-Hydbom A, Silfver KÅ, Stenqvist A, Giwercman A. The Impact of Paternal and Maternal Smoking on Semen Quality of Adolescent Men. PLoS One. 2013; 8(6):e66766.
- Beal MA, Yauk CL, Marchetti F. From sperm to offspring: Assessing the heritable genetic consequences of paternal smoking and potential public health impacts. Mutat Res 2017; 773:26–50.
- Nieschlag E. Classification of andrological disorders In: Nieschlag E, Behre HM, eds. Andrology. Berlin, Heildelberg, New York: Spriger-Verlag 1997; 79-83
- Redmon JB, Carey P, Pryor JL. Varicocele-the most common cause of male factor infertility? Hum Reprod Update 2002; 8:53-58
- World Health Organisation. The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics. Fertil Steril 1992; 57: 1289-1293
- Peivandi S, Jafarpour H, Abbaspour M, Ebadi A. Effect of letrozole on spermogram parameters and hormonal profile in infertile men: A clinical trial study. Endocr Regul 2019; 53:231-236.
- Villanueva-Diaz CA, Vega-Hernandez EA, Diaz-Perez MA, et al. Sperm dysfunction in subfertile patients with varicocele and marginal semen analysis. Andrologia 1999; 31:263-267.
- Zhang Y, Ma T, Su Z, Ye M, Tian H, Li J, Liu J. Varicoceles affect semen quality of infertile men in Southern China: A cross-sectional study of 5447 cases. Medicine (Baltimore). 2017; 96(31):e7707.
The Relationship Between Sperm Parameters and Pregnancy Outcomes in Patients Undergoing Intra Uterine Insemination
Abstract
Aim: Intrauterine insemination is a widely used method in infertile patients. Sperm parameters that affect pregnancy
success in these patients are still a problematic issue. This study aims to determine the effect of sperm parameters on
intrauterine insemination results.
Material and Method: In this study; 300 cycles of 170 infertile patients who underwent intrauterine insemination after
ovulation induction with recombinant FSH in the infertility outpatient clinic of the Dr. Zekai Tahir Burak Women's Health
Training and Research Hospital between January 2009 and January 2011 were examined. Age, basal FSH, total FSH
dose used, number of treatment cycles, smoking, varicocele, semen parameters and treatment results were compared.
Patients were divided into groups as Total progressive motile sperm count ≤10 million and >10 million, morphology ≤4%
and morphology >4% in semen parameters. Pregnancy results of total progressive motile sperm count and morphology
groups were analyzed. In male patients, the effects of smoking and varicocele on total progressive motile sperm count
and morphology from sperm parameters were evaluated.
Results: No statistically significant difference was found between the total progressive motile sperm count ≤10 million
and total progressive motile sperm count >10 million groups and between the morphology≤4% and morphology>4%
groups in terms of clinical pregnancy rates. It was found that smoking in men decreased morphology, while varicocele
decreased both total progressive motile sperm count and morphology.
Conclusion: Pregnancy rates in intrauterine insemination cycles show no correlation with either morphology alone or
total progressive motile sperm count alone. It was found that smoking in infertile men decreased pregnancy rates by
particularly disrupting the morphology. It was concluded that varicocele reduces both morphology and total progressive
motile sperm count in male patients, but this does not affect pregnancy outcomes.
Keywords
Intrauterine insemination; sperm parameters; total progressive motile sperm count; morphology
References
- Fritz AM, Speroff L. Clinical Gynecologic Endocrinology and Infertility, 2011.
- Tomlinson MJ, Amissah-Arthur JB, Thompson KA, Kasraie JL, Bentick B. Prognostic indicators for intrauterine insemination (IUI): statistical model for IUI success. Hum Reprod 1996; 11:1892-1896.
- Guzick D, Sullivan M, Adamson GD, et al. Efficacy of treatment for unexplained infertility. Fertil Steril 1998; 70:207-213.
- Goverde AJ, McDonnell J, Vermeiden JP, Schats R, Rutten FF, Schoemaker J. IUI or IVF in idiopathic subfertility and male subfertility. Lancet 2000; 355:13-18.
- Kirby CA, Flaherty SP, Godfrey BM, et al. A prospective trial of intrauterine insemination of motile spermatozoa versus timed intercourse. Fertil Steril 1991; 56:102-107.
- Berger T, Marrs RP, Moyer DL. Comparison of techniques for selection of motile spermatozoa. Fertil Steril 1985; 43:268-273.
- DiMarzo SJ, Kennedy JF, Young PE, et al. Effect of controlled ovarian hyperstimulation on pregnancy rates intrauterine insemination. Am J Obstet Gynecol 1992; 166:1607-1612.
- ESHRE Capri Workshop Group. Intrauterine insemination. Hum Reprod Update 2009; 15:265-277.
- Sharpe RM. Environment, lifestyle and male infertility. Baillieres Best Pract Res Clin Endocrinol Metab 2000; 14:489–503.
- Papadimas J, Mantalenakis S. Reproductive Endocrinology in males. Thessaloniki, University Studio Press, 1993.
- Kantartzi P-D. [Update on the role of varicocele in male infertility]. Master degree dissertation. Thessaloniki, 2006.
- Van Noord-Zaadstra BM, Looman CW, Alsbach H, Habbena JDF, teVelde ER, Karbaat J. Delaying child-bearing: effect of age on fecundity and outcome of pregnancy, Br Med J 1991; 302:1361-1365.
- Shenfi eld F, Doyle P, Valentine A, Steele SJ, Tan S-L, Effects of age, gravidity and male infertility status on cumulative conception rates following artificial insemination with cryopreserved donor semen: analysis of 2998 cycles of treatment in one centre over 10 years. Hum Reprod 1993; 8:60-64.
- Demir B, Dilbaz B, Cinar O, et al. Factors affecting pregnancy outcome of intrauterine insemination cycles in couples with favourable female characteristics. J Obstet Gynaecol. 2011; 31:420-423.
- Barroso G, Oehninger S, Monzo A, Kolm P, Gibbons WE, Muasher Sj. High FSH:LH ratio and low LH levels in basal cycle day 3: impact on follicular development and IVF outcome. J Assist Reprod Genet 2001; 18:499-505.
- Burr RW, Siegberg R, Flaherty S, Wang XJ and Matthews CD. The influence of sperm morphology and the number of motile sperm count inseminated on the outcome intrauterine insemination combined with mild ovarian stimulation. Fertil Steril 1996; 65:127-132.
- A Nyboe Andersen, V Goossens, S Bhattacharya, et al. Assisted reproductive technology and intrauterine inseminations in Europe, 2005: results generated from European registers by ESHRE: ESHRE. The European IVF Monitoring Programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE). Hum Reprod 2009; 24:1267-1287.
- Thonneau P, Marchand S, Tallec A, et al. Incidence and main causes of infertility in a resident population (1,850,000) of three French regions (1988–1989). Hum Reprod 1991; 6:811-816.
- Ombelet W, Dhont N, Thijssen A, Bosmans E, Kruger T. Semen quality and prediction of IUI success in male subfertility: a systematic review. Reprod Biomed Online 2014; 28:300-309.
- Wainer R, Merlet F, Bailly M, Lombroso R, Camus E and Bisson JP. Prognosis for intrauterine insemination with partner’s sperm according to the characteristics of the spermatozoa.Contracept Fertil Sex 1996;24:897-903.
- Wainer R, Albert M, Dorion A, Influence of the number of motile spermatozoa inseminated and of their morphology on the success of intrauterine insemination Hum Reprod 2004;19:2060-2065.
- Lindheim SR, Barad DH, Zinger M, et al. Abnormal sperm morphology is highly predictive of pregnancy outcome during COH and IUI. J Assist Reprod Genet 1996; 13:569-572.
- Karabinus DS, Gelety TJ. The impact of sperm morphology evaluated by strict criteria on intrauterine insemination success. Fertil Steril 1997; 67:536-541.
- Check ML, Bollendorf A, Check JH, Katsoff D. et al. Reevaluation of the clinical importance of evaluating sperm morphology using strict criteria. Arch Androl 2002; 48:1-3.
- Lockwood GM, Deveneau NE, Shridharani AN, Strawn EY, Sandlow JI. Isolated abnormal strict morpholohy is not a contraindication for intrauterine insemination. Andrology 2015; 3:1088-1093.
- Van Waart J, Kruger TF, Lombard CJ, Ombelet W. Predictive value of normal sperm morphology in intra uterine insemination (IUI): a structured literature review. Hum Reprod Update 2001; 7:495-500.
- Ghaffari MA, Rostami M. The effect of cigarette smoking on human sperm creatine kinase activity: as an ATP buffering system in sperm. Int J Fertil Steril 2013; 6:258–265.
- İrez T, Ocal P, İdil M, et al. Effects of smoking cigarette on intrauterine insemination outcomes. Basic Clin Sci 2013;2:20–4.
- Harlev A, Agarwal A, Gunes SO, Shetty A, du Plessis SS. Smoking and Male Infertility: An Evidence-Based Review. World J Mens Health 2015; 33:143–160.
- Agarwal A, Majzoub A, Esteves SC, Ko E, Ramasamy R, Zini A. Clinical utility of sperm DNA fragmentation testing: practice recommendations based on clinical scenarios. Transl Androl Urol 2016; 5:935–950.
- Jensen MS, Mabeck LM, Toft G, Thulstrup AM, Bonde JP. Lower sperm counts following prenatal tobacco exposure. Hum Reprod 2005; 20:2559–2566.
- Axelsson J, Rylander L, Rignell-Hydbom A, Silfver KÅ, Stenqvist A, Giwercman A. The Impact of Paternal and Maternal Smoking on Semen Quality of Adolescent Men. PLoS One. 2013; 8(6):e66766.
- Beal MA, Yauk CL, Marchetti F. From sperm to offspring: Assessing the heritable genetic consequences of paternal smoking and potential public health impacts. Mutat Res 2017; 773:26–50.
- Nieschlag E. Classification of andrological disorders In: Nieschlag E, Behre HM, eds. Andrology. Berlin, Heildelberg, New York: Spriger-Verlag 1997; 79-83
- Redmon JB, Carey P, Pryor JL. Varicocele-the most common cause of male factor infertility? Hum Reprod Update 2002; 8:53-58
- World Health Organisation. The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics. Fertil Steril 1992; 57: 1289-1293
- Peivandi S, Jafarpour H, Abbaspour M, Ebadi A. Effect of letrozole on spermogram parameters and hormonal profile in infertile men: A clinical trial study. Endocr Regul 2019; 53:231-236.
- Villanueva-Diaz CA, Vega-Hernandez EA, Diaz-Perez MA, et al. Sperm dysfunction in subfertile patients with varicocele and marginal semen analysis. Andrologia 1999; 31:263-267.
- Zhang Y, Ma T, Su Z, Ye M, Tian H, Li J, Liu J. Varicoceles affect semen quality of infertile men in Southern China: A cross-sectional study of 5447 cases. Medicine (Baltimore). 2017; 96(31):e7707.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Obstetrics and Gynaecology |
| Journal Section | Research Article |
| Authors | |
| Publication Date | September 30, 2021 |
| Acceptance Date | September 22, 2021 |
| Published in Issue | Year 2021 Volume: 3 Issue: 3 |
