October 17-21 2015 Baltimore Maryland

O-20 Monday, October 19, 2015 11:30 AM
REDEFINING AND CLARIFYING THE RELATIONSHIP
BETWEEN TOTAL MOTILE SPERM COUNTS (TMSC) AND
INTRAUTERINE INSEMINATION (IUI) PREGNANCY
RATES. R. S. Rubin, a K. S. Richter, b F. Naeemi, b S. Shipley, b
P. R. Shin, c J. E. O’Brien. b a Urology, Medstar Georgetown University
Hospital, Washington, DC; b Shady Grove Fertility Reproductive Science
Center, Rockville, MD; c Shady Grove Fertility Center, Washington, DC.
OBJECTIVE: The value of post-wash TMSC for predicting IUI outcomes
is not well defined. Limitations of previous reports include small sample
sizes and attempts to identify clinically meaningful thresholds as opposed
to gradual trends across a continuum of TMSC. To clarify the relationship between
post-wash TMSC and IUI outcomes we evaluated a large single institution
sample.
DESIGN: Retrospective review
MATERIALS AND METHODS: All stimulated clomiphene citrate, letrozole,
and/or injectable gonadotropin IUI cycles performed at a single institution
from 2004 to 2014 were reviewed, excluding double insemination.
Generalized estimating equations (GEE) analysis was used to account for
multiple cycles by individual patients and to adjust for age, BMI, infertility
diagnoses, stimulation protocol, and pre-insemination endometrial thickness,
serum estradiol, and numbers of follicles R14 mm.
RESULTS: 47,553 insemination cycles were available to evaluate the relationship
between TMSC and clinical pregnancy (defined as ultrasound
confirmation of an intrauterine gestational sac). Pregnancy rates were highest
with a clear threshold noted at R9 million TMSC. Pregnancy rates declined
gradually as TMSC decreased.
Complete data for the adjusted GEE analysis were available for 40,655 cycles.
Adjusted GEE analysis among cycles with R9 million TMSC
confirmed that TMSC in this range was unrelated to pregnancy (p¼0.47).
Conversely, TMSC was highly predictive of pregnancy (Wald c 2 ¼120) in
adjusted GEE analysis among cycles with