The evaluation of pre and post processing semen analysis parameters at the time of intrauterine insemination in couples diagnosed with male factor infertility and pregnancy rates based on stimulation agent. A retrospective cohort study

Eur J Obstet Gynecol Reprod Biol. 2014 Aug;179:159-62. doi: 10.1016/j.ejogrb.2014.05.003. Epub 2014 May 20.


Objective: To identify pre or post processing semen analysis parameters that may be predictive of successful pregnancy in couples with male factor infertility undergoing intra uterine insemination (IUI). To evaluate the pregnancy rate based on ovulation inducing agent in couples with male factor infertility per the 2010 world health organization criteria treated with IUI.

Study design: This retrospective study was performed at Stanford University medical center. All couples with male factor infertility fitting inclusion criteria were included over a 2 year period of time. 147 couples with male factor infertility were included and 356 IUIs were analyzed. All subjects in this study had Kruger strict analysis >4% normal forms. Logistic regression analysis was used to control for confounding effects and multiplicity.

Results: The overall pregnancy rate was 5.3%. No parameter in either the pre or post analysis predicted pregnancy. Furthermore, it was found that natural cycle and letrazole treatment had similar pregnancy rates (3% and 3%) p=ns. Similar outcomes were also observed between clomiphene citrate and gonadotropin stimulated cycles (7.5% and 6.0%) p=ns.

Conclusions: Total motile sperm count which has been found to be a predictor of pregnancy when evaluated in isolation, may be due to a confounding effect. These low pregnancy rates should be considered when deciding whether to suggest IUI and when selecting a protocol for ovulation induction for couples with male factor infertility.

Keywords: IUI; Intrauterine insemination; Male factor infertility; Predictors of pregnancy; Semen analysis; Stimulation protocol.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Adult
  • Aromatase Inhibitors / therapeutic use
  • Female
  • Humans
  • Infertility, Male*
  • Insemination, Artificial, Homologous / methods*
  • Letrozole
  • Male
  • Nitriles / therapeutic use*
  • Ovulation Induction / methods*
  • Pregnancy
  • Pregnancy Rate*
  • Semen Analysis*
  • Triazoles / therapeutic use*


  • Aromatase Inhibitors
  • Nitriles
  • Triazoles
  • Letrozole