Burks Heather, Peck Jennifer D, Hansen Karl R, Stoner Julie, Craig LaTasha B
Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States of America.
Department of Biostatistics and Epidemiology, Hudson College of Public Health, The University of Oklahoma Health Sciences, Oklahoma City, Oklahoma, United States of America.
PLoS One. 2025 Mar 19;20(3):e0317521. doi: 10.1371/journal.pone.0317521. eCollection 2025.
The objective of this study was to determine the relationship between strict morphology as assessed on the initial semen analysis during fertility workup and pregnancy rates after intrauterine insemination. This is a retrospective study of couples undergoing intrauterine insemination from 2007 to 2012. Couple characteristics and semen analysis parameters were recorded and evaluated. Risk ratios (RR) and 95% confidence intervals (95% CI) were calculated, accounting for within-couple (cluster) correlation among repeated intrauterine insemination cycles. Four hundred thirty-five women (average ± standard deviation age 31.7 ± 4.8) undergoing 1,287 intrauterine insemination cycles were analyzed. Fecundability was not statistically different when low strict morphology (≤1% and 2-4%) was compared to the reference range of morphology > 14% [RR 0.99 (0.41-2.40) and 0.90 (0.48-1.70)]. Results were unchanged when adjusted for female characteristics, medication, and inseminating total motile sperm count [aRR 1.22 (0.51-2.93) and 1.00 (0.53-1.91)]. Evaluating combined effects of morphology with inseminating total motile sperm count, pregnancy rates among cycles with total motile count < 5 million and strict morphology ≤ 4% normal were reduced when compared to cycles with total motile count > 20 million and morphology > 4% normal (RR 0.37, 95% CI 0.17-0.82). These relationships remained when evaluating live birth/ongoing pregnancy per cycle. In intrauterine insemination cycles, initial strict morphology was associated with subsequent fecundability only when inseminating total motile count was below 5 million. For cycles with total motile count above this threshold, no impact of low morphology on success rates with intrauterine insemination was observed.
本研究的目的是确定在生育检查期间初次精液分析所评估的严格形态学与宫内授精后的妊娠率之间的关系。这是一项对2007年至2012年接受宫内授精的夫妇进行的回顾性研究。记录并评估了夫妇特征和精液分析参数。计算了风险比（RR）和95%置信区间（95%CI），并考虑了重复宫内授精周期中夫妇内部（聚类）相关性。对435名接受1287个宫内授精周期的女性（平均年龄±标准差为31.7±4.8岁）进行了分析。当将低严格形态学（≤1%和2 - 4%）与形态学>14%的参考范围进行比较时，生育力在统计学上无差异[RR 0.99（0.41 - 2.40）和0.90（0.48 - 1.70）]。在对女性特征、药物治疗和授精时的总活动精子数进行调整后，结果不变[aRR 1.22（0.51 - 2.93）和1.00（0.53 - 1.91）]。评估形态学与授精时的总活动精子数的联合效应时，与总活动精子数>2000万且形态学>4%正常的周期相比，总活动精子数<500万且严格形态学≤4%正常的周期中的妊娠率降低（RR 0.37，95%CI 0.17 - 0.82）。在评估每个周期的活产/持续妊娠情况时，这些关系依然存在。在宫内授精周期中，仅当授精时的总活动精子数低于500万时，初始严格形态学才与随后的生育力相关。对于总活动精子数高于此阈值的周期，未观察到低形态学对宫内授精成功率有影响。
