2025년 미국불임학회(ASRM) P-635 Effect of Intrauterine Insemination in Patients with Severe Oligozoospermia 중증 과소정자증 환자의 자궁내 수정 효과

G.W. Kim¹, H.J. Son¹, M.J. Kim¹, G.D. Heo¹, H.Y. Kim¹, Y.W. Kim¹, J.H. Choi¹, K.H. Lee¹, H.K. Noh¹, J.N. Lee¹.
1Mamapapa&baby Ob/Gyn Ulsan, Korea, Republic of South.

Objective

Intrauterine insemination (IUI) is a non-invasive and cost-effective first-line treatment for infertile couples. The pregnancy rate following IUI with ovarian hyperstimulation varies considerably, ranging from 4% to 40%, influenced by factors such as the specific technique used and the underlying cause of infertility. Although the significant impact of semen parameters on IUI outcomes is well-recognized, a clear and universally accepted threshold for predictive sperm parameters and characteristics for successful IUI has yet to be defined.
This study aimed to compare and investigate the impact of semen volume and sperm concentration on pregnancy rates in intrauterine insemination cycles of patients with severe oligozoospermia.

Materials and Methods

This retrospective study was conducted in 251 severe oligozoospermia cycles among 5351 cycles treated at our infertility center over a 10-year period (2015–2024). Semen parameters were recorded for each male partner. Semen samples were re-evaluated after density gradient centrifugation and sperm washing. Infertility investigations were performed according to the service protocol, and patients with severe oligozoospermia were categorized into two groups according to the final sperm count after washing (Group 1: <5 × 10^6/mL, Group 2: ≥5 × 10^6/mL) and final sperm volume (Group 3: 0.1 mL, Group 4: 0.2 mL). Pregnancy rates were compared using the chi-square test.

Results

The overall IUI pregnancy rate was 17.1% (913 out of 5351 cycles). In patients with severe oligozoospermia, the pregnancy rate was 11.2% (28 out of 251 cycles).
There were no significant differences in patient age (34.4±3.6 vs. 34.5±3.6 years), final semen volume (0.2±0.1 ml vs. 0.2±0.1 ml) and motility (88.3±14.1% vs. 87.9±13.5%) between the two groups categorized by final sperm count after washing. Furthermore, there was no significant difference in pregnancy rate based on final sperm volume between the two groups categorized by final semen volume (Group 3: 9.9% (7 out of 71) vs. Group 4: 11.7% (21 out of 180), p = 0.86). However, the final sperm count (Group 1: 2.6 x10^6/mL ±1.2 vs. Group 2: 9.8 x10^6/mL ±5.2) and the pregnancy rate (Group 1: 7.2% (8 out of 111) vs. Group 2: 14.3% (20 out of 140)) were significantly higher in Group 2 compared to Group 1 (P<0.05).

Conclusions

These study results suggest that sperm count (or concentration), rather than semen volume, may be more important in improving pregnancy rates in patients with severe oligozoospermia undergoing IUI.

한글요약

인공수정 시술(IUI)에서 중증 희소정자증 환자의 임신율에 미치는 영향을 정액량과 정자 농도에 따라 비교 분석하였다. 2015년부터 2024년까지 본원에서 시행된 중증 희소정자증 IUI 주기 중, 세척 후 정자 농도에 따라 두 그룹으로 나눈 결과, 농도가 높은 그룹에서 임신율이 유의하게 높았다. 반면, 최종 정액량에 따른 그룹 간 임신율 차이는 통계적으로 유의하지 않았다. 따라서 중증 희소정자증 환자의 IUI 성공률 향상에는 정액량보다 정자 농도가 더 중요한 요인임을 시사한다.