An Analysis of pre and post-Processing Semen Parameters at The Time of Intrauterine Insemination; and The Confounding Effects of Total Motile Sperm Counts on Pregnancy Outcome: A Prospective Cohort Study

Document Type : Original Article


1 McGill University, MUHC, Boulevard de Maisonneuve, Montreal QC, Canada

2 Seed of Life, Fertility and Women’s Care Medical Center, Mount Elizabeth Novena Specialist Center, Singapore

3 New York Medical College, School of Health Science and Practice, Valhalla, NY, USA


Background: This study aims to determine whether pre or post-processing semen parameters obtained during intrauterine
insemination (IUI) predict pregnancy when controlling for confounding effects.
Materials and Methods: A prospective cohort study of 2231 semen analyses was conducted at McGill University of
IVF center. Any couples who underwent IUI with partner sperm, over a 2.5-year period, were included. Controlled
ovarian stimulation was done with Clomiphene Citrate, Letrozole, or Gonadotropins. Statistical analysis was performed
using t tests, two types of stepwise logistic regression, and stepwise discriminant analysis. A comparison of
pre and post-processing semen parameters was undertaken to determine the probability of pregnancy.
Results: There were significant differences between pregnant and non-pregnant women in post-processing concentration
(P=0.043), post-processing total motile sperm count (TMSC) (P=0.049), and post-linearity (P=0.012). However,
when variable out-of-the-equation logistic regression or discriminant analysis, which controls for confounding effects
between variables, were used, the findings were no longer significant. It was statistically proven that when a variable
in the equation logistic regression was employed, post-processing concentration (P=0.005) and post-processing
TMSC (P=0.009) remained reliable predictors of pregnancy.
Conclusion: Two of three prediction models suggested that TMSC’s relationship with pregnancy is due to confounding
factors. One model maintained the validity of the TMSC. While TMSC has always been studied as an important
predictor of insemination pregnancies, this finding may be due to confounding effects between semen parameters and
therefore requires further investigation as to this relationship.


Main Subjects

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