Total Progressive Motility Count as a Predictor of Clinical Pregnancy in Intrauterine Insemination: A Prospective Cohort Study

Introduction Infertility is the inability to achieve pregnancy after one year of unprotected intercourse. However, over 50% of couples undergoing infertility evaluations will conceive within 2 to 3 years, either naturally or with the help of interventions such as intrauterine insemination or in vitro fertilization, leading to a successful pregnancy. The study aimed to assess the impact of total progressive motile sperm count on the live birth rate in intrauterine insemination (IUI) procedures. Material and Methods This prospective cohort study was conducted during 2022–2023 at Yas Hospital Complex of Tehran University of Medical Sciences, Iran on infertile couples who were referred to this center for IUI. Participants were mothers under 43 years old with a sperm count of at least 1 million. Ovarian stimulation was conducted using various protocols, and sperm was prepared using the swim-up method. The luteal phase was supported with progesterone, and pregnancies were confirmed through ultrasound and β-hCG measurement. Results In this study, 374 cases underwent 581 IUI cycles. The clinical pregnancy rate was 23.5%, and the live birth rate was 14.4%. In cases of clinical pregnancy, sperm count, TPMS, and TMSC were significantly higher, and abnormal morphology and SDFA were significantly lower compared to cases with no clinical pregnancy. There was no statistically significant difference in sperm indices between groups in cases of abortion and live birth. Factors such as shorter duration of marriage, primary infertility, infertility origin (male or female), absence of varicocele, clomiphene consumption, and decreased SDFA are all associated with an increased likelihood of achieving clinical pregnancy. The data we obtained indicates that TPMS and TMSC can predict clinical pregnancy. The area under the curve for clinical pregnancy was 0.628 for TPMC and 0.598 for TMSC. When the cutoff value for TPMC was set at 50%, the specificity for clinical pregnancy was 46%, and the sensitivity was 67%. Similarly, for TMSC, at a cutoff value of 51.50% for a clinical pregnancy, the specificity and sensitivity were 70% and 58%, respectively. The data shows that the number and percentage of live births and clinical pregnancies increase as the quantity within the respective groups increases. Conclusion The study found that both the total motile sperm count (TMSC) and total progressive motile sperm count (TPMC) was significant factors in predicting the success of Intrauterine Insemination (IUI). TPMC was identified as a significant predictor of clinical pregnancy and live birth rates in IUI procedures