Impact of Total Progressive Motile Spermatozoa Concentration Following Pellet Swim-up versus Double Density Gradient Centrifugation on Intrauterine Insemination Outcome: A Retrospective Cohort Study

2026-04-01

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Sowbarnika Arunkumar

Kavidharshini Nanthakumar *

Thanikachalam, Puvithra

DOI：10.7860/JCDR/2026/87253.23140

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Introduction: Intrauterine Insemination (IUI) is a widely used treatment modality for infertile couples; however, the factors determining successful outcomes have been extensively studied. The prewash Total Motile Sperm Count (TMSC) has been shown to be a poor predictor of IUI outcomes and data regarding postwash Total Progressive Motile Spermatozoa Concentration (TPMSC) have remained inconsistent, with proposed values varying widely across studies. Aim: To evaluate the impact of TPMSC following sperm preparation by pellet and swim-up (PSU) and Double Density Gradient Centrifugation (DDGC) on the IUI outcomes. Materials and Methods: This retrospective cohort study included 490 patients who underwent IUI at an Assisted Reproductive Technology (ART) Clinic, Chennai, Tamil Nadu, India between January 2015 and January 2025. After considering the inclusion and exclusion criteria, the study cohort was broadly categorised based on the sperm preparation method (PSU: n=363, DDGC: n=127) and were then divided into four groups - Group I: TPMSC <5 x10(6)/mL, Group II: TPMSC 5-9x10(6)/mL, Group III: TPMSC 10-20x10(6)/mL, Group IV: TPMSC >20x10(6)/mL. The primary outcome was positive pregnancy rate, assessed and compared across TPMSC categories, while secondary outcomes included biochemical pregnancy, clinical pregnancy, ectopic pregnancy, and miscarriage rates. Statistical analysis was performed using IBM Statistical Package for the Social Sciences (SPSS) software, with categorical data evaluated using the Chi-square test. Results: A significant increase in pregnancy rate was observed in the group with TPMSC >20 x106/mL (24.3%, p-value <0.001) when the sample was prepared by PSU, compared to lower TPMSC categories. In contrast, no such association was observed with the DDGC technique (p-value=0.154). There was no significant difference in biochemical, ectopic, clinical pregnancy and miscarriage rates among the groups. Conclusion: The overall clinical pregnancy rate was 15.1% in the PSU group and 15% in the DDGC group. However, no association was observed between TPMSC and secondary outcomes in either the PSU or DDGC groups.

Keywords:

Infertility

Sperm preparation

Clinical pregnancy rate

Impact of Total Progressive Motile Spermatozoa Concentration Following Pellet Swim-up versus Double Density Gradient Centrifugation on Intrauterine Insemination Outcome: A Retrospective Cohort Study

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