Objective: To determine the effect of sperm morphology from the specific sample used for intrauterine insemination (IUI) on clinical pregnancy rates (CPR).
predictive performance and accuracy of several clinical parameters and compared them to EAU guidelines.RESULTS: A positive semen culture was found in 56 (10%) men. The most commonly identified pathogens belonged to Enterobacteriaceae (15% of all positive examinations). Of all, 141 (26%) patients had leukocytospermia >10 6 WBCs/mL and would have therefore deserved semen culture testing based on EAU guidelines; of them, 12 (9%) actually displayed a positive semen culture. Conversely, 44 (79%) out of 56 patients with positive semen culture would have been missed. Overall predictive accuracy, sensibility, and specificity of EAU guidelines were 48%, 21%, and 74%. No further clinical parameter was significantly associated with positive sperm culture and could be therefore used as a predictor, except for increased serum neutrophil-to-lymphocyte (NRL) ratio (predictive accuracy 60%, p¼0.03 vs. EAU guidelines).CONCLUSIONS: The vast majority (79%) of asymptomatic infertile men with a positive sperm culture may miss a proper assessment if applying EAU guidelines. Not a single parameter, except for NLR, can assist medical decision making. Therefore, a semen culture should be offered to every infertile man.
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