A 32-year-old woman has primary infertility for 3 years. Her husband's semen analysis shows total motile sperm count of 3 million with 2% normal morphology. Her investigations are normal. Which is the MOST appropriate treatment?

• A Intrauterine insemination (IUI) with partner's sperm
• B Donor sperm intrauterine insemination
• C Empirical clomiphene citrate for superovulation with timed intercourse
• D In vitro fertilization and intracytoplasmic sperm injection (IVF-ICSI) ✓

Explanation

A total motile sperm count below 5 million with severe morphological abnormality (teratospermia, 2% normal by strict Kruger criteria) constitutes severe male factor infertility. ICSI, in which a single sperm is injected directly into the oocyte, is the treatment of choice and achieves fertilization rates of 60–70% even with severely compromised sperm. IUI requires a minimum total motile sperm count of 5–10 million post-wash for reasonable success rates and is inadequate in this scenario.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.