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Abstract : Hyaluronic acid is a polymer found in the extracellular matrix of the cumulus oophorus and is thought to have a part in the selection of mature spermatozoa. The concept behind the hyaluronan binding assay (HBA) is that mature spermatozoa are selectively attracted to hyaluronan (HA) during the natural process of fertilization. Based on sperm binding to HA, the three binding zones were classified as having excellent binding for >90%, medium binding for 60-90%, and low binding for 60% in the literature. This study suggests that intrauterine insemination (IUI) be used in cases where the binding was greater than 60%. This study aimed to determine the predictive value of the Hyaluronan Binding Assay (HBA), on the success of intrauterine insemination (IUI) in couples with not well diagnosed infertility or mild male factor infertility. Forty(40) infertile couples will be enrolled in our study. On the day of IUI procedure, HBA test will be performed by using fresh semen samples, then prepared by direct and indirect swim-up techniques after that, the rates of sperm binding to HBA will be calculated. HBA values and semen parameters will be compared, the best selected spermatozoa will be intrauterinely inseminated. Later on the statistical analysis will be used to evaluate the relationship between HBA ratio and pregnancy status and make comparison between pregnant and non pregnant. The infertile patients that will be involved in this study. Sperm parameters will be assessed according to WHO manual. Included different types on male infertility especially mild and unexplained infertile patients which must be included. All of parameters will be evaluated in relevance to IUI outcome. In this study, the cut-off value for the HBA ratio, which serves as a predictor of a positive pregnancy test result, was 83%. There was a significant positive correlation between HBR and sperm concentration before (p=0.002) and after (p0.001) activation, progressively motile sperm after activation (p=0.037), and total progressively motile sperm count after activation (p 0.001), as well as a significant correlation between HBR and morphologically normal sperm after activation (p=0.028); however, there was an insignificant correlation with progressively motile sperm (p=0.915) and morphologically normal sperm(p=0.296) both before activation. Despite the fact that the HBA values (84%) in the pregnant group were higher than those in the non-pregnant group (77%) in this study, the pregnancy rate (20%) was not reached as a statistically significant level. Additionally, there was no connection between HBA readings and whether a woman was pregnant. Additionally, there was no significant correlation between pregnancy status and HBA ratios based on the suggested hyaluronan binding assay rate between direct and indirect swim up sperm activating techniques showed a marginally higher assay rate in the indirect swim up procedure (80.94 percent versus 77.71 percent and p =0.197). Direct swim-up sperm activation was used, and the pregnancy rate was somewhat higher (31.3 percent versus 12.5 percent and p=0.146) in the indirect swim-up procedure. There are a few studies that assess the predictive impact of HBA on IUI cycles in the literature. [17] looked at the relationships between HBA levels and TMC, morphology, and pregnancy outcomes in IUI cycles but found no statistically significant relationships between those factors. This study likewise discovered no statistical association between HBA levels and pregnancy outcomes, supporting [17] findings. However, our findings showed a significant link between HBA levels and TMC and morphology. HBA can be used along with semen parameters to confirm sperm quality, it should be noted that the binding to HA is associated with sperm maturity but it does not predict the success of IUI in couples who have infertility that is not explained or has a mild male component.

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