Acceptable pregnancy rate of unstimulated intrauterine insemination: a retrospective analysis of 17,830 cycles

Ishida

Reprod Medicine & Biology

et al. 2018

PurposeThis study aimed to evaluate the effect of advanced paternal age on pregnancy outcomes and sperm parameters following intrauterine insemination (IUI). We used IUI data rather than assisted reproductive technology data, which might mask the effects of sperm impairments.MethodsWe retrospectively analyzed 1576 IUI cycles in women under 40 years old between April 2012 and May 2016 at the National Center for Child Health and Development in Japan. The main outcomes were clinical pregnancy and live birth.ResultsThe mean male age was significantly lower in cycles that resulted in pregnancy compared with those without pregnancy (38.0 vs 39.1 years; P < 0.001), with a similar trend for live‐birth cycles. However, there was no relationship between advanced paternal age and pregnancy outcomes after adjusting for confounding factors and correlations within patients using generalized estimating equations, and the age of the female partner was the only factor affecting pregnancy rate. Furthermore, advanced paternal age had no effect on sperm parameters.ConclusionsAdvanced paternal age alone does not adversely affect pregnancy or live‐birth rates or sperm parameters following IUI.

Section: Introductionmentioning

confidence: 99%

Advanced paternal age alone does not adversely affect pregnancy or live‐birth rates or sperm parameters following intrauterine insemination

Ishida

Reprod Medicine & Biology

et al. 2018

“…It remains controversial whether ovarian stimulation improved the outcome of IUI treatment in ovulatory women. Some investigators have suggested a beneficial effect, whereas others observed no benefit . In some cases, the protocols of ovarian stimulation were clearly defined, but in others, different protocols were grouped together .…”

Section: Discussionmentioning

confidence: 99%

“…Some investigators have suggested a beneficial effect, 12,14 whereas others observed no benefit. 11 In some cases, the protocols of ovarian stimulation were clearly defined, 12,15 but in others, different protocols were grouped together. 13,14 In our study when all ovarian stimulation protocols were lumped together, we could not find any difference in pregnancy or live birth rate.…”

Section: Discussionmentioning

confidence: 99%

The impact of ovarian stimulation on the outcome of intrauterine insemination treatment: an analysis of 8893 cycles

Liu

Wang

et al. 2016

BJOG

Objective To evaluate the impact of ovarian stimulation on the outcome of intrauterine insemination (IUI). Design Retrospective analysis. Setting A single university‐based centre. Population A total of 5109 couples with 8893 cycles. Methods The outcome of IUI with different protocols for ovarian stimulation was examined. Main outcome measures The live birth rate (LBR), twin pregnancy rate and ovarian hyperstimulation syndrome (OHSS). Results In ovulatory women without ovarian stimulation, the LBR was 7.6%. Stimulation with clomifene citrate (CC), letrozole (LE), human menopausal gonadotrophin (HMG), CC or LE combined with HMG achieved LBRs of 6.1, 5, 7.9, 8 and 12.2%, respectively. LE combined with HMG achieved a significantly improved LBR compared with no stimulation. HMG stimulation was associated with a higher rate of twins (7.4%) than no stimulation (0%, P < 0.01). In ovulatory women, the LBR appeared lower in CC and LE compared with no stimulation (P > 0.05). In anovulatory women, ovarian stimulation with CC, LE, HMG, CC or LE combined with HMG achieved LBRs of 11.3, 5.1, 11.8, 12.6 and 13.6%, respectively. No significant difference was observed. There were no triplet pregnancies or OHSS in stimulated cycles. Conclusions In ovulatory women, ovarian stimulation with LE combined with HMG achieved a significantly improved live birth rate. HMG stimulation resulted in a high risk for twins. Tweetable abstract In ovulatory women, ovarian stimulation with letrozole and HMG resulted in a significantly improved LBR.

“…Our results are in accordance with three RCTs summarized by Cohlen et al [33], where no significant differences in clinical pregnancy or live birth rate were found between various time frames of that ranged. [20] discovered that the trend of pregnancy rates relevant to cycle number was different according to female age: significantly higher in the first three cycles than in the 4th to 6th cycles or 7th to 9th cycles when women less than 40 years old but no difference was observed at the age over 41 years old. In contrast to the results above, in our study CPR remained stable from the first to the sixth cycle, which was supported by Merviel et al [3].…”

Section: Timing Of Inseminationmentioning

confidence: 99%

What is the optimal protocol for Intrauterine Insemination (IUI)? A Mini Review and A Retrospective Study to Evaluate Effective Factors Influencing Pregnancy after IUI

Herrero²,

Zhu

et al. 2019

Preprint

Background: Although it is well documented on the study of intrauterine insemination (IUI), the effectiveness of various factors on IUI treatment is inconsistent. The aim of this study is to investigate the various factors that influence IUI outcome and attempt to set up optimal protocol for IUI patients. Methods: This was a retrospective cohort study including1948 cycles (843 couples) that performed IUI between January 2012 and December 2013 in a single centre. Various factors that may affect IUI outcome were analyzed using chi-square. Moreover, we conducted multiple logistic regression to evaluate the main factors on the effects of IUI outcome. In addition, follicle growth and endometrial development relevant to conception were also assessed among protocols. Results: The clinical pregnancy rate (CPR) per cycle was 12.5% in the present study. Seven factors were identified to be associated significantly with CPR by multivariate logistic regression analysis: female age, type of infertility, ovarian stimulation protocol, preovulatory follicles, endometrial thickness, growing length of preovulatory follicle, post-washed total motile spermatozoa count (TMSC). Comparing with 11 days or less, more than 15 days for ovarian response and endometrial development before insemination induced a better success rate. Although ovarian stimulation with gonadotrophin or letrozole induced higher CPR when comparing to stimulation with clomiphene citrate or without stimulation, ovarian stimulation with letrozole was superior to gonadotrophin by its similar CPR to gonadotrophin but lower follicle number, without the risk of multiple pregnancy. Women younger than 41 years with elevated endometrial thickness inseminated with TMSC ≥ 4.0 million had better chance to obtain pregnancy. Number of treatment cycle was not a factor to affect CPR, with a stable CPR in the first four cycles. Conclusions: We conclude that women no more than 41 years old are suitable to perform at least 4 cycles of IUI before proceeding to IVF. The optimized IUI treatment requires ovarian stimulation with letrozole to induce one/two follicles and fertilize with four or more million motile spermatozoa and an elevated endometrium on day 15 or after in the cycle. Key words: infertility, intrauterine insemination, effective factors, clinical pregnancy rate.