Factors Leading to Pregnancies in Stimulated Intrauterine Insemination Cycles and the Use of Consecutive Ejaculations Within a Small Clinic Environment

Abstract

Introduction Understanding and improving IUI pregnancy rates has enormous global appeal and application. This pilot study goes one step further by utilising consecutive ejaculates from men with oligozoospermia and comparing with normozoospermic male group. Materials and Methods A retrospective analysis was performed on 117 IUI-stimulated treatment cycles in a small fertility clinic in North Middlesex University Hospitals Trust, UK, within a NHS setting. Risks of OHSS and multiple births are carefully controlled. Results In our cohort, several factors are associated with positive IUI pregnancies and these were: age of the woman, inseminating with C5 total progressive motile sperm; having C50 % Grade A sperm progression and having C1 Dr. Gulam Bahadur is a past member of the HFEA. His main involvement is in andrology with special emphasis on diagnostic analyses, male cancer patients, counselling, sperm donor recruitment and sperm freezing, and recovery rates following cryopreservation. Important ways to optimise pregnancy rates in simple first-line treatment intrauterine insemination are being researched and applied within a number of UK NHS Trust Hospitals. Dr Bahadur has made significant contributions to the understanding of semen qualities in subfertile males, cancer patients, adolescent cancer patients and produced one of the first reports on ovarian tissue freezing for cancer patients.The Journal of Obstetrics and Gynecology of India (September-October 2016) 66(S1):S513-S520 DOI 10.1007/s13224-016-0876-0 123follicle achieved with a realistic hMG dosage, hCG trigger and IUI of 29.7 h (2.5-38.4 h), with an endometrial thickness of 10.7 mm (6.6-13.4 mm). Bifollicular presence in at least half the cases along with hMG protocols added usefully to the pregnancy outcomes. Conclusions The pregnancy rates per cycle were 19 and 23 % in the consecutive ejaculates and non-consecutive ejaculate groups, respectively, P = 0.59. For the whole cohort, the pregnancy rate was 20.51 % per cycle and 33.8 % per women. This approach if validated with large RCT will have universally beneficial effects.

Sperm Parameters before and after Swim-Up of a Second Ejaculate after a Short Period of Abstinence

“…In IUI or ART, for example, it could be suggested to separate spermatozoa by the swim-up of a second ejaculate, particularly if the first one results in suboptimal parameters. In fact, Bahadur and colleagues [34] showed that recurrent ejaculates successfully improved IUI pregnancy rates and that reduced male abstinence to 12-24 h was associated to improved pregnancy rate with ICSI [34]. In the latter case, after swim-up with the second consecutive semen sample, the oocyte can be injected with spermatozoa of better quality, considering the increased probability of choosing a gamete with intact DNA among the many deemed morphologically "normal" by the embryologist.…”

Sperm DNA Fragmentation: A New Guideline for Clinicians

“…Therefore, short-term recurrent ejaculation may be a simple noninvasive maneuver to improve SDF. Although the beneficial effect of short EA on natural conception is unclear, application of the technique to assisted reproduction may have its value [224][225][226]. In addition to higher pregnancy rates in ICSI, recurrent ejaculation has been associated with a significantly lower SDF [227] (Table 3).…”

A New Dawn for Intrauterine Insemination: Efficient and Prudent Practice will Benefit Patients, the Fertility Industry and the Healthcare Bodies

“…First-line treatment using IUI must be attempted in all patients except in women with cervical atresia, cervicitis, endometritis or bilateral tubal obstruction and in most cases of amenorrhoea or severe oligozoospermia. 'Consecutive ejaculate' qualities in subfertile males also support in-depth analyses of subfertile males [8].…”

“…The systematic review found no difference in the pregnancy rate per couple with two inseminations compared with one [15]. In the majority of studies, IUI is done 32-36 h following hCG administration, although in one pilot study it appears that optimal time post-hCG trigger for a pregnancy was 30 h [8]. There may also be differences in what is optimal for trigger in Clomid cycles and hMG cycles.…”