Predictive factors for intrauterine insemination outcomes: a review

Abstract

Purpose Intrauterine insemination (IUI) is a frequently utilized method of assisted reproduction for patients with mild male factor infertility, anovulation, endometriosis, and unexplained infertility. The purpose of this review is to discuss factors that affect IUI outcomes, including infertility diagnosis, semen parameters, and stimulation regimens. Methods We reviewed the published literature to evaluate how patient and cycle specific factors affect IUI outcomes, specifically clinical pregnancy rate, live birth rate, spontaneous abortion rate and multiple pregnancy rate. Results Most data support IUI for men with a total motile count > 5 million and post-wash sperm count > 1 million. High sperm DNA fragmentation does not consistently affect pregnancy rates in IUI cycles. Advancing maternal and paternal age negatively impact pregnancy rates. Paternal obesity contributes to infertility while elevated maternal BMI increases medication requirements without impacting pregnancy outcomes. For ovulation induction, letrozole and clomiphene citrate result in similar pregnancy outcomes and are recommended over gonadotropins given increased risk for multiple pregnancies with gonadotropins. Letrozole is preferred for obese women with polycystic ovary syndrome. IUI is most effective for women with ovulatory dysfunction and unexplained infertility, and least effective for women with tubal factor and stage III-IV endometriosis. Outcomes are similar when IUI is performed with ovulation trigger or spontaneous ovulatory surge, and ovulation may be monitored by urine or serum. Most pregnancies occur within the first four IUI cycles, after which in vitro fertilization should be considered. Conclusions Providers recommending IUI for treatment of infertility should take into account all of these factors when evaluating patients and making treatment recommendations.

Can methods of artificial intelligence aid in optimizing patient selection in patients undergoing intrauterine inseminations?

“…Many authors have confirmed the importance of sperm quality, exposing a total motile sperm count above 5 × 10 6 to be suitable for the procedure. Nevertheless, in addition to all known prognostic factors, we still lack methods to optimally select suitable patients and are therefore unable to significantly improve the outcomes [7][8][9].…”

Relationship between Human Seminal Prostaglandins on Intrauterine Insemination Pregnancy Outcomes

“…The composition of seminal fluid from different men differs in makeup across a number of analytes [14]. While not completely understood, the reasons for these differences may be linked to differences in donor genetics, diet, and activity level prior to sample delivery [15,16]. Furthermore, discrepancies between samples provided by the same donor on a different day or time of day have been noted.…”

The Effect of Spontaneous LH Surges on Pregnancy Outcomes in Patients Undergoing Letrozole-HMG IUI: A Retrospective Analysis of 6,285 Cycles

“…Based on these test results, the inclusion criteria of our study were made as follows: female age <40 years, CD 3 FSH <10 mIU/ml, patent fallopian tubes and a normal uterine cavity according to hysteroscopy, and a male partner with a total sperm concentration of >10 million sperm/ml, a total post-wash sperm count>2 million, and a normal morphology ≥4% ( 11 ). In addition, only patients who had one of the following infertility causes were included: ovulatory dysfunction, unexplained factors, mild male factors, and sexual dysfunction.…”