Recombinant FSH versus highly purified FSH in intrauterine insemination: systematic review and metaanalysis

Matorras, Roberto; Osuna, Carmen; Expósito, Antonia; Crisol, Lorena; Pijoán, José Ignacio

doi:10.1016/j.fertnstert.2011.02.030

Cited by 18 publications

(11 citation statements)

References 17 publications

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“…Wainer et al [41] reported that a minimum of 5 million motile spermatozoa should be inseminated only when the normal morphology of the sperm after preparation is < 30%, as the quantity compensates--at least in part--for poor seminal quality; they further noted that if these parameters cannot be reached, in vitro fertilization should be recommended. Other clinical parameters have also been evaluated, including the comparison of recombinant FSH and highly purified FSH for ovarian stimulation [42], the use of GnRH antagonists to avoid a premature LH surge [43,44], the association of chromatin condensation in spermatozoa with conventional semen parameters [45], and the use of a soft versus firm catheter for the insemination procedure [46], all of which were designed to identify predictive factors of the likelihood of achieving pregnancy in IUI.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of the motile sperm organelle morphology examination (MSOME) in predicting pregnancy after intrauterine insemination

Akl

Oliveira

Petersen

et al. 2011

Reprod Biol Endocrinol

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BackgroundAlthough the motile sperm organelle morphology examination (MSOME) was developed merely as a selection criterion, its application as a method for classifying sperm morphology may represent an improvement in the evaluation of semen quality. The aim of this study was to determine the prognostic value of normal sperm morphology using MSOME with regard to clinical pregnancy (CP) after intrauterine insemination (IUI).MethodsA total of 156 IUI cycles that were performed in 111 couples were prospectively analysed. Each subject received 75 IU of recombinant FSH every second day from the third day of the cycle. Beginning on the 10th day of the cycle, follicular development was monitored by vaginal ultrasound. When one or two follicles measuring at least 17 mm were observed, recombinant hCG was administered, and IUI was performed 12-14 h and 36-40 h after hCG treatment. Prior to the IUI procedure, sperm samples were analysed by MSOME at 8400× magnification using an inverted microscope that was equipped with DIC/Nomarski differential interference contrast optics. A minimum of 200 motile spermatozoa per semen sample were evaluated, and the percentage of normal spermatozoa in each sample was determined.ResultsPregnancy occurred in 34 IUI cycles (CP rate per cycle: 21.8%, per patient: 30.6%). Based on the MSOME criteria, a significantly higher percentage of normal spermatozoa was found in the group of men in which the IUI cycles resulted in pregnancy (2.6+/-3.1%) compared to the group that did not achieve pregnancy (1.2+/-1.7%; P = 0.019). Logistic regression showed that the percentage of normal cells in the MSOME was a determining factor for the likelihood of clinical pregnancy (OR: 1.28; 95% CI: 1.08 to 1.51; P = 0.003). The ROC curve revealed an area under the curve of 0.63 and an optimum cut-off point of 2% of normal sperm morphology. At this cut-off threshold, using the percentage of normal sperm morphology by MSOME to predict pregnancy was 50% sensitive with a 40% positive predictive value and 79% specificity with an 85% negative predictive value. The efficacy of using the percentage of normal sperm morphology by MSOME in predicting pregnancy was 65%.ConclusionsThe present findings support the use of high-magnification microscopy both for selecting spermatozoa and as a routine method for analysing semen before performing IUI.

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Section: Discussionmentioning

confidence: 99%

Efficacy of the motile sperm organelle morphology examination (MSOME) in predicting pregnancy after intrauterine insemination

Akl

Oliveira

Petersen

et al. 2011

Reprod Biol Endocrinol

View full text Add to dashboard Cite

show abstract

“…Wainer et al [41] reported that a minimum of 5 million motile spermatozoa should be inseminated only when the normal morphology of the sperm after preparation is < 30%, as the quantity compensates-at least in part-for poor seminal quality; they further noted that if these parameters cannot be reached, in vitro fertilization should be recommended. Other clinical parameters have also been evaluated, including the comparison of recombinant FSH and highly purified FSH for ovarian stimulation [42], the use of GnRH antagonists to avoid a premature LH surge [43,44], the association of chromatin condensation in spermatozoa with conventional semen parameters [45], and the use of a soft versus firm catheter for the insemination procedure [46], all of which were designed to identify predictive factors of the likelihood of achieving pregnancy in IUI.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of motile sperm organelle morphology examination (MSOME) for predicting pregnancy after intrauterine insemination

Akl¹,

Oliveira²,

Petersen³

et al. 2011

Fertility and Sterility

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Background: Although the motile sperm organelle morphology examination (MSOME) was developed merely as a selection criterion, its application as a method for classifying sperm morphology may represent an improvement in the evaluation of semen quality. The aim of this study was to determine the prognostic value of normal sperm morphology using MSOME with regard to clinical pregnancy (CP) after intrauterine insemination (IUI). Methods: A total of 156 IUI cycles that were performed in 111 couples were prospectively analysed. Each subject received 75 IU of recombinant FSH every second day from the third day of the cycle. Beginning on the 10th day of the cycle, follicular development was monitored by vaginal ultrasound. When one or two follicles measuring at least 17 mm were observed, recombinant hCG was administered, and IUI was performed 12-14 h and 36-40 h after hCG treatment. Prior to the IUI procedure, sperm samples were analysed by MSOME at 8400× magnification using an inverted microscope that was equipped with DIC/Nomarski differential interference contrast optics. A minimum of 200 motile spermatozoa per semen sample were evaluated, and the percentage of normal spermatozoa in each sample was determined. Results: Pregnancy occurred in 34 IUI cycles (CP rate per cycle: 21.8%, per patient: 30.6%). Based on the MSOME criteria, a significantly higher percentage of normal spermatozoa was found in the group of men in which the IUI cycles resulted in pregnancy (2.6+/-3.1%) compared to the group that did not achieve pregnancy (1.2+/-1.7%; P = 0.019). Logistic regression showed that the percentage of normal cells in the MSOME was a determining factor for the likelihood of clinical pregnancy (OR: 1.28; 95% CI: 1.08 to 1.51; P = 0.003). The ROC curve revealed an area under the curve of 0.63 and an optimum cut-off point of 2% of normal sperm morphology. At this cut-off threshold, using the percentage of normal sperm morphology by MSOME to predict pregnancy was 50% sensitive with a 40% positive predictive value and 79% specificity with an 85% negative predictive value. The efficacy of using the percentage of normal sperm morphology by MSOME in predicting pregnancy was 65%.

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“…A Cochrane review by Pandian et al, concluded that IVF has higher live birth rate compared to other treatment modalities. 5 Also the analysis of cost effectiveness of the various treatment options for patients with unexplained infertility showed direct proportionate relationship between the pregnancy rate/cycle and the treatment cost, but couples sometimes prefer a less expensive and less invasive option. 5 In four randomized trials of patients with unexplained subfertility, pregnancy rates were better when IUI was done in stimulated cycles than in natural cycles.…”

Section: Introductionmentioning

confidence: 99%

“…5 Also the analysis of cost effectiveness of the various treatment options for patients with unexplained infertility showed direct proportionate relationship between the pregnancy rate/cycle and the treatment cost, but couples sometimes prefer a less expensive and less invasive option. 5 In four randomized trials of patients with unexplained subfertility, pregnancy rates were better when IUI was done in stimulated cycles than in natural cycles. 6 However, there are various criteria affecting the success rate of IUI including age, indications of IUI, and the sperm preparation techniques, insemination methods, and timing of insemination.…”

Section: Introductionmentioning

confidence: 99%

“…6 However, there are various criteria affecting the success rate of IUI including age, indications of IUI, and the sperm preparation techniques, insemination methods, and timing of insemination. 5 There is no consensus on the optimal timing of IUI. In most of published studies, insemination was done 32-36 hours following human chorionic gonadotropin (hCG) administration.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Two different timing of intra uterine insemination in patients of unexplained infertility: a randomized clinical trial

Elsersy

2017

Int J Reprod Contracept Obstet Gynecol

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Intrauterine insemination (IUI) is a simple and relatively less invasive and less expensive procedure than other forms of assisted reproductive technology. It entails introduction of prepared semen inside the uterine cavity directly overcoming any cervical factor and increasing the concentration of motile sperms near the fallopian tube. ABSTRACTBackground: Unexplained infertility is diagnosed when the basic infertility workup is found to be normal. The objective was to compare between the results of IUI performance at 24 hours or 36 hours after hCG injection in couples with unexplained infertility. Methods: A prospective comparative study was conducted on 250 patients diagnosed with unexplained infertility who were randomly allocated in two equal groups. Each patient received ovulation induction. Follicular growth scanning was performed, patients received 10.000 hCG injection when there was mature follicle equaled to or more than 18mm. Then they randomly allocated to either group 1 who underwent IUI 24 hours after hCG injection or group 2 who underwent IUI 36 hours after hCG injection. Results: The positive qualitative serum β -hCG test was higher in group 1 who received IUI 24 hours after hGC injection, 24%, while in group 2 who received IUI 36 hours after hGC injection, it was 16.8% but no statistical differences between the two studied groups could be observed. The most important finding in this study is that the clinical pregnancy rate in group 1 was significantly higher than in group 2. Conclusions: Earlier IUI procedures increased the clinical pregnancy rate in patients with unexplained infertility during ovulation induction with gonadotropins. Correct timing of insemination is essential.

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Recombinant FSH versus highly purified FSH in intrauterine insemination: systematic review and metaanalysis

Cited by 18 publications

References 17 publications

Efficacy of the motile sperm organelle morphology examination (MSOME) in predicting pregnancy after intrauterine insemination

Efficacy of the motile sperm organelle morphology examination (MSOME) in predicting pregnancy after intrauterine insemination

Efficacy of motile sperm organelle morphology examination (MSOME) for predicting pregnancy after intrauterine insemination

Two different timing of intra uterine insemination in patients of unexplained infertility: a randomized clinical trial

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