Should couples with unexplained infertility have three to six cycles of intrauterine insemination with ovarian stimulation or in vitro fertilization as first-line treatment?

Ombelet, Willem; Eekelen, Rik van; McNally, Aine; Ledger, William; Doody, Kevin J.; Farquhar, Cynthia

doi:10.1016/j.fertnstert.2020.10.029

Cited by 15 publications

(13 citation statements)

References 46 publications

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“…Although there are studies that recommend three to six cycles of IUI with ovarian stimulation as a first-line therapy for women younger than 40 years with unexplained infertility, we consider that IUIs are personally demanding, resource intensive, and are not without risks, one of the most prevalent risks being the frustration and demoralization of couples. In this situation, identifying the variables associated with successful IUI outcomes and the calculation of a prediction score may allow better counseling and treatment planning [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Fertility Predictors in Intrauterine Insemination (IUI)

Huniadi

Bimbo-Szuhai

Botea

et al. 2023

JPM

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(1) Background: Intrauterine insemination (IUI) is considered a first-line procedure for infertile or hypo-fertile couples among assisted reproductive techniques. In our retrospective study, we identified variables associated with a successful IUI and the probability of obtaining a pregnancy. This is useful to identify couples with a good chance of obtaining a pregnancy through an IUI procedure (2) Methods: The study was conducted at a university-level fertility clinic in Oradea, Romania. Patients eligible to participate in the study were infertile couples who underwent IUI treatment in the interval between January 2015 and October 2020. (3) Results: In our study, we found that duration of infertility, couple age, endometrium thickness, sperm concentration, and motility are important factors in determining the outcome of IUI. Several demographics were measured for each couple including maternal and paternal age, the type and duration of infertility, the number of procedures, the type of ovarian stimulation, number of follicles, endometrial thickness, the type and day of ovulation induction, associated pathology, tubal patency, and pre/post washes sperm count and progressive sperm motility. (4) Conclusions: Fertility prediction studies are necessary, and an individualized prognostic score should be applied for each couple for tailoring their expectations and better counseling.

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Section: Introductionmentioning

confidence: 99%

Fertility Predictors in Intrauterine Insemination (IUI)

Huniadi

Bimbo-Szuhai

Botea

et al. 2023

JPM

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“…AIH has been used as the first‐choice treatment for UI patients due to its short cycles, low cost, low rate of complications and simple procedure. Willem Ombelet also concluded that three to six cycles of AIH should be recommended as a first‐choice therapy for young women with UI 2 . However, the low live birth rate associated with the AIH technique has not met some patients' needs.…”

Section: Introductionmentioning

confidence: 99%

Comparing the prognosis of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer between unexplained primary infertility patients with repeated artificial insemination with homologous semen failure and tubal infertility patients

Zeng

Xie

et al. 2023

J of Obstet and Gynaecol

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Background: Both in vitro fertilization and embryo transfer (IVF-ET) and intracytoplasmic sperm injection and embryo transfer (ICSI-ET) have been recommended for unexplained primary infertility after recurrent artificial insemination with homologous semen failure (UAIHF), but few studies focused on the safety and efficiency of the IVF/ICSI-ET technique for these patients. In this study, we compared the IVF/ICSI-ET outcomes and perinatal and postnatal complications between UAIHF patients and tubal infertility (TI) patients. Methods: We conducted a retrospective study of UAIHF and TI patients who underwent IVF/ICSI-ET at Guangxi Reproductive Medical Center, the First Affiliated Hospital of Guangxi Medical University from January 2012 to March 2021. After propensity score matching (PSM), we analyzed the IVF/ICSI-ET outcomes and rates of perinatal and postnatal complications. Results: PSM analysis revealed that the baselines of age, infertility duration, and body mass index were comparable. The fertilization method was significantly different between the two groups. Through IVF/ICSI-ET, UAIHF patients had a similar clinical outcome compared to TI patients. Regarding perinatal and postnatal complications, the incidence of premature rupture of membranes (PROM) (7.54% vs. 3.17%, p = 0.030) was significantly higher in UAIHF patients. Conclusions: UAIHF patients could achieve satisfying pregnancy outcomes by IVF/ICSI-ET. ICSI-ET did not seem to improve the clinical outcomes of UAIHF patients compared to those of TI patients who underwent IVF-ET, which might be related to possible underlying diseases in these patients. In addition, the incidence of PROM was significantly higher in UAIHF patients, which might be related to the ICSI technique used and uncertain potential idiopathic diseases associated with unexplained infertility patients.

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“…Globally, there is an increasing tendency toward assisted reproductive technology (ART) treatment (3,4). ART remains the best and most effective treatment choice for many indications like bilateral tubal damage, male factor, severe endometriosis, and unexplained subfertility (5). The physiological regulation of the ovary is a complicated process ; the growth factor, steroid hormones, gonadotropins, and cytokines all take part.…”

Section: Introductionmentioning

confidence: 99%

Comparing the ICSI outcome between different causes of subfertility and estimate the role of IL-1β in predicting ICSI outcome.

2022

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Background : The physiological regulation of the ovary is a complicated process ; the growth factor, steroid hormones, gonadotropins, and cytokines all take part. Inflammatory cytokines are found in many compartments of the ovary, such as the follicles. The ovarian tissue produces them in addition to the macrophages. In this study, we aimed to compare the level of serum and follicular fluid IL-1Beta (IL-1β β) for different groups of infertile patients, comparing the ICSI outcome between sub-fertile couples due to different causes. The results of this study IL-1β β was significantly higher in the patients with unexplained subfertility (p-value < 0.05), no significant difference was found in the ICSI outcome between patients with different causes of subfertility. The lowest pregnancy rate was found in patients with unexplained subfertility, but the difference is insignificant. In conclusion, immunity plays a role in unexplained subfertility as patients with unexplained subfertility have a significantly higher serum level IL-1β β than the other causes of subfertility. However, IL-1β β does not affect ICSI outcome. Therefore, the ICSI outcome is not affected by the cause of subfertility.

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Should couples with unexplained infertility have three to six cycles of intrauterine insemination with ovarian stimulation or in vitro fertilization as first-line treatment?

Cited by 15 publications

References 46 publications

Fertility Predictors in Intrauterine Insemination (IUI)

Fertility Predictors in Intrauterine Insemination (IUI)

Comparing the prognosis of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer between unexplained primary infertility patients with repeated artificial insemination with homologous semen failure and tubal infertility patients

Comparing the ICSI outcome between different causes of subfertility and estimate the role of IL-1β in predicting ICSI outcome.

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