Abstract
BackgroundSome studies have stated that intrauterine insemination (IUI) with controlled ovarian stimulation (COS) might increase the pregnancy rate, while others suggest that IUI in the natural cycle (NC) should be the first line of treatment. It remains unclear whether it is necessary to use COS at the same time when IUI is applied to treat isolated male factor infertility. Thus, we aimed to investigate efficacy of IUI with COS for isolated male factor infertility.MethodsA total of 601 IUI cycles from 307 couples who sought medical care for isolated male factor infertility between January 2010 and February 2020 were divided into two groups: NC-IUI and COS-IUI. The COS-IUI group was further divided into two subgroups according to the number of pre-ovulatory follicles on the day of HCG: cycles with monofollicular development (one follicle group) and cycles with at least two pre-ovulatory follicles (≥ 2 follicles group). The IUI outcomes, including clinical pregnancy, live birth, spontaneous abortion, ectopic pregnancy, and multiple pregnancy rates were compared.ResultsThe clinical pregnancy, live birth, spontaneous abortion, and ectopic pregnancy rates were comparable between the NC-IUI and COS-IUI group. Similar results were also observed among the NC-IUI, one follicle, and ≥ 2 follicles groups. However, with respect to the multiple pregnancy rate, a trend toward higher multiple pregnancy rate was observed in the COS-IUI group compared to the NC-IUI group (8.7% vs. 0, P = 0.091), and a significant difference was found between the NC-IUI and ≥ 2 follicles group (0 vs. 16.7%, P = 0.033).ConclusionIn COS cycles, especially in those with at least two pre-ovulatory follicles, the multiple pregnancy rate increased without a substantial gain in overall pregnancy rate; thus, COS should not be preferred in IUI for isolated male factor infertility. If COS is required, one stimulated follicle and one healthy baby should be the goal considering the safety of both mothers and foetuses.
Highlights
Some studies have stated that intrauterine insemination (IUI) with controlled ovarian stimulation (COS) might increase the pregnancy rate, while others suggest that IUI in the natural cycle (NC) should be the first line of treatment
Some studies stated that IUI with COS might increase the pregnancy rate [11,12,13,14], while others suggested that IUI in natural cycle (NC) should be the first-line treatment [4, 15,16,17]
Of the 75 pregnancies, 68 resulted in the birth of a single child (n = 67) or twins (n = 1), five pregnancies ended in spontaneous abortion, two pregnancies ended in ectopic pregnancy, and there was one case of heterotopic pregnancy who underwent laparoscopic left salpingectomy at 7 weeks of gestation, and delivered a live baby by caesarean section at 35 weeks of gestation
Summary
Some studies have stated that intrauterine insemination (IUI) with controlled ovarian stimulation (COS) might increase the pregnancy rate, while others suggest that IUI in the natural cycle (NC) should be the first line of treatment It remains unclear whether it is necessary to use COS at the same time when IUI is applied to treat isolated male factor infertility. Some studies stated that IUI with COS might increase the pregnancy rate [11,12,13,14], while others suggested that IUI in natural cycle (NC) should be the first-line treatment [4, 15,16,17] It remains unclear if it is necessary to use COS at the same time when IUI is applied to treat isolated male factor infertility. To the best of our knowledge, the present study includes the largest number of couples with male infertility to date in which the outcome of IUI was analysed between NC and COS cycles
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