Performing two inseminations rather than one in intrauterine insemination cycles may not improve outcome

Abstract

OBJECTIVE: To determine whether performing one or two Intra-uterine inseminations (IUI) per ovulation induction cycle affect pregnancy rate.DESIGN: Retrospective chart review of all IUI cycles performed at a University Infertility clinic in 2007.MATERIALS AND METHODS: Charts of infertile couples undergoing IUI were identified and abstracted data included demographics, duration and cause of infertility, previous infertility treatment and outcome, menstrual and relevant gynecologic history, and previous pelvic surgery. Semen analysis and IUI specimen parameters were recorded. The status of the endometrial cavity and tubal patency was documented. Ovulation induction method and monitoring, if any, was also recorded. Day 3 FSH, antral follicular count, and clomiphene challenge test, when performed, were recorded. In cycles with one insemination, IUI was performed 1 to 1.5 days from LH surge or administration of hCG. In cycles with 2 inseminations, IUI was performed on the 2 consecutive days following LH surge or hCG administration.RESULTS: During the study period 123 patients completed 271 IUI cycles, with 2 inseminations per cycle performed in 140 cycles and one insemination in 131 cycles. There were 27 pregnancies with pregnancy rate (PR) of 10% per cycle and 22% per patient. Women younger than 30 yr significantly had higher PR per cycle than those older than 30yr (21.3% vs. 7.6%, p=0.004).The per cycle PR was significantly higher when the total motile sperm count was more than 5 million in the washed insemination sample (11.8% vs. 2%, p=0.037). The PR in the double insemination cycles was not significantly different from the PR in the single insemination cycles (9.3% vs. 10.7%, p= 0.7). In a logistic regression model controlling for covariates, there was no correlation between number of inseminations per cycle and PR. This model, however, showed a significant correlation between PR and total motile sperm count in the washed insemination sample (OR 1.02, p=0.003).CONCLUSIONS: Performing a second insemination during an IUI cycle does not seem to add any benefit to one insemination. PR seems to be more affected by the woman's age and the total number of motile sperms in the washed insemination specimen. OBJECTIVE: To determine whether performing one or two Intra-uterine inseminations (IUI) per ovulation induction cycle affect pregnancy rate. DESIGN: Retrospective chart review of all IUI cycles performed at a University Infertility clinic in 2007. MATERIALS AND METHODS: Charts of infertile couples undergoing IUI were identified and abstracted data included demographics, duration and cause of infertility, previous infertility treatment and outcome, menstrual and relevant gynecologic history, and previous pelvic surgery. Semen analysis and IUI specimen parameters were recorded. The status of the endometrial cavity and tubal patency was documented. Ovulation induction method and monitoring, if any, was also recorded. Day 3 FSH, antral follicular count, and clomiphene challenge test, when performed, were recorded. In cycles with one insemination, IUI was performed 1 to 1.5 days from LH surge or administration of hCG. In cycles with 2 inseminations, IUI was performed on the 2 consecutive days following LH surge or hCG administration. RESULTS: During the study period 123 patients completed 271 IUI cycles, with 2 inseminations per cycle performed in 140 cycles and one insemination in 131 cycles. There were 27 pregnancies with pregnancy rate (PR) of 10% per cycle and 22% per patient. Women younger than 30 yr significantly had higher PR per cycle than those older than 30yr (21.3% vs. 7.6%, p=0.004).The per cycle PR was significantly higher when the total motile sperm count was more than 5 million in the washed insemination sample (11.8% vs. 2%, p=0.037). The PR in the double insemination cycles was not significantly different from the PR in the single insemination cycles (9.3% vs. 10.7%, p= 0.7). In a logistic regression model controlling for covariates, there was no correlation between number of inseminations per cycle and PR. This model, however, showed a significant correlation between PR and total motile sperm count in the washed insemination sample (OR 1.02, p=0.003). CONCLUSIONS: Performing a second insemination during an IUI cycle does not seem to add any benefit to one insemination. PR seems to be more affected by the woman's age and the total number of motile sperms in the washed insemination specimen.