Clomiphene Intrauterine Insemination Research Articles

Use of uterine artery Doppler velocimetry values to predict pregnancy in intrauterine insemination cycles in couples with unexplained infertility

Background/Aim: It is known that pregnancy success in IUI cycles performed in couples with unexplained infertility is below 20% even under the best conditions. Predicting the success in IUI cycles and directing patients to appropriate assisted reproductive treatment is essential for the time and budget. In this context, we aimed to investigate the use of uterine artery Doppler velocimetry values to predict pregnancy in intrauterine insemination (IUI) cycles in couples with unexplained infertility. Methods: In this prospective cohort study, couples with unexplained infertility were randomly assigned to two groups: clomiphene citrate (CC) and gonadotropin. The CC group used 50-150 mg CC daily between the 5th and 9th days of the menstrual period, while the gonadotropin group used 37.5-75 IU of recFSH daily from the 3rd day of the menstrual period until the dominant follicle developed. Ovulation was triggered by recHcg when at least one dominant follicle of 17 mm or larger was detected. Intrauterine insemination was performed 36 hours after the trigger. Uterine artery flow pulsatility index (PI), resistance index (RI)and the systolic-diastolic ratio (S/D) were measured in all patients by Doppler ultrasound on the 3rd day of menstruation and trigger day. Uterine artery Doppler values of the group that achieved pregnancy and those who could not conceive were compared as the main outcome of the study. Results: The study was designed over 143 IUI cycles, 89 cycles in the gonadotropin group and 54 cycles in the CC group. In 143 IUI cycles, 24 (16%) pregnancies were obtained, seven (12%) in the CC group and 17 (12%) in the gonadotropin group. In both CC and gonadotropin cycles, mean age, BMI, duration of infertility, hormone levels on the third day of menstruation, endometrial thickness on 3rd day of menstruation and on the trigger day, dominant follicle number and mean follicle diameter were similar in the pregnant and non-pregnant groups (P<0.05). There was no statistical difference in uterine artery Doppler values (RI, PI and S/D) measured neither on the 3rd day of the cycle nor on the trigger day between pregnant and non-pregnant groups in patients receiving CC or gonadotropin (P<0.05). Conclusion: Considering the hormonal changes in stimulated cycles or other factors that may have an impact on endometrial blood flow and endometrial receptivity, we think that only uterine artery Doppler velocity measurement values are not effective in predicting pregnancy success in CC or gonadotropin-induced IUI cycles.

Factors affecting success in intrauterine insemination cycles; 2-year single center experience

Abstract&#x0D; Objective: The aim of this study is to evaluate the success rates of intrauterine insemination cycles due to ovulation induction with clomiphene citrate and gonadotropins, and to identify factors associated with successful outcomes in women with unexplained infertility and ovulatory dysfunction.&#x0D; Material and Methods: Between June 2017 and October 2019, 223 intrauterine insemination cycle records were scanned retrospectively in 152 infertile couples diagnosed with ovulatory dysfunction or unexplained infertility. &#x0D; Result: A total of 33 positive pregnancy test results were obtained, which had shown a pregnancy success rate of 14.8%. Pregnancy success rate in Gonadotropin IUI (Intrauterine Insemination) cycles was found as 16.6% and pregnancy success rate in CC (Clomiphene Citrate) IUI cycles was found as 9.3%. While it has been detected that smoking has had a negative effect on IUI success rate for the infertile population with ovulatory dysfunction and unexplained infertility (p=0.012); factors such as female age, BMI (Body mass index), infertility span, basal FSH (Follicle Stimulating Hormone), basal LH (Luteinizing Hormone), basal estradiol levels and trigger-day endometrial thickness were found to have no correlation with IUI success rate at all.

The effect of clomiphene citrate (CC) dose and initiation day on endometrial thickness (ET) in women undergoing clomiphene citrate/intrauterine insemination (CC/IUI) cycles

The effect of clomiphene citrate (CC) dose and initiation day on endometrial thickness (ET) in women undergoing clomiphene citrate/intrauterine insemination (CC/IUI) cycles

Optimal follicular size for ovulatory trigger in natural and clomiphene citrate intrauterine insemination cycles

Intrauterine insemination (IUI) during a natural cycle (NC) or following ovulation induction with clomiphene citrate (CC) forms the mainstay of fertility treatment in many young patients. IUIs in such patients are frequently performed after administration of a human chorionic gonadotropin (hCG) ovulatory trigger. The primary objective of this study is to identify the optimal lead follicular size for an ovulatory trigger in either NC or CC IUI cycles. Retrospective cohort study. Patients <40 years of age, with patent fallopian tubes, a normal uterine cavity, and a male partner with >15 million sperm/mL, undergoing an IUI in either a NC or CC ovulation induction cycle between 2004 and 2013 were analyzed for inclusion. All patients with a spontaneous LH surge or undergoing successive IUIs in the same treatment cycle were excluded. The hCG ovulatory trigger was administered either subcutaneously or intramuscularly, after visualization of a >17 mm follicle in the NC group or >19 mm follicle in the CC group, and an endometrial thickness of >7 mm in both groups. IUIs were performed 24-30 hours following the ovulatory trigger. Clinical pregnancy rates were plotted for the NC and CC groups against lead follicular size, in increments of 1 mm beginning at 17 mm. Odds ratios (OR) for clinical pregnancy at different lead follicular sizes were calculated by using 17 mm and 19 mm as reference values for the NC and CC groups, respectively. 3272 IUI cycles met inclusion criteria: 1201 NC and 2071 CC. The median age in the NC and CC groups was 36.4 (31.4-41.4) years and 34.3 (29.8-38.8) years, respectively. In the NC group, the clinical pregnancy rate (14%) was highest when the ovulatory trigger was administered at a lead follicular size of 19 mm compared to the reference group of 17 mm (8%). However, these odds were not statistically significant (OR 1.80, 95% CI 0.73-4.41). The aforementioned odds remained unchanged even after adjusting for age. In contrast, the clinical pregnancy rate in the CC group was highest when the lead follicular size was 22 mm at the time of the ovulatory trigger (16%). Compared to the reference group of 19 mm, the odds for clinical pregnancy with a lead follicle of 22 mm was 2.14 times higher (OR 2.14, 95% CI 1.20-3.83; P=0.01). The higher odds for clinical pregnancy persisted even after stratifying for age: 25-35 years (OR 2.55, 95% CI 1.25-5.20) and 35-40 years (OR 1.90, 95% CI 1.01-3.58). Our results suggest that administration of a hCG ovulatory trigger at a lead follicular size of 22 mm is associated with higher odds of clinical pregnancy in patients undergoing IUI following ovulation induction with CC. Although triggering at a lead follicular size of 19 mm in the NC group is also associated with an increased odds of clinical pregnancy, these odds remain non-significant when compared to the reference group of 17 mm.

Does anti-mullerian hormone (AMH) level predict pregnancy outcome in patients with unexplained infertility undergoing clomiphene citrate/intrauterine insemination (CC/IUI)?

AMH has become an important predictor of ovarian reserve. Low AMH levels forecast reduced response to gonadotropins in IVF cycles as well as inferior clinical pregnancy rates (CPR). This study was conducted in order to determine whether AMH has the same predictive value in patients with unexplained infertility undergoing CC/IUI.

Clomiphene citrate intrauterine insemination (IUI) before gonadotropin IUI affects the pregnancy rate and the rate of high-order multiple pregnancies

Objective To determine if previous treatment with clomiphene citrate intrauterine insemination (CC-IUI) affects pregnancy and high-order multiple pregnancy (HOMP) rates in subsequent hMG-IUI or FSH-IUI cycles. Design Retrospective cohort study. Setting Private infertility clinic. Patient(s) Five hundred fifty-one patients (age <38 years) without tubal factor infertility, treated with 918 cycles of hMG/FSH-IUI after one or more unsuccessful cycles of CC-IUI; 908 patients treated with 1459 cycles of hMG/FSH-IUI without prior CC-IUI. Intervention(s) CC-IUI, hMG-IUI, FSH-IUI. Main outcome measure(s) Pregnancy rate per cycle, HOMP (three or more gestational sacs). Result(s) Pregnancy rates during the first three hMG-IUI or FSH-IUI cycles averaged 21.8 ± 1.1% without previous CC-IUI, 19.6 ± 1.3% after one to four cycles of CC-IUI, and 3.6 ± 2.6% after ≥ five previous CC-IUI cycles. The HOMP rates were 8.8% without previous CC-IUI, 7.5% after one, 5.7% after two and <2.6% (0 out of 38) after ≥ three previous CC-IUI cycles. Conclusion(s) Pregnancy rates in hMG/FSH-IUI cycles are significantly reduced after four unsuccessful CC-IUI cycles. High-order multiple pregnancies due to hMG/HMG-IUI are reduced following previous unsuccessful CC-IUI cycles.

Effect on pregnancy rate and high order multiple pregnancy of clomiphene-intrauterine insemination before gonadotropin-intrauterine insemination

Objective: To determine how previous treatment with clomiphene citrate-intrauterine insemination (CC-IUI) affected pregnancy and high order (3 or more gestations) multiple pregnancy (HOMP) rates in subsequent human menopausal gonadotropin (hMG)-IUI or follicular stimulating (FSH)-IUI cycles.

Clomiphene Citrate-Intrauterine Insemination (CC-IUI) Cycles as Treatment for Infertility: A Useful Therapy or Just Killing Time?

Objectives: Clomiphene citrate-intrauterine insemination (CC-IUI) cycles are often recommended by physicians as a first line therapy for infertile couples. This treatment is also often requested by patients who are reluctant to proceed with gonadotropin-IUI or in-vitro fertilization-embryo transfer cycles due to concerns about financial cost or the higher risks of multiple pregnancy and ovarian hyperstimulation syndrome. The objectives of this study were to determine if treatment success could be predicted by: 1) patient characteristics prior to treatment or 2) individual cycle parameters.Design: Retrospective chart review of all patients (68 patients, 135 cycles) treated with CC-IUI at a single academic infertility center over a one-year period.Materials and Methods: Patients were treated with CC at doses of 50–150 mg daily on cycle days 5–9, with vaginal ultrasounds performed every 2–4 days starting on cycle day 10. When one or more follicles had a mean diameter of ≥18 mm, ovulation was triggered with HCG 5,000 IU IM 38–40 hours prior to IUI. Sperm were prepared using density gradient centrifugation, and IUI performed with a Tomcat catheter. Luteal support consisted of HCG 2,500 IU IM 6 days after the first injection. Livebirth after 24 weeks of pregnancy (LB) was the sole outcome measure. Charts were reviewed to evaluate: 1) pre-cycle patient characteristics: infertility diagnosis, presence of ovulatory dysfunction, female age, presence of male factor, # of previous treatment cycles, and parity; and 2) individual cycle parameters: # of follicles ≥16 mm on day of HCG, endometrial thickness, total # of motile sperm inseminated, and use of donor sperm. Logistic regression or Chi square were used to analyze data as appropriate.Results: Over 12 months, eleven LB occurred in 68 patients (16.1%) undergoing 135 cycles (8.1%). Only female age significantly predicted treatment success: in women ≤34 yrs, LB occurred in 10/84 cycles (11.9%) vs. 1/51 cycles (1.9%) in patients ≥35 yrs (P<0.05). No other patient characteristics nor any individual cycle parameters were predictive of treatment success.Conclusions: CC-IUI was a highly effective therapy for women aged ≤34 yrs; it was clearly unhelpful for those ≥35 yrs and should be discouraged in these women. Objectives: Clomiphene citrate-intrauterine insemination (CC-IUI) cycles are often recommended by physicians as a first line therapy for infertile couples. This treatment is also often requested by patients who are reluctant to proceed with gonadotropin-IUI or in-vitro fertilization-embryo transfer cycles due to concerns about financial cost or the higher risks of multiple pregnancy and ovarian hyperstimulation syndrome. The objectives of this study were to determine if treatment success could be predicted by: 1) patient characteristics prior to treatment or 2) individual cycle parameters. Design: Retrospective chart review of all patients (68 patients, 135 cycles) treated with CC-IUI at a single academic infertility center over a one-year period. Materials and Methods: Patients were treated with CC at doses of 50–150 mg daily on cycle days 5–9, with vaginal ultrasounds performed every 2–4 days starting on cycle day 10. When one or more follicles had a mean diameter of ≥18 mm, ovulation was triggered with HCG 5,000 IU IM 38–40 hours prior to IUI. Sperm were prepared using density gradient centrifugation, and IUI performed with a Tomcat catheter. Luteal support consisted of HCG 2,500 IU IM 6 days after the first injection. Livebirth after 24 weeks of pregnancy (LB) was the sole outcome measure. Charts were reviewed to evaluate: 1) pre-cycle patient characteristics: infertility diagnosis, presence of ovulatory dysfunction, female age, presence of male factor, # of previous treatment cycles, and parity; and 2) individual cycle parameters: # of follicles ≥16 mm on day of HCG, endometrial thickness, total # of motile sperm inseminated, and use of donor sperm. Logistic regression or Chi square were used to analyze data as appropriate. Results: Over 12 months, eleven LB occurred in 68 patients (16.1%) undergoing 135 cycles (8.1%). Only female age significantly predicted treatment success: in women ≤34 yrs, LB occurred in 10/84 cycles (11.9%) vs. 1/51 cycles (1.9%) in patients ≥35 yrs (P<0.05). No other patient characteristics nor any individual cycle parameters were predictive of treatment success. Conclusions: CC-IUI was a highly effective therapy for women aged ≤34 yrs; it was clearly unhelpful for those ≥35 yrs and should be discouraged in these women.