Double Intrauterine Insemination Research Articles

Outcome of single and double intrauterine insemination techniques in infertility cases

Outcome of single and double intrauterine insemination techniques in infertility cases

For women with subfertility, how does double intrauterine insemination (IUI) compare with single IUI in stimulated cycles?

For women with subfertility, how does double intrauterine insemination (IUI) compare with single IUI in stimulated cycles?

SINGLE IUI IN PATIENTS USING DONOR SPERM Results IN EQUIVALENT PREGNANCY OUTCOMES COMPARED TO DOUBLE IUI

Patients using donor sperm for intrauterine insemination (IUI) might be counseled to undergo double IUI to increase exposure to sperm. While a double IUI approach has not been shown to improve outcomes compared to single IUI in the general population, patients using donor sperm such as same-sex female couples and single mothers by choice lack supplementary access to partner sperm around the time of ovulation.1 However, sperm banks worldwide are currently facing a shortage of donor sperm, and double IUI increases cost and inconvenience to the patient.

Doubleversus single intrauterine insemination (IUI) in stimulated cycles for subfertile couples.

In subfertile couples, couples who have tried to conceive for at least one year, intrauterine insemination (IUI) with ovarian hyperstimulation (OH) is one of the treatment modalities that can be offered. When IUI is performed a second IUI in the same cycle might add to the chances of conceiving. In a previous update of this review in 2010 it was shown that double IUI increases pregnancy rates when compared to single IUI. Since 2010, different clinical trials have been published with differing conclusions about whether double IUI increases pregnancy rates compared to single IUI. To determine the effectiveness and safety of double intrauterine insemination (IUI) compared to single IUI in stimulated cycles for subfertile couples. We searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase and CINAHL in July 2020 and LILACS, Google scholar and Epistemonikos in February 2021, together with reference checking and contact with study authors and experts in the field to identify additional studies. We included randomised controlled, parallel trials of double versus single IUIs in stimulated cycles in subfertile couples. Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We identified in nine studies involving subfertile women. The evidence was of low quality; the main limitations were unclear risk of bias, inconsistent results for some outcomes and imprecision, due to small trials with imprecise results. We are uncertain whether double IUI improves live birth rate compared to single IUI (odds ratio (OR) 1.15, 95% confidence interval (CI) 0.71 to 1.88; I2 = 29%; studies = 3, participants = 468; low quality evidence). The evidence suggests that if the chance of live birth following single IUI is 16%, the chance of live birth following double IUI would be between 12% and 27%. Performing a sensitivity analysis restricted to only randomised controlled trials (RCTs) with low risk of selection bias showed similar results. We are uncertain whether double IUI reduces miscarriage rate compared to single IUI (OR 1.78, 95% CI 0.98 to 3.24; I2 = 0%;studies = 6, participants = 2363;low quality evidence). The evidence suggests that chance of miscarriage following single IUI is 1.5% and the chance following double IUI would be between 1.5% and 5%. The reported clinical pregnancy rate per woman randomised may increase with double IUI group (OR 1.51, 95% CI 1.23 to 1.86; I2 = 34%;studies = 9, participants = 2716;low quality evidence). This result should be interpreted with caution due to the low quality of the evidence and the moderate inconsistency. The evidence suggests that the chance of a pregnancy following single IUI is 14% and the chance following double IUI would be between 16% and 23%. We are uncertain whether double IUI affects multiple pregnancy rate compared to single IUI (OR 2.04, 95% CI 0.91 to 4.56; I2 = 8%; studies = 5;participants = 2203;low quality evidence). The evidence suggests that chance of multiple pregnancy following single IUI is 0.7% and the chance following double IUI would be between 0.85% and 3.7%. We are uncertain whether double IUI has an effect on ectopic pregnancy rate compared to single IUI (OR 1.22, 95% CI 0.35 to 4.28; I2 = 0%; studies = 4,participants = 1048;low quality evidence). The evidence suggests that the chance of an ectopic pregnancy following single IUI is 0.8% and the chance following double IUI would be between 0.3% and 3.2%. Our main analysis, of which the evidence is low quality, shows that we are uncertain if double IUI improves live birth and reduces miscarriage compared to single IUI. Our sensitivity analysis restricted to studies of low risk of selection bias for both outcomes is consistent with the main analysis. Clinical pregnancy rate may increase in the double IUI group, but this should be interpreted with caution due to the low quality evidence. We are uncertain whether double IUI has an effect on multiple pregnancy rate and ectopic pregnancy rate compared to single IUI.

Factors Affecting Artificial Insemination Pregnancy Outcome.

ObjectiveThe aim of the present study was to explore related clinical pregnancy outcome factors in intrauterine insemination (IUI).Materials and MethodsThe clinical data of 3984 IUI cycles in 1862 couples experiencing infertility who attended the Reproductive Center of Binzhou Medical University Hospital between July 2006 and July 2017 were retrospectively analyzed. Female and male patient age, endometrial thickness (EMT), the post-wash total motile sperm count (PTMC), artificial insemination timing, insemination frequency, and ovarian stimulation protocols were compared between the study’s pregnant group and non-pregnant group in order to explore any correlation.ResultsThere were statistically significant differences in female and male age, EMT, artificial insemination timing, insemination frequency, and ovarian stimulation protocols between the two groups (p < 0.05). The clinical pregnancy rate was significantly higher in ovarian stimulation cycles than in natural cycles (21.2% and 11.6%, respectively; p < 0.01), the clinical pregnancy rate was significantly higher in double IUI than in single IUI (17.8% and 12.1%, respectively; p < 0.01), and EMT was significantly greater in the pregnant group than in the control group (p < 0.05). However, the differences in clinical pregnancy rates among the PTMC groups were not statistically significant (14.8%, 14.4%, 17.3%, and 17.3%, respectively; p > 0.05).ConclusionThe results of the present study demonstrate that the clinical IUI pregnancy rate is correlated with the factors of female age, male age, EMT, artificial insemination timing, insemination frequency, and ovarian stimulation protocols; the ovarian stimulation protocol can noticeably improve the patient pregnancy outcome. Furthermore, compared with single IUI, double IUI can significantly increase the clinical pregnancy rate.

Evaluation of Prognostic Factors for Clinical Pregnancy Rate Following Artificial Insemination by Husband in the Chinese Population.

Background: To determine the independent prognostic factors and develop a multivariate logistic regression model for predicting successful pregnancy following artificial insemination by husband (AIH) in infertile Chinese couples.Methods: A total of 3,015 AIH cycles with superovulation from 1,853 infertile Chinese couples were retrospectively analyzed. The clinical characteristics and sperm parameters were compared between the pregnant and non-pregnant groups. Multivariate logistic regression analysis was performed to remove the confounding factors and create an equation to predict the successful pregnancy. Receiver operating characteristic (ROC) curves were constructed for evaluating the abilities for prognostic classification of the independent predictors and the equation.Results: The overall pregnancy rate was 13.0%. The pregnancy rate of double intrauterine insemination (IUI) (18.9%) was significantly higher than that of single IUI (11.4%). The pregnancy rate of the stimulated cycle (14.4%) was significantly higher than that of the natural cycle (9.0%). The pregnancy rates of the age groups <40 years are ~3 times higher than that of the ≥40 years age group. Among sperm parameters, the influencing factors included straight-line velocity (VSL), sperm deformity index (SDI), and normal form rate (all P < 0.05). A multivariate logistic regression equation was created based on the above influencing factors. ROC analysis showed that the prognostic power of the equation is better than those of individual predictors.Conclusion: Cycle treatment options, single/double IUI, female age, sperm VSL, SDI, and normal form rate could predict successful pregnancy following AIH in China. The multivariate logistic regression equation exhibited a greater value for prognostic classification than single predictors.

IUI: Optimizing results, minimizing complications

Intrauterine insemination is a procedure in Assisted Reproductive Techniques (ART) where processed and concentrated motile sperms are placed directly into the uterine cavity. Although NICE [2013] recommends In Vitro Fertilisation over intrauterine insemination after 2 years of unprotected intercourse, Intrauterine Insemination (IUI) appears to be a low cost and effective option before proceeding for In Vitro Fertilisation (IVF). Minimal requirement for IUI is patency of at least one fallopian tube. Adequate number of motile sperms should be present in pre wash specimen of semen. At total sperm count 3–5 million, pregnancy rate is less than 1% per cycle. In unexplained infertility there may be undetected subtle functional defects in follicular development, maturation and ovulation like luteinised unruptured follicle, luteal phase defect. Ovarian stimulation increases the number of dominant follicles and improves their quality resulting in improvement in pregnancy rate. Single IUI has benefits of fewer visits, less cost and stress. Evidence suggests no difference in clinical pregnancy rate between single versus double IUI. WHO recommends ejaculatory abstinence of 2–7 days before semen collection (WHO, 2010), for diagnostics and semen preparation. Shorter time interval between processing and insemination leads to less sperm chromatin decondensation & sperm DNA fragmentation and higher Pregnancy Rate. The luteinizing hormone surge can be detected almost 36 hours before ovulation in serum and 24 hours before ovulation in urine. The optimal time interval between human chorionic gonadotropin (hCG) injection and IUI seems to be between 12 and 36 hours; 24 hours after leutinising hormone (LH) Surge. Nature of sperms is the best guide for choice of technique. “Swim up” techniques are recommended in cases of normozoospermia and “Density Gradient” should be chosen in cases of any pathology of semen. The pregnancy rate per cycle is highest in the first three treatment cycles. Most couples show acceptable cumulative ongoing pregnancy rates after six cycles of IUI with ovulation induction. In vitro fertilization should be considered after 3–6 cycles taking all factors into consideration.

Double intrauterine insemination (IUI) of no benefit over single IUI among lesbian and single women seeking to conceive.

To explore clinical benefit of performing two intrauterine inseminations (IUI) 24h apart-a double IUI vs. a single IUI among lesbian and single women. Retrospective cohort study using electronic medical record review during a 17-year period (11/1999-3/2017). A total of 11,396 patients at a single academic-affiliated private practice were included in this study. All cycles with a single or double IUI were included. A sub-analysis of first cycles only (n = 10,413) was also performed. Canceled IVF cycles converted to IUI were excluded. T tests and Wilcoxon rank-sum tests were used for continuous data, and chi-square for categorical data. Multivariable logistic regression controlled for patient age, day 3 follicle-stimulating hormone (D3 FSH), body mass index (BMI), peak estradiol (E2), and post-wash total motile sperm counts to model the association between IUI number and ongoing pregnancy rate (OPR) according to sperm source (autologous vs. donor). Generalized estimating equations and mixed effect models accounted for multiple cycles from the same woman. Adjusted odds ratio (AOR) with 95% CI was determined. Sub-analyses of sexual orientation and partner status were performed to compare heterosexual couples with proven infertility to women with lesbian and single women. During the study period, 22,452 cycles met inclusion criteria (single IUI 1283 vs. double IUI 21,169). Mean patient age and BMI were similar between groups. For couples using autologous sperm, OPR was significantly higher with double IUI (12.0% vs. 14.1%; p = 0.0380). A similar increase was observed for donor sperm OPR among heterosexual couples (14.4% vs. 16.2%), though this did not reach statistical significance (p = 0.395). A sub-analysis restricted to donor sperm demonstrates a clinical benefit of second IUI in heterosexual couples, 8.5% vs. 17.6% OPR (AOR 2.94; CI 1.00-10.99; p = 0.0496). When lesbian and single patients were evaluated, there was no difference (17.2% vs. 15.2%; AOR 0.99; CI 0.59-1.70; p = 0.0958). Double IUI is associated with a significantly higher OPR for heterosexual couples using an autologous or donor sperm source. The benefit of a second IUI is less clear in patients with undocumented fertility status using donor sperm, such as single and lesbian women.

Ongoing pregnancy rates (OPR) from 30,000 single vs. double intrauterine insemination (IUI) cycles according to sperm source, sexual orientation and partner status

Ongoing pregnancy rates (OPR) from 30,000 single vs. double intrauterine insemination (IUI) cycles according to sperm source, sexual orientation and partner status

P26.04: To appraise the current evidence comparing double and single intrauterine insemination (IUI) on the reproductive outcomes in subfertile couples

P26.04: To appraise the current evidence comparing double and single intrauterine insemination (IUI) on the reproductive outcomes in subfertile couples

Single versus double intrauterine insemination—in artificial insemination donor stimulated cycles—impact on the clinical pregnancy rate: A randomized trial

Introduction: Male factor infertility affects almost 30–50% of infertile couples worldwide. The use of donor sperm intrauterine insemination (IUI) is an option for couples with absolute azoospermia, severe male factor infertility, sexual dysfunction and unaffordability for in-vitro fertilization. The data on the utility of double IUI using donor sperm are limited due to the lack of randomized controlled trial’s and conflicting conclusions. The objective of this study was to evaluate the utility of frozen double donor sperm IUI to improve clinical pregnancy rate. Materials and Methods: A total of 200 participants that fulfilled the inclusion criteria were enrolled for the study following randomization after preliminary work up. Random distribution was made using sequentially numbered envelope method in both groups (single and double IUI). Results: In this dataset comparing single and double donor sperm IUI, there was no significant difference in clinical pregnancy rates. The clinical pregnancy of 11 participants (11%) (out of 100 participants) in single IUI group and 13 participants (13%) (out of 100 participants) in double IUI group was seen. Conclusion: However, clinical pregnancy rate was statistically significant with gonadotrophins in double IUI group in our study.

Single versus Double Intrauterine Insemination in Controlled Ovarian Hyperstimulation Cycles: A Randomized Trial.

There are many factors that affect intrauterine insemination (IUI) success rate and identifying those factors can be helpful. This study aimed to investigate the single versus double IUI in controlled ovarian hyperstimulation cycles. This is a randomized clinical trial with equal randomization (1:1) conducted on 580 women who underwent IUI in a private infertility clinic from May 2013 to November 2014 in Rasht, Iran. Women were randomly assigned to single (n = 290) or double (n = 290) IUI groups. Women in the single group underwent IUI performed 36 hours after human chorionic gonadotropin (HCG) administration. Women in the double group underwent two IUIs performed 18 and 40 hours after HCG administration. The main outcome was clinical pregnancy confirmed by evidence of fetal cardiac activity. Data were analyzed by SPSS software. Comparisons of frequencies were done using the Fisher exact test and Chi-square test. For comparing means between the two groups, the independent t-test was used. The P-value < 0.05 was considered to indicate statistical significance. Pregnancy rate was 11.7% (34/290) in the single IUI group and 13.4% (39/249) in the double IUI group. The difference between the two groups was not statistically significant (P = 0.617, OR = 1.17, 95% CI: 0.72 - 1.91). Also, we could not show significant difference between single and double IUI groups in different cause of infertility groups regarding the success rate. Based on findings, double versus single IUI did not increase the pregnancy rate of IUI and further investigations are recommended.

Comparison of two sperm processing techniques for low complexity assisted fertilization: sperm washing followed by swim-up and discontinuous density gradient centrifugation.

ObjectiveThis study aimed to assess and compare sperm motility, concentration, and morphology recovery rates, before and after processing through sperm washing followed by swim-up or discontinuous density gradient centrifugation in normospermic individuals.MethodsFifty-eight semen samples were used in double intrauterine insemination procedures; 17 samples (group 1) were prepared with sperm washing followed by swim-up, and 41 (group 2) by discontinuous density gradient centrifugation. This prospective non-randomized study assessed seminal parameters before and after semen processing. A dependent t-test was used for the same technique to analyze seminal parameters before and after semen processing; an independent t-test was used to compare the results before and after processing for both techniques.ResultsThe two techniques produced decreases in sample concentration (sperm washing followed by swim-up: P<0.000006; discontinuous density gradient centrifugation: P=0.008457) and increases in motility and normal morphology sperm rates after processing. The difference in sperm motility between the two techniques was not statistically significant. Sperm washing followed by swim-up had better morphology recovery rates than discontinuous density gradient centrifugation (P=0.0095); and the density gradient group had better concentration recovery rates than the swim-up group (P=0.0027).ConclusionThe two methods successfully recovered the minimum sperm values needed to perform intrauterine insemination. Sperm washing followed by swim-up is indicated for semen with high sperm concentration and better morphology recovery rates. Discontinuous density gradient centrifugation produced improved concentration recovery rates.

Effect of Timing and Number of Intrauterine Insemination (IUI) on the Cycle Clinical Outcome

Objective To study the effect of timing and number of intrauterine insemination (IUI) per cycle on the outcome of artificial insemination by husband (AIH). Methods A total of 195 infertile couples underwent 379 cycles of IUI with husband's sperm. They were divided into 4 groups according to the ovulation and the number of IUIs per cycle: single IUI was performed 24 h after hCG injection, including single IUI before ovulation (group A) and single IUI after ovulation (group B); double IUI was performed 24 h and 48 h after hCG injection, including double IUI before and after ovulation (group C) and double IUI before ovulation (group D). The relationship between IUI pregnancy rate and the factors like processed total motile sperm (PTMS), timing and number of IUIs per cycle was analyzed. Results When PTMS Conclusion IUI treatment is recommended to be performed when PTMS ≥ 5 × 106. An ideal pregnancy rate can be achieved by single IUI which is performed 24 h after hCG injection, and double IUI performed without ovulation could not result in significant improvement of cycle pregnancy rate.

Single-donor and double-donor sperm intrauterine insemination cycles: does double intrauterine insemination increase clinical pregnancy rates?

To compare the pregnancy outcomes in the setting of a single- vs. double-donor sperm intrauterine insemination (IUI) treatment cycle. Retrospective cohort study. Large, private assisted reproductive technology practice. Donor sperm IUI recipients. None. Clinical pregnancy. There were 2,486 double and 673 single-donor sperm IUI cycles. The two groups were similar for age, body mass index, and the number of prior cycles. The clinical pregnancy rates were similar between the two groups (single: 16.4% vs. double: 13.6%). In univariate regression analysis, age, total motile sperm, and diminished ovarian reserve (DOR) were associated with pregnancy. Generalized estimating equation models accounting for repeated measures, age, DOR and total motile sperm and the interactions of these factors demonstrated that single and double IUI had similar odds of pregnancy (odds ratio 1.12; 95% confidence interval, 0.96-1.44). Pregnancy rates remained similar between the two groups in matched comparison and other subgroup analyses. Single and double-donor IUI cycles had similar clinical pregnancy rates. This large data set did not demonstrate a benefit to routine double IUI in donor sperm cycles.

Single and double donor sperm intrauterine insemination cycles for male factor infertility: does double IUI increase clinical pregnancy rates?

Recent data has suggested a potential benefit in double intrauterine insemination (IUI). The objective was to compare pregnancy outcomes in single vs double donor sperm IUI cycles for male factor infertility.

Couples with male factor infertility undergoing gonadotropin/IUI have greater clinical pregnancy rates with double vs. single iui

Intrauterine insemination (IUI) is often combined with oral ovulation induction agents or gonadotropins for the treatment of infertility. Daily IUI on two consecutive days “double IUI” has emerged as a treatment option that may result in better pregnancy rates. There is conflicting data regarding the benefit of double IUI for male factor infertility.We hypothesized that double IUI clinical pregnancy rates (CPR) would be greater for patients with male factor infertility.

Double versus single homologous intrauterine insemination for male factor infertility: a systematic review and meta-analysis

Male factor infertility affects 30%-50% of infertile couples worldwide, and there is an increasing interest in the optimal management of these patients. In studies comparing double and single intrauterine insemination (IUI), a trend towards higher pregnancy rates in couples with male factor infertility was observed. Therefore, we set out to perform a meta-analysis to examine the superiority of double versus single IUI with the male partner's sperm in couples with male factor infertility. An odds ratio (OR) of 95% confidence intervals (CIs) was calculated for the pregnancy rate. Outcomes were analysed by using the Mantel-Haesel or DerSimonian-Laird model according to the heterogeneity of the results. Overall, five trials involving 1125 IUI cycles were included in the meta-analysis. There was a two-fold increase in pregnancies after a cycle with a double IUI compared with a cycle with a single IUI (OR: 2.0; 95% CI: 1.07-3.75; P<0.03). Nevertheless, this result was mainly attributed to the presence of a large trial that weighted as almost 50% in the overall analysis. Sensitivity analysis, excluding this large trial, revealed only a trend towards higher pregnancy rates among double IUI cycles (OR: 1.58; 95% CI: 0.59-4.21), but without statistical significance (P=0.20). Our systematic review highlights that the available evidence regarding the use of double IUI in couples with male factor infertility is fragmentary and weak. Although there may be a trend towards higher pregnancy rates when the number of IUIs per cycle is increased, further large and well-designed randomized trials are needed to provide solid evidence to guide current clinical practice.

Effectiveness of Combined Empirical Therapies and Double IUI Procedures in Treatment of Male Factor Infertility

Objective: Current information on using anti-estrogenic compounds, antioxidant vitamins and minerals in treatment of male factor infertility still remains controversial. Herein, we investigated the pregnancy outcome in male factor infertile patients using a combination of non-specific empiric modalities and Intra Uterine Insemination (IUI) procedures. Subjects and Methods: The study involved a group of 33 infertile couples with mild male factor infertility who previously failed two IUI attempts. The patients received tamoxifen, vitamin E, zinc, and selenium for three months prior to their third IUI treatment cycle. Four important parameters were mainly noted: sperm concentration, motility, forward progression and the percentage normal forms. Results: There was no difference between these parameters in semen samples of our study group in the first and second IUI treatment cycles (p<0.96, p<0.23, p<0.59, p<0.84 respectively). However, after completion of the empiric therapy course and in the third IUI treatment cycle, significant differences in overall values for the four semen parameters were detected in comparison to the earlier two IUI cycles (range p<0.005 to p<0.0005), except for semen volume and sperm normal forms, resulting in a chemical pregnancy rate of 30.3%, a clinical pregnancy rate of 21.2% and a delivery rate of 18.1%. Grouping the female patients according to the Body Mass Index (BMI) showed imperative differences in pregnancy outcome, yet there was no clear effect of age over pregnancy success rates in our study group. Conclusion: Combined empirical therapies can improve semen parameters in infertile men with mild male factor. Double insemination procedures with improved semen samples, can contribute in increasing the chances of pregnancy and life birth more significantly in females with lower BMI.

SINGLE VERSUS DOUBLE INTRAUTERINE INSEMINATION IN CONTROLLED OVARIAN STIMULATION CYCLES FOR SUBFERTILE MALES

This study aimed to compare the efficacy of single intrauterine insemination (IUI) with double IUI in controlled ovarian hyperstimulation (COH) and IUI cycles for subfertile males. This is a prospective, nonrandomized study in hospital based outpatient infertility center. The subfertile males were diagnosed by at least two sperm analyses. The study included ovulatory women having patent tubes and undergoing COH cycles with either single or double IUI. Controlled ovarian hyperstimulation was induced by either clomiphene citrate (CC) with gonadotropins or only gonadotropins. Intrauterine insemination of husband’s sperm was performed 36 hours after hCG administration in single IUI group. In the double IUI group, first IUI was performed 12-18 hours and second IUI 36 hours after hCG administration. The decision as to which intervention group a patient was placed in was determined by the day of hCG administration. Ovarian response to hyperstimulation was the only factor influencing the day of hCG administration. Statistical analyses was carried out by using the student’s t test and chi-squared test. The main outcome measure is Clinical Pregnancy rate (CPR). Pregnancy was determined ultrasonographically by the presence of fetal cardiac activity. A total of 191 couples underwent 216 COH-IUI cycles; 110 couples underwent 124 cycles with single IUI and 81 couples underwent 92 cycles with double IUIs. Cycle pregnancy rates were 9.2% (12/124) in the single IUI group and 8.2% (9/92) in the double IUI group, respectively (p=0.782). It is concluded that a single IUI may be as effective as double IUI for couples undergoing COH/IUI for subfertile males.