Effectiveness Of Intrauterine Insemination Research Articles

Male fertility: a review of the publications from April – June 2021

The article provides an overview of the most significant publications on the topic of male infertility. The main selection criteria were considered the practical significance of the article, as well as the impact factor of the journal in which it was published, according to the SCImago Journal Rank (SJR). As a result, a list of 10 works published in the II quarter (April – June) of 2021 was formed. The review includes articles on the following issues: the effectiveness of repeated micro-TESE in non-obstructive azoospermia, the role of COVID-19 in male fertility, the effect of testosterone therapy on spermatogenesis, testicular microlithiasis, electroejaculation as a method of obtaining spermatozoa, harm from carrying cell phones near the genitals, prediction of the effectiveness of intrauterine insemination, the effect of advanced paternal age on sperm aneuploidy, and the importance of the microbiome for male fertility.

Assisted reproductive medicine in Poland, 2013-2016: Polish Society of Reproductive Medicine and Embryology (PTMRiE) and Fertility and Sterility Special Interest Group of the Polish Society of Gynaecologists and Obstetricians (SPiN PTGiP) report.

The purpose of this publication is to present data on the results and complications associated with infertility treatment using assisted reproductive technology (ART) and intrauterine insemination (IUI) in Poland between 2013 and 2016. The report was prepared by the Polish Society of Reproductive Medicine and Embryology (PTMRiE) and the Fertility and Sterility Special Interest Group of the Polish Society of Gynaecologists and Obstetrics (SPiN PTGiP) as a part of the European IVF Monitoring program (EIM) for the European Society of Human Reproduction and Embryology (ESHRE). Reporting was voluntary and the data was not subject to external control. The report presents the availability and structure of infertility treatment services, the number of procedures, their effectiveness and complications. Between 2013 and 2016, a total of 106,718 treatment cycles using ART [64,413 classical in vitro fertilization and in vitro fertilization with intracytoplasmic sperm injection (IVF + ICSI), 36,041 frozen embryo replacements (FER)] and 51,405 IUI were recorded. The clinical pregnancy rates per embryo transfer in IVF, ICSI and FER were 38.3%, 38.1% and 32.4%, respectively. The effectiveness of IUI with husband/partner's semen (IUI-H) was 11.1% and with donor semen (IUI-D) 16.7%. Multiple delivery rates were 11.3% and 6.2% in IVF + ICSI and IUI, respectively. The most common complication was the ovarian hyperstimulation syndrome (OHSS) (0.34%). PTMRiE and SPiN PTGiP report is the only national study documenting Polish reproductive medicine. The results of infertility treatment effectiveness in Poland are comparable with the European data, complications are less frequent than in other countries. The low percentage of multiple pregnancies, and so perinatal complications, is especially valuable. However, due to the lack of a central database and register, the possibility of external control and monitoring of pregnancies and births is limited. Thus, a fully reliable assessment of the treatment quality in our country is not possible.

Relationship between natural and intrauterine insemination-assisted live births and the degree of sperm autoimmunisation.

What is the relationship between the degree of sperm autoimmunisation, as assessed by IgG-mixed antiglobulin reaction (MAR) test, and natural and intrauterine insemination (IUI)-assisted live births? Compared with a lower degree of positivity (50-99%), a 100%-positive MAR test was associated with a much lower occurrence of natural live births in infertile couples, who could be successfully treated with IUI, as first-line treatment. The World Health Organization (WHO) has recommended screening for antisperm antibodies, through either the IgG-MAR test or an immunobead-binding test, as an integral part of semen analysis, with 50% antibody-coated motile spermatozoa considered to be the clinically relevant threshold. However, the predictive value of the degree of positivity of the MAR test above such a cut-off on the occurrence of natural pregnancies remains largely undetermined. Furthermore, the effectiveness of IUI in cases of strong sperm autoimmunisation is not yet well-established. This was a retrospective cohort study on 108 men with a ≥50%-positive MAR test, where the couple had attended a university/hospital andrology/infertility clinic for the management of infertility from March 1994 to September 2017. The IgG-MAR test was carried out as an integral part of semen analysis. The patients were divided into two groups: 100% and 50%-99%-positive MAR test. The post-coital test (PCT) was performed in all the couples, and IUI was offered as the first-line treatment. Laboratory and other clinical data were retrieved from a computerised database. Data on subsequent pregnancies were obtained by contacting patients over the telephone. A total of 84 men (77.8%) were successfully contacted by telephone, and they agreed to participate. Of these, 44 men belonged to the group with a 100%-positive MAR test, while 40 showed lower MAR test positivity. The couples with a 100%-positive MAR test showed a natural live birth rate per couple (LBR) that was considerably lower than that observed with a lower degree of positivity (4.5% vs. 30.0%; P = 0.00001). Among the clinical variables, a significant difference between the two groups was observed only for the PCT outcome, which was poor in the 100%-positive MAR test group. Better PCT outcomes (categorised as negative, subnormal and good) were positively associated with the occurrence of natural live births (6.3, 21.7 and 46.2%, respectively; P = 0.0005 for trend), for which the sole independent negative predictor was the degree of sperm autoimmunisation. IUI was performed as the first-line treatment in 38 out of 44 couples with a 100%-positive MAR test, yielding 14 live births (36.8%). In couples with lower MAR test positivity, the LBR after IUI (26.9%) was similar to the natural LBR in this group (30.0%). Given the retrospective nature of the study, we cannot exclude uncontrolled variables that may have affected natural pregnancies during the follow up or a selection bias from the comparison of natural live births with those after IUI. The routine use of the IgG-MAR test in the basic fertility workup is justified as it influences decision making. A 100%-positive IgG-MAR test can represent the sole cause of a couple's infertility, which could be successfully treated with IUI. On the other hand, a lower degree of positivity may only represent a contributing factor to a couple's infertility, and so the decision to treat or wait also depends on the evaluation of conventional prognostic factors including the PCT outcome. This study was supported by PRIN 2017, Ministero dell'Università e della Ricerca Scientifica (MIUR), Italy. On behalf of all authors, the corresponding author states that there is no conflict of interest. N/A.

Effect of Cervical Canal Cleaning on IUI Outcome

Background: Intrauterine insemination (IUI) is known as one of the method for infertility treatment. The effectiveness of IUI is not identical in all cases. Objective: For facilitating of IUI and decrease of entrance of bacteria into uterus to increase pregnancy rate, cervical canal cleaning by swab is compared with IUI without cervical canal cleaning. Material and Method: This study was conducted between 1st september 2008, 30th september 2009 in Mirza koochak Khan infertility center. After the initial investigations and omitting severe male and female infertility, 310 cases were selected. They divided two groups. IUI with swab as treated group (n=154) and IUI without swab as control group (n=156) variables were age, pregnancy rate and number of follicles. Result: There were no statistical differences in age and type of infertility between two groups. Pregnancy rate in treated group was 14.3 % which is more than 10.3% in control group. This difference was significant between two groups. Conclusion: There has been some research in which cervical canal cleaning before IUI increased pregnancy rate. In the recent study pregnancy rate was increased by cervical canal cleaning with swab before IUI. We observed meaningful statistical differences between two groups.

The role of intrauterine insemination in male infertility

Male infertility is a common condition and intrauterine insemination (IUI) is used to treat the mild to moderate forms. Male subfertility determination is usually based on routine semen analysis but recent publications have questioned its diagnostic and prognostic accuracy as well as the effectiveness of IUI itself, as a treatment modality. We carried out a structured review of the literature to assess the current evidence regarding the diagnosis of male infertility, the effectiveness and cost effectiveness of IUI in male infertility and factors that affect the outcome of IUI. There is still uncertainty regarding the criteria for diagnosing male infertility and predicting treatment outcome based on standard semen parameters. The presence of seminal defects compromises the outcome of IUI in comparison with unexplained infertility. The total motile sperm count (TMSC) appears to have a consistent, direct relationship with treatment outcome, but there is no definite predictive threshold for success. However, it is reasonable to offer IUI as first-line treatment if TMSC is greater than 10 million when balancing the risk and cost of alternate treatments, such as in vitro fertilization (IVF). Sperm DNA studies and sperm preparation techniques warrant further studies in order to establish their clinical relevance. There are limited data on the clinical and cost-effectiveness of IUI in male infertility and large high-quality randomized controlled trials are warranted. However the difficulties in organizing such a study, at the present time, are a matter for discussion.

Total fertilization failure and idiopathic subfertility

BackgroundTo gain more insight in whether failure of intrauterine insemination (IUI) treatment in patients with idiopathic subfertility could be related to diminished fertilization, the aim of this study is to compare the fertilization of an initial IVF procedure after six cycles of IUI and the fertilization of an initial IVF procedure without preceding IUI cycles in couples with idiopathic subfertility.MethodsWe performed a complimentary analysis of a randomized controlled trial, in which the number of total fertilization failure (TFF) in the first IVF procedure after unsuccessful IUI was compared to those of IVF without preceding IUI in patients with idiopathic subfertility. These patients participated in a previous study that assessed the cost effectiveness of IUI versus IVF in idiopathic subfertility and were randomized to either IUI or IVF treatment.Results45 patients underwent IVF after 6 cycles of unsuccessful IUI and 58 patients underwent IVF immediately without preceding IUI. In 7 patients the IVF treatment was cancelled before ovum pick. In the IVF after unsuccessful IUI group TFF was seen in 2 of the 39 patients (5%) versus 7 of the 56 patients (13%) in the immediate IVF group. After correction for confounding factors the TFF rate was not significantly different between the two groups (p = 0.08, OR 7.4; 95% CI: 0.5–14.9).ConclusionOur data showed that TFF and the fertilization rate in the first IVF treatment were not significantly different between couples with idiopathic subfertility undergoing IVF after failure of IUI versus those couples undergoing IVF immediately without prior IUI treatment. Apparently, impaired fertilization does not play a significant role in the success rate of IUI in patients with idiopathic subfertility.

Sociodemographic characteristics of patients from poor-resource region and effectiveness of intra-uterine insemination with low-cost protocol

OBJECTIVE: Although the recent progress in assisted reproductive technology (ART), in developing countries, couples cannot afford infertility treatment at all due to the socio-economic factors. In those countries, the accessibility and economic cost create an obstacle to adequate reproductive health care. The aim of this study was to evaluate sociodemographic aspects of infertile couples from a Brazilian northeast region, and to assess the cost-effectiveness of intra-uterine insemination (IUI) with low-cost protocol. DESIGN: Prospective controlled clinical trial. MATERIALS AND METHODS: This study was carried out at a public infertility ambulatory, which attend the Sergipe state population in northeast of Brazil, and habitually offers only infertility diagnosis trial. The couples attended the infertility ambulatory from January to June 2007 (n=167) were offered to participate, and filled up a sociodemographic questionnaire. Couples with IUI indication (n=54) were submitted to low-cost protocol. Ovarian stimulation used clomiphene citrate, 50 mg for five days. Urinary-hCG 10,000 IU was given to trigger ovulation, and IUI was performed 35 hour after that. Luteal support used natural progesterone. This study was approved by the National Ethics Committee. RESULTS: The women age was 32.8±4.8 years. The couples were trying to get pregnancy for 6.2±3.7 years, and 61.1% patients had high school education. Also, it were observed an inverse correlation between the education level and period of infertility (p=0.001). Patients were classified as primary infertility (86.8%) or secondary infertility (13.2%), and 72 patients (43.1%) had indication to low-complexity ART. Among them, 58 patients agreed to underwent IUI; 4 patients (6.9%) got pregnant naturally and 54 patients received the treatment with low-cost protocol. Patients were submitted until to 3 IUI cycles, and the pregnancy rate was 9.2%. On patients who got pregnant, it occurred on first IUI. CONCLUSIONS: Our finding shows that patients with less education take more time to seek for a medical assistance, which may decrease the treatment outcomes. Demographic surveys had been demonstrated a high prevalence of secondary infertility in developing countries, however we found primary infertility more often. One of the most challenging tasks in developing countries is to reduce the costs, but not the quality, of ART. Although the number of patients treated had been small in this study, the IUI with low-cost protocol can be an option to low-income patients.

AC-006 Comparative assessment of effectiveness of intrauterine insemination with and without ovarian stimulation in subfertile couples

AC-006 Comparative assessment of effectiveness of intrauterine insemination with and without ovarian stimulation in subfertile couples

Effectiveness of intrauterine insemination in subfertile couples with an isolated cervical factor: a randomized clinical trial

After randomization of subfertile couples with an isolated cervical factor to intrauterine insemination for 6 months or expectant management for 6 months, 26 women (51%) vs. 16 women (33%) conceived, respectively. Of these pregnancies, 22 (43%) vs. 13 (27%) were ongoing (relative risk, 1.6; 95% confidence interval, 0.91 to 2.8). There was one multiple pregnancy in the group that was allocated to intrauterine insemination. This trial suggests a beneficial effect of IUI in couples with an isolated cervical factor.

Effect of intrauterine insemination with spermatozoa or foreign protein on the mechanism of action of oestradiol in the rat oviduct.

Previously, we showed that oestradiol accelerates oviductal egg transport through a non-genomic action involving oviductal protein phosphorylation in non-mated rats, and through a genomic action in mated rats. Thus, sensory stimulation, seminal fluid or sperm cells may be the source of signals that switch the mechanism of action of oestradiol in the oviduct to a genomic pathway. The present study examined the ability of spermatozoa to switch the mode of action of oestradiol in the absence of the sensory stimulation and seminal fluid provided by mating. Pro-oestrous rats were inseminated in each uterine horn with epididymal spermatozoa and 12 h later were injected subcutaneously with oestradiol and intrabursally with the mRNA synthesis inhibitor alpha-amanitin. The number of eggs in the oviduct, assessed 24 h later, showed that alpha-amanitin blocked the oestradiol-induced egg transport acceleration, indicating that the interaction of spermatozoa with the genital tract shifts the action of oestradiol from non-genomic to genomic. Other rats were inseminated with live or dead spermatozoa and then treated with the protein kinase inhibitor H-89, and oestradiol. Treatment with H-89 did not block the oestradiol-induced acceleration of egg transport in these rats, although dead spermatozoa did not enter the oviduct, indicating that the mere presence of spermatozoa in the uterus abrogated the non-genomic action of oestradiol in the oviduct. Treatment with H-89 also failed to prevent the acceleration of oviductal egg transport induced by oestradiol in rats inseminated with hamster spermatozoa or with BSA, whereas in rats inseminated with their own serum (autologous proteins), H-89 was able to prevent the effect of oestradiol. This finding reveals that the effect of insemination on the mode of action of oestradiol is neither species-nor sperm-specific and it is produced by foreign organic material. It can be concluded that the presence of spermatozoa or foreign protein in the uterus is one of the components of mating that is capable of switching the action of oestradiol in the oviduct from a non-genomic to a genomic mode.

Effect of intrauterine insemination with spermatozoa or foreign protein on the mechanism of action of oestradiol in the rat oviduct

Previously, we showed that oestradiol accelerates oviductal egg transport through a non-genomic action involving oviductal protein phosphorylation in non-mated rats, and through a genomic action in mated rats. Thus, sensory stimulation, seminal fluid or sperm cells may be the source of signals that switch the mechanism of action of oestradiol in the oviduct to a genomic pathway. The present study examined the ability of spermatozoa to switch the mode of action of oestradiol in the absence of the sensory stimulation and seminal fluid provided by mating. Pro-oestrous rats were inseminated in each uterine horn with epididymal spermatozoa and 12 h later were injected subcutaneously with oestradiol and intrabursally with the mRNA synthesis inhibitor alpha-amanitin. The number of eggs in the oviduct, assessed 24 h later, showed that alpha-amanitin blocked the oestradiol-induced egg transport acceleration, indicating that the interaction of spermatozoa with the genital tract shifts the action of oestradiol from non-genomic to genomic. Other rats were inseminated with live or dead spermatozoa and then treated with the protein kinase inhibitor H-89, and oestradiol. Treatment with H-89 did not block the oestradiol-induced acceleration of egg transport in these rats, although dead spermatozoa did not enter the oviduct, indicating that the mere presence of spermatozoa in the uterus abrogated the non-genomic action of oestradiol in the oviduct. Treatment with H-89 also failed to prevent the acceleration of oviductal egg transport induced by oestradiol in rats inseminated with hamster spermatozoa or with BSA, whereas in rats inseminated with their own serum (autologous proteins), H-89 was able to prevent the effect of oestradiol. This finding reveals that the effect of insemination on the mode of action of oestradiol is neither species-nor sperm-specific and it is produced by foreign organic material. It can be concluded that the presence of spermatozoa or foreign protein in the uterus is one of the components of mating that is capable of switching the action of oestradiol in the oviduct from a non-genomic to a genomic mode.

The effectiveness of intrauterine insemination in couples with sterility due to male infertility with and without a woman's hormone factor

Objective: To examine the efficacy of IUI on fecundity and baby-take-home rates in cases of infertility attributable to a male factor with and without a woman's hormone factor. Design: Retrospective analysis. Setting: Department of Gynecology and Obstetrics at the General Public Hospital, Horn, Austria. Patient(s): Seventy-eight long-standing involuntarily childless couples. Intervention(s): After a follicular phase GnRH analog (buserelin) protocol with hMG stimulation of the woman and a Percoll gradient preparation and capacitation of the man's semen, an IUI was performed. Main Outcome Measure(s): Fecundity and baby-take-home rates. Result(s): One hundred nine inseminations were followed by 53 pregnancies (48.6%; 95% confidence intervals (CI) 38.9%-58.4%) and 38 deliveries (34.9%; 95% CI 26.0%-44.6%). Forty-nine children were born and 47 are alive (43.1%). Conclusion(s): Intrauterine insemination combined with buserelin gonadotropin stimulation, Percoll semen preparation, and sperm capacitation is a feasible solution to the problem of sterility attributable to a male factor with and without a woman's hormone factor.

Effect of antisperm antibodies on postcoital results and effect of intrauterine insemination on pregnancy outcome.

The effect of antisperm antibodies (ASA) in males was determined in 59 men using the direct immunobead test (IBT). Postcoital tests were evaluated in couples for whom all female factors appeared to be corrected. Pregnancy rates in 6 months were compared in couples with good postcoital tests vs. those with poor results; the latter group was treated with timed intrauterine insemination (IUI). Thirty-one percent of males with positive ASA (greater than or equal to 50%) had normal postcoital tests and all four achieved pregnancies. Fifty-six percent of men with positive ASA and poor postcoital scores achieved pregnancies following IUI therapy of their wives in 6 months; 83% of couples with normal postcoital tests achieved pregnancies as did couples treated with IUI when the postcoital was poor but the male ASA negative.

A prospective study of intrauterine insemination of processed sperm from men with oligoasthenospermia in superovulated women

The effectiveness of intrauterine insemination (IUI) was compared with that of intracervical insemination (ICI) in 49 infertile couples, in whom the major cause for infertility was oligoasthenospermia. All women had ovulation stimulated with either a clomiphene citrate (CC)-human gonadotropin combination or human gonadotropins alone. The ovulatory dose of human chorionic gonadotropin (hCG) was given after adequate estradiol levels were reached. The timing of inseminations was standardized--IUI was 28 hours after hCG and ICI was immediately after hCG administration. Only one insemination per month was performed with either IUI or ICI. The first treatment cycle was assigned randomly to be either IUI or ICI, and subsequent inseminations were alternated. A total of 182 cycles were completed, with 96 IUIs and 86 ICIs. Pregnancy occurred in eight patients, seven with IUI (14.3%) and one with ICI (2.0%); the difference is significant at P less than 0.05. The pregnancy rate per treatment cycle was 7.3% versus 1.2% (P less than 0.001). This study supports the use of IUI with processed sperm in the treatment of infertility due to oligoasthenospermia.