Outcome Of Intrauterine Insemination Research Articles

Impact of tubal patency test selection on the live birth rate following intrauterine insemination in couples with unexplained infertility: a retrospective cohort study.

We planned a study to evaluate the impact of selecting hysterosalpingography (HSG) over diagnostic laparoscopy during initial fertility evaluation on IUI treatment outcomes in couples diagnosed with unexplained infertility. The study comprised a retrospective cohort and included couples evaluated for infertility at our tertiary level hospital between January 2008 and December 2019. Couples diagnosed with unexplained infertility based on tubal patency tests (either HSG or diagnostic laparoscopy) were included. We compared outcomes following ovarian stimulation (OS) and intrauterine insemination (IUI) between women who underwent HSG versus laparoscopy for up to three treatment cycles. A total of 7413 women were screened, out of which 1002 women were diagnosed with unexplained infertility. We did not find a significant statistical difference in the clinical pregnancy (16.7% vs. 11.7%; OR (odds ratio) 1.51; 95% CI (confidence interval) 0.90-2.5) or live birth rate per IUI cycle (15.1% vs. 10.7%; OR 1.51, 95% CI 0.9-2.6) in women who underwent HSG for tubal evaluation as compared to laparoscopy. After adjustment for potential confounders through multivariate analysis, we found that outcomes were comparable between the HSG and laparoscopy. The current study did not find any significant difference in treatment outcomes following OS and IUI in women with unexplained infertility who underwent HSG compared to laparoscopy for the assessment of the tubal patency during the initial fertility workup. The finding suggests minimal or no impact of selecting HSG over diagnostic laparoscopy as a tubal patency test on the subsequent IUI outcomes.

Intrauterine Insemination After Human Chorionic Gonadotropin Trigger or Luteinizing Hormone Surge: A Meta-analysis.

To assess the odds of pregnancy after intrauterine insemination (IUI) timed by ultrasound monitoring and human chorionic gonadotropin (hCG) administration compared with monitoring luteinizing hormone (LH) levels. We searched PubMed (MEDLINE), EMBASE (Elsevier), Scopus (Elsevier), Web of Science (Clarivate Analytics), ClinicalTrials.gov (National Institutes of Health), and the Cochrane Library (Wiley) from the inception until October 1, 2022. No language limitations were applied. After deduplication, 3,607 unique citations were subjected to blinded independent review by three investigators. Thirteen studies (five retrospective cohort, four cross-sectional, two randomized controlled trials, and two randomized crossover studies) that enrolled women undergoing natural cycle, oral medication (clomid or letrozole), or both for IUI were included in the final random-effects model meta-analysis. Methodologic quality of included studies was assessed with the Downs and Black checklist. Data extraction was compiled by two authors, including publication information, hCG and LH monitoring guidelines, and pregnancy outcomes. No significant difference in odds of pregnancy between hCG administration and endogenous LH monitoring was observed (odds ratio [OR] 0.92, 95% CI 0.69-1.22, P=.53). Subgroup analysis of the five studies that included natural cycle IUI outcomes also showed no significant difference in odds of pregnancy between the two methods (OR 0.88, 95% CI 0.46-1.69, P=.61). Finally, a subgroup analysis of 10 studies that included women who underwent ovarian stimulation with oral medications (clomid or letrozole) did not demonstrate a difference in odds of pregnancy between ultrasonography with hCG trigger and LH-timed IUI (OR 0.88, 95% CI 0.66-1.16, P=.32). Statistically significant heterogeneity was noted between studies. This meta-analysis showed no difference between pregnancy outcomes between at-home LH monitoring and timed IUI. PROSPERO, CRD42021230520.

The impact of cryopreserved sperm on intrauterine insemination outcomes: is frozen as good as fresh?

Frozen sperm utilization might negatively impact cycle outcomes in animals, implicating cryopreservation-induced sperm damage. However, in vitro fertilization and intrauterine insemination (IUI) in human studies are inconclusive. This study is a retrospective review of 5,335 IUI [± ovarian stimulation (OS)] cycles from a large academic fertility center. Cycles were stratified based on the utilization of frozen (FROZEN, n = 1,871) instead of fresh ejaculated sperm (FRESH, n = 3,464). Main outcomes included human chorionic gonadotropin (HCG) positivity, clinical pregnancy (CP), and spontaneous abortion (SAB) rates. Secondary outcome was live birth (LB) rate. Odds ratios (OR) for all outcomes were calculated utilizing logistic regression and adjusted (adjOR) for maternal age, day-3 FSH, and OS regimen. Stratified analysis was performed based on OS subtype [gonadotropins; oral medications (OM): clomiphene citrate and letrozole; and unstimulated/natural]. Time to pregnancy and cumulative pregnancy rates were also calculated. Further subanalyses were performed limited to either the first cycle only or to the partner's sperm only, after excluding female factor infertility, and after stratification by female age (<30, 30-35, and >35 years old). Overall, HCG positivity and CP were lower in the FROZEN compared to the FRESH group (12.2% vs. 15.6%, p < 0.001; 9.4% vs. 13.0%, p < 0.001, respectively), which persisted only among OM cycles after stratification (9.9% vs. 14.2% HCG positivity, p = 0.030; 8.1% vs. 11.8% CP, p = 0.041). Among all cycles, adjOR (95% CI) for HCG positivity and CP were 0.75 (0.56-1.02) and 0.77 (0.57-1.03), respectively, ref: FRESH. In OM cycles, adjOR (95% CI) for HCG positivity [0.55 (0.30-0.99)] and CP [0.49 (0.25-0.95), ref.: FRESH] favored the FRESH group but showed no differences among gonadotropin and natural cycles. SAB odds did not differ between groups among OM and natural cycles but were lower in the FROZEN group among gonadotropin cycles [adjOR (95% CI): 0.13 (0.02-0.98), ref.: FRESH]. There were no differences in CP and SAB in the performed subanalyses (limited to first cycles or partner's sperm only, after excluding female factors, or after stratification according to female age). Nevertheless, time to conception was slightly longer in the FROZEN compared to the FRESH group (3.84 vs. 2.58 cycles, p < 0.001). No significant differences were present in LB and cumulative pregnancy results, other than in the subgroup of natural cycles, where higher LB odds [adjOR (95% CI): 1.08 (1.05-1.12)] and higher cumulative pregnancy rate (34% vs. 15%, p = 0.002) were noted in the FROZEN compared to the FRESH group. Overall, clinical outcomes did not differ significantly between frozen and fresh sperm IUI cycles, although specific subgroups might benefit from fresh sperm utilization.

Pregnancy outcomes of intrauterine insemination without ovarian stimulation in couples affected by unilateral tubal occlusion and male infertility

BackgroundInformation available to date regarding the pregnancy outcomes of intrauterine insemination (IUI) without ovarian stimulation (OS) in infertile patients with unilateral tubal occlusion remains scarce. The objectives of this study were to investigate for couples affected by unilateral tubal occlusion (diagnosed via hysterosalpingography (HSG)/transvaginal real-time three-dimensional hysterosalpingo-contrast sonography (TVS RT-3D-HyCoSy)) and male infertility: (1) whether significant differences exist in pregnancy outcomes between IUI with or without OS cycles, and (2) whether the pregnancy outcomes of IUI without OS in women with unilateral tubal occlusion were similar to those of women with bilateral patent tubes.Methods258 couples affected by male infertility completed 399 IUI cycles. The cycles were divided into three groups: group A, IUI without OS in women with unilateral tubal occlusion; group B, IUI with OS in women with unilateral tubal occlusion; and group C, IUI without OS in women with bilateral patent tubes. The main outcome measures, including clinical pregnancy rate (CPR), live birth rate (LBR), and first trimester miscarriage rate, were compared between either groups A and B or groups A and C.ResultsAlthough the number of dominant follicles > 16 mm were significantly higher in group B than that in group A (group B vs. group A: 1.6 ± 0.6 vs. 1.0 ± 0.2, P < 0.001), the CPR, LBR, and first trimester miscarriage rate were comparable between these two groups. When comparing group C to group A, the duration of infertility was significantly longer in group C than that in group A (group A vs. group C: 2.3 ± 1.2 (year) vs. 2.9 ± 2.1 (year), P = 0.017). Except for the first trimester miscarriage rate, which was significantly higher in group A (42.9%, 3/7) than that in group C (7.1%, 2/28) (P = 0.044), no significant differences were observed in the CPR and LBR in these two groups. After adjusting for female age, body mass index, and the duration of infertility, similar results were obtained between groups A and C.ConclusionsIn couples affected by unilateral tubal occlusion (diagnosed via HSG/TVS RT-3D-HyCoSy) and male infertility, IUI without OS might be an alternative treatment strategy. However, when compared to patients with bilateral patent tubes, the patients with unilateral tubal occlusion showed a higher first trimester miscarriage rate following IUI without OS cycles. Further studies are warranted to clarify this relationship.

Reproductive inequity and inferior intrauterine insemination outcomes in patients with limited English proficiency: a retrospective cohort study

To evaluate if language preference influences intrauterine insemination outcomes. Retrospective cohort. The study was conducted at an urban medical center in New York from January 2016 to August 2021. All women older than 18 years undergoing their first IUI cycle with an infertility diagnosis were included. Intrauterine insemination after ovarian stimulation. Primary outcomes were intrauterine insemination success rate and duration of infertility before seeking infertility care. The primary outcomes used the Kaplan-Meier estimator to investigate the difference in duration of infertility before specialty consultation and logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) of clinical pregnancy among English speakers vs. those with limited English proficiency (LEP) undergoing initial IUI. Secondary outcomes included final IUI outcomes compared by language preference. Adjusted analyses controlled for race/ethnicity. A total of 406 patients were included in this study, of which 86% preferred English, 7.6% preferred Spanish, and 5.2% preferred other. Patients with LEP have longer duration of infertility before seeking infertility care than English-proficient women (mean 4.53 ± 3.65 years vs. 2.01 ± 1.58 years). Although clinical pregnancy rate of initial IUI did not significantly vary (OR, 2.92; 95% CI, 0.68-12.47 unadjusted and OR, 2.88; 95% CI, 0.67-12.35 adjusted), the cumulative pregnancy rate was significantly higher in English-proficient patients than in LEP patients at the time of final IUI (22.32% vs. 15.38%). This is despite a similar number of total IUIs (2.40 English vs. 2.70 LEP). Additionally, LEP patients were significantly more likely to discontinue care after unsuccessful IUI, instead of proceeding to further fertility treatments such as invitro fertilization. Limited English proficiency is associated with longer duration of infertility before initiating care as well as poorer IUI outcomes, including lower cumulative pregnancy rate. Further research is needed to assess what clinical and socioeconomic factors are contributing to lower IUI success rates and lower continuation in infertility care in LEP patients.

A short versus a long time interval between semen collection and intrauterine insemination: a randomized controlled clinical trial.

Does a short interval (i.e. ≤90 min), compared to a long interval (i.e. ≥180 min), between semen collection and intrauterine insemination (IUI) increase the cumulative chance of an ongoing pregnancy after six IUI cycles? A long interval between semen collection and IUI resulted in a borderline significant improvement in cumulative ongoing pregnancies and a statistically significant shorter time to pregnancy. Retrospective studies assessing the effect of the time interval between semen collection and IUI on pregnancy outcomes have shown inconclusive results. Some studies have indicated a beneficial effect of a short interval between semen collection and IUI on IUI outcomes, while others have not found any differences. To date, no prospective trials have been published on this subject. The study was performed as a non-blinded, single-center RCT with 297 couples undergoing IUI treatment in a natural or stimulated cycle. The study was conducted between February 2012 and December 2018. Couples with unexplained or mild male subfertility and an indication for IUI were randomly assigned for up to six IUI cycles into either the control group (long interval, i.e. 180 min or more between semen collection and insemination) or the study group (short interval, i.e. insemination as soon as possible after semen processing and within 90 min of semen collection). The study was carried out in an academic hospital-based IVF center in the Netherlands. The primary endpoint of the study was ongoing pregnancy rate per couple, defined as a viable intrauterine pregnancy at 10 weeks after insemination. In the short interval group, 142 couples were analyzed versus 138 couples in the long interval group. In the intention-to-treat (ITT) analysis, the cumulative ongoing pregnancy rate was significantly higher in the long interval group (71/138; 51.4%) compared to that in the short interval group (56/142; 39.4%; relative risks 0.77; 95% CI 0.59-0.99; P = 0.044). The time to pregnancy was significantly shorter in the long interval group (log-rank test, P = 0.012). A Cox regression analysis showed similar results (adjusted hazard ratio 1.528, 95% CI 1.074-2.174, P = 0.019). Limitations of our study are the non-blinded design, the long inclusion and follow-up period of nearly seven years and the large number of protocol violations, especially because they predominantly occurred in the short interval group. The non-significant results in the per-protocol (PP) analyses and the weaknesses of the study should be taken into account in the assessment of the borderline significance of the results in the ITT analyses. Because it is not necessary to perform the IUI immediately after semen processing, there can be more time available to choose the optimum work-flow and clinic occupancy. Clinics and laboratories should find their optimal timing of insemination, considering the time between human chorionic gonadotropin injection and insemination in relation to the sperm preparation techniques used as well as the storage time and conditions until insemination. There were no external funding and no competing interests to declare. Dutch trial registry, trial registration number NTR3144. 14 November 2011. 5 February 2012.

Fertility Predictors in Intrauterine Insemination (IUI).

(1) Background: Intrauterine insemination (IUI) is considered a first-line procedure for infertile or hypo-fertile couples among assisted reproductive techniques. In our retrospective study, we identified variables associated with a successful IUI and the probability of obtaining a pregnancy. This is useful to identify couples with a good chance of obtaining a pregnancy through an IUI procedure (2) Methods: The study was conducted at a university-level fertility clinic in Oradea, Romania. Patients eligible to participate in the study were infertile couples who underwent IUI treatment in the interval between January 2015 and October 2020. (3) Results: In our study, we found that duration of infertility, couple age, endometrium thickness, sperm concentration, and motility are important factors in determining the outcome of IUI. Several demographics were measured for each couple including maternal and paternal age, the type and duration of infertility, the number of procedures, the type of ovarian stimulation, number of follicles, endometrial thickness, the type and day of ovulation induction, associated pathology, tubal patency, and pre/post washes sperm count and progressive sperm motility. (4) Conclusions: Fertility prediction studies are necessary, and an individualized prognostic score should be applied for each couple for tailoring their expectations and better counseling.

Can the Prediction of Intrauterine Insemination Results by Used Aniline Blue Stain (ABS) and Sperm Chromatin Dispersion (SCD) Levels?

Introduction: This study aimed to perform routine seminal fluid analysis, sperm DNA fragmentation, and sperm function tests at the chromatin maturation level and evaluate pregnancy in the patients passing intrauterine insemination before starting Intrauterine Insemination (IUI) method. Materials and Methods: In this prospective study, 111 couples who underwent Intrauterine Insemination (IUI) in unexplained infertility patients were admitted to Al-Farah IVF and assisted reproductive center in Baghdad, Iraq between November 2020 and February 2021 were evaluated. Semen fluid analysis was performed based on (WHO 4th) guiding rules. In addition, Sperm Chromatin Dispersion (halo test) and sperm maturation were performed with Aniline Blue Stain (ABS). Results: Sperm Chromatin Dispersion (SCD) groups were compared in terms of pregnancy outcome; the positive pregnancy rate was found to be above in the normal SCD groups (p = 0.0005). In addition, Aniline Blue Stain (ABS) groups were compared in the terms of pregnancy outcome; the positive pregnancy rate was found to be higher in the normal ABS group (p = 0.017). Conclusion: Our study showed that the use of DNA fragmentation (SCD) and sperm maturation tests (ABS) together with routine semen analysis in intrauterine insemination cases will make a significant contribution to the prediction of Intrauterine Insemination (IUI) increased results. So, these results indicate a defect in the effect of DNA fragmentation on the outcome of intrauterine insemination.

Factors Influencing the Pregnancy Outcome of Intrauterine Insemination and Follow-up Treatment.

Many factors were reported associated with the pregnancy rate of intrauterine insemination (IUI), which played key role is still debated. The aim of this study was to explore related clinical pregnancy outcome factor in IUI cycles of non-male factor. The clinical data of 1232 IUI cycles in 690 couples experiencing infertility who attended the Reproductive Center of Jinling Hospital between July 2015 and November 2021 were retrospectively analysed. Female and male age, body mass index (BMI), anti-Müllerian hormone (AMH), male semen parameters before and after wash, endometrial thickness (EMT), artificial insemination timing and ovarian stimulation (OS) protocols were compared between the pregnant group and the non-pregnant group in order to explore any correlation. Continuous variables were analysed using independent-samples t-test, and Chi-square test was used for comparison of measurement data between the two groups. P <0.05 was considered statistical significance. There were statistically significant differences in female AMH, EMT and duration of OS between the two groups. The AMH was higher in the pregnant group than in the non-pregnant group (P < 0.01), the stimulated days was significantly longer (P < 0.05) and EMT was significantly greater (P < 0.01) in the pregnant group than in the non-pregnant group. Further analysis showed that when patients with IUI had the following conditions: AMH &gt; 4.5 ng/ml, EMT between 8 and 12 mm and letrozole + human menopausal gonadotropin stimulation with higher clinical pregnancy. However, there were no differences between the pregnant group and the non-pregnant group amongst the female and male age, BMI, hormones on baseline and day of human chorionic gonadotrophin, number of ovulated oocytes, sperm parameters before and after wash, treatment protocols and the timing of IUI (P > 0.05). Furthermore, there were 240 couples who not pregnant received one or more cycles of in vitro fertilisation/intracytoplasmic sperm injection/ pre-implantation genetic technology treatment, and another 182 couples forgo follow-up treatment. The results of the present study demonstrate that the clinical IUI pregnancy rate is correlated with the factors of female AMH, EMT and OS protocol; more studies and samples are necessary to evaluate whether other factors affect pregnancy rate.

Is There a Relationship between Sperm DNA Fragmentation and Intra-Uterine Insemination Outcome in Couples with Unexplained or Mild Male Infertility? Results from the ID-Trial.

Sperm DNA fragmentation has been proposed as a candidate test for the assessment of sperm function on the premise that damage to the sperm chromatin is associated with a detrimental reproductive outcome. The objective of our study was to investigate whether sperm DNA fragmentation testing has a prognostic value, and thus can play a pivotal role in selecting future patients for intra-uterine insemination (IUI) therapy. This was a prospective cohort study conducted in a University Hospital setting. SDF was measured through TUNEL assay on the fresh semen sample presented at diagnosis and at insemination in couples with idiopathic/mild male infertility undergoing natural cycle IUI treatment. The generalized estimating equation (GEE)-model and multivariable model were used to analyze the probability of live birth and clinical pregnancy, respectively. ROC analysis was carried out to determine an SDF cut-off. There was an inverse relationship between SDF in the ejaculate of the diagnostic semen sample and CP (p = 0.02; OR 0.94 95% CI (0.90, 0.989)) as well as LB (p = 0.04; OR 0.95 95% CI (0.90, 0.9985)). No significant association was found between SDF after gradient and IUI outcome in the diagnostic sample nor between SDF (ejaculate/after gradient) in the IUI samples. The ROC analysis proposed a cutoff of 17.5% as the best compromise between sensitivity and specificity in the diagnostic SDF for live birth; however, the test diagnostics are low, with an AUC of 0.576. Overall, this study strengthens the hypothesis of an inverse relationship between SDF and CP/LB. Furthermore, SDF taken together with other clinical characteristics might provide more insight into male reproductive potential and predicting IUI outcome. Couples with SDF ≥ 17.5% in the diagnostic semen sample did not reach live birth. Further research is necessary to establish the diagnostic and prognostic potential of SDF as an add-on test.

Does luteal Phase Support with Vaginal Micronized Progesterone Effect on Pregnancy Rates in Intrauterine Insemination (IUI) Cycles in Two Infertility Center During Six-Year Follow-up?

Introduction: Husband artificial intrauterine insemination (IUI) is a standard method of assisted reproduction for patients with mild male infertility, anovulation, endometriosis, and unknown infertility. In this study, we evaluated the effect of luteal phase support on the success rate of IUI cycles with vaginal micronized progesterone compared to the control. Material and Methods: This retrospective cohort study included 94 infertile women referring to two infertility centers in Sari, Iran, from 2015 to 2021. In these women, Clomiphene citrate or Letrozole was used, follicular monitoring continued, and human Gonadotropin was added based on ultra-sonographic findings. Intramuscular HCG was added when one or two follicles were to 17 mm. IUI was done 36 hours later, and micronized vaginal progesterone 400mg once daily was added on the day after insemination (n=114). IUI outcomes were evaluated with a serum Beta-HCG test and vaginal ultrasound two and five weeks later. Pregnant women were followed up until the end of the pregnancy. Data were analyzed with SPSS25 and STATA14 software. Results: Progesterone consumption had no significant relationship with pregnancy rates but a significant correlation with the number of antral follicles. Pregnancy occurrence was significantly associated with patient satisfaction, FSH, and AMH levels but not correlated with the duration and kinds of infertility. Conclusion: Vaginal micronized progesterone as luteal phase support is not effective in increasing pregnancy occurrences in IUI cycles like IVF cycles, but patients’ satisfaction may be increased among women impregnated undergoing IUI and progesterone support.

Low BMI is associated with poor IUI outcomes: a retrospective study in 13,745 cycles.

To evaluate the association between body mass index (BMI) and pregnancy outcomes in women receiving intrauterine insemination (IUI) treatment. The study included 6407 women undergoing 13,745 IUI cycles stratified by BMI. Cox regression was used to analyze the association between BMI and cumulative live births across multiple IUI cycles. A generalized estimating equation (GEE) was used to analyze the live birth rate per cycle. Compared with normal-weight women (n = 4563), underweight women (n = 990) had a lower cumulative pregnancy and live birth rate (20.71% vs 25.93% and17.17% vs 21.61%, respectively), while overweight women (n = 854) had a higher cumulative pregnancy and live birth rate (31.97%, 26.58%). Adjusted for confounders, the hazard ratio (HR) for achieving live birth following up to a maximum of four IUI cycles was 0.80 (95% CI: 0.67-0.95), comparing underweight with normal weight. In the GEE analyses, low BMI was also associated with a lower per-cycle birth rate (OR 0.79, 95% CI: 0.66-0.95), with adjustment for cycle-specific parameters, including ovarian stimulation, endometrial thickness, and follicular diameter. Low BMI is associated with poor IUI outcomes.

INTRAUTERINE INSEMINATION OUTCOMES BETWEEN REPRODUCTIVE ENDOCRINOLOGY & INFERTILITY (REI) FELLOWS AND WOMEN’S HEALTH NURSE PRACTITIONERS (NP)

To evaluate intrauterine insemination (IUI) outcomes performed by reproductive endocrinology & infertility (REI) fellows versus women’s health nurse practitioners (NP) when accounting for patient and procedure specific variables.

Short versus long time interval between semen collection and intrauterine insemination (IUI): a randomized controlled clinical trial

Background and Aim: Retrospective studies assessing the effect of the time interval between semen collection and IUI on pregnancy outcomes showed inconclusive results. Some studies indicated a beneficial effect on IUI outcomes of a short interval between semen collection and IUI, while others did not find any differences. To date, no prospective trials have been published on this subject. Therefore we investigated in a randomized controlled clinical trial (RCT) if a short interval between semen collection and IUI increases the cumulative chance of an ongoing pregnancy after six IUI cycles, compared to a long interval.

The relationship of total progressive motile sperm count with the outcome of IUI? An analysis of 5171 cycles

Background: The role of motile sperm count in intrauterine insemination (IUI) success rate is controversial. This retrospective cohort study performed among unselected infertile couples undergoing IUI was to explore the association between the total progressive motile sperm count (TPMSC) and the live birth rate (LBR) following IUI. Methods: The total cohort of 5363 cycles, 2666 infertile couples between January 2015 and December 2018 and finally 5171 cycles, 2647 couples were included for analysis in Sun Yat-sen memorial hospital of Sun Yat-sen University. The primary outcome was LBR per cycle. And the secondary outcome measure was clinical pregnancy rate (CPR) per cycle. Results: From the receiver operating characteristic (ROC) analysis of female age predicting live birth, female age cutoff was defined as 28 years. With a female age of ≤28 years, the CPRs were 11.5%, 14.9%, 16.1%, and 15.8% in quartile groups of pre-wash TPMSC, respectively. For the LBRs the values were 9.4%, 12.9%, 14.4%, and 11.3%, and there were also no significant differences in quartile groups of pre-wash TPMSC with ≤24 million (M), [24M–50M], [50M–97M], >97M. No statistically significant differences in the CPRs (p = .051) and LBRs (p = .088) were also observed in the quartiles groups of post-wash TPMSC. With a female age of >28 years, the CPR in couples with post-wash TPMSC ≤22.32 M was significantly lower than with post-wash TPMSC >81.0 M (p = .007). There was an obvious trend in which CPRs and LBRs increased with the post-wash TPMSC during the <81 M interval in women >28 years. Conclusions: The optimal female age cutoff for live birth was 28 years in IUI cycles. Pre-wash and post-wash TPMSC were not significantly associated with CPR and LBR per cycle. When female age >28 years, there was a better outcome with post-wash TPMSC >22.32 million.

The pregnancy outcomes of infertile women with polycystic ovary syndrome undergoing intrauterine insemination with different attempts of previous ovulation induction.

BackgroundPolycystic ovary syndrome (PCOS) is one of the most common reasons for infertility. The consensus of the treatment of infertile women with PCOS is ovulation induction (OI) for six to nine attempts before in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Nowadays, more attention was paid to a rising, noninvasive treatment, intrauterine insemination (IUI), as some experts claimed IUI could benefit PCOS patients with infertility. Our study means to investigate the outcomes of IUI for PCOS patients and if patients’ previous OI cycles can be a predictive factor for IUI outcomes.MethodsA total of 1,086 PCOS patients was included and 1,868 IUI cycles were performed between January 2007 and July 2021 in the department of assisted reproduction in Shanghai Ninth People’s Hospital. All included patients underwent IUI treatments with letrozole+human menopausal gonadotropin (LE+hMG) for ovarian stimulation.ResultsThe pregnancy outcomes were not associated with the attempts of failed OI cycles previously. Specifically, the clinical pregnancy rate was 21.14% for PCOS patients without previous OI cycles, 21.95% for PCOS patients with 1-2 previous OI cycles and 23.64% for PCOS patients with 3 or more previous OI cycles (p=0.507). The corresponding live birth rate was 16.64%, 18.06%, and 18.68%, respectively, of which the difference was not statistically significant (p=0.627). The cumulative rate per patient was 38.59% for clinical pregnancy and 31.03% for live birth, and approximately 98% of the pregnancies occurred in the first 3 cycles of IUI.ConclusionPCOS women with different attempts of OI cycles had similar pregnancy outcomes after IUI, thus a history of repeated failures of OI treatments was not a predictive factor for the pregnancy outcomes in IUI cycles. Most pregnancies occurred in the first three cycles of IUI, so we strongly recommended three attempts of IUI for PCOS women before they switched to IVF/ICSI. Generally, IUI might be an assist for infertile women with PCOS before IVF/ICSI and might accelerate pregnancy for target women without invasive manipulations.

O-184 The impact of cryopreserved sperm on Intrauterine Insemination (IUI) outcomes: Is frozen as good as fresh?

Abstract Study question Are the outcomes of IUI cycles [with or without ovarian stimulation (OS)] comparable when frozen instead of fresh-ejaculated sperm is utilized? Summary answer Overall, clinical outcomes did not differ significantly between frozen and fresh sperm IUI cycles, although specific subgroups might benefit from fresh sperm utilization. What is known already At present, data from animal studies point towards less favorable outcomes with frozen sperm utilization, implicating cryopreservation-induced damages to the cytoskeleton, DNA, and acrosome leading to adverse effects on spermatozoa’s motility, viability, and ability to fuse with the oocyte. Assisted Reproductive Technology (ART) data, mostly focusing on severe male factor infertility diagnoses, suggest no major differences between in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles utilizing frozen over fresh sperm, often surgically extracted. Nevertheless, contemporary data from IUI(±OS) cycles are still scarce. Study design, size, duration Data from 5335 IUI(±OS) cycles (time-period: 01/2004-12/2021) from a large academic fertility center were retrospectively reviewed. Cycles were stratified in two groups based on utilization of frozen instead of fresh-ejaculated sperm for the IUI [FROZEN (n = 1871, all infertility diagnoses), and FRESH (n = 3464, idiopathic infertility diagnosis only), respectively]. Cycle outcomes were compared between groups. Participants/materials, setting, methods Participants: women seeking IUI (±OS) treatments. Outcome Measures: HCG-positivity, clinical pregnancy (CP), spontaneous abortion (SAB) rates. Initial analysis included all cycles irrespective of OS regimen. Cycles were then stratified by OS regimen into three subgroups [injectable gonadotropins, oral medications (OM): clomiphene-citrate and letrozole, and unstimulated/natural]. Odds ratios (OR) for all relevant outcomes were calculated utilizing logistic regression and adjusted for maternal age, day-3 FSH, and OS regimen. Time-to-pregnancy and first-cycle only analyses were also performed. Main results and the role of chance Unadjusted HCG-positivity, and CP were lower in the FROZEN compared to the FRESH group (12.2% vs. 15.6%, p &amp;lt; 0.001; 9.4% vs. 13.0%, p&amp;lt;.001, respectively), which persisted only among OM after stratification (9.9% vs. 14.2% HCG-positivity, p=.030; 8.1% vs. 11.8% CPR, p=.041, for FROZEN compared to FRESH, respectively). Among all cycles, adjOR(95%CI) for HCG-positivity and CP were respectively: 0.75(0.56-1.02), and 0.77(0.57-1.03), ref: FRESH). Following stratification by OS regimen, adjOR(95%CI) for HCG-positivity and CP showed no difference between groups among gonadotropin and natural cycles but favored the FRESH group in OM cycles [HCG-positivity: 0.55(0.30-0.99); CP: 0.49(0.25-0.95), ref.: FRESH]. SAB odds did not differ between groups among OM and natural cycles but were lower in the FROZEN compared to FRESH group among gonadotropin cycles [adjOR(95%CI): 0.13(0.02-0.98), ref.: FRESH]. However, regarding the latter comparison, numbers were small and the 95%CI wide. When analysis was limited to first-cycles only and further stratified by OS regimen, the previously noted differences in CP and SAB odds no longer existed within the OS subgroups. Nevetheless, time-to-conception was slightly longer in the FROZEN compared to the FRESH group (3.84 vs. 2.58 cycles, p&amp;lt;.001). Limitations, reasons for caution Study is limited by its retrospective nature. The two groups differed somewhat in age, infertility diagnosis, utilized OS regimen, and as expected in total motile sperm counts. Despite the less favorable characteristics of the FROZEN group, no detrimental effect of sperm cryopreservation on IUI outcomes was noted. Wider implications of the findings Our study, the largest to date, showed no significant difference in IUI outcomes between cycles utilizing frozen instead of fresh-ejaculated sperm. Although, specific subgroups might benefit from fresh sperm utilization and time-to-pregnancy might be shorter with fresh over frozen sperm, patients should be counselled about the non-inferiority of frozen sperm. Trial registration number Not applicable

O-299 Analyzing the impact of simple wash versus density gradient sperm preparations on intrauterine insemination outcomes. Is the cost-effective and time-efficient option just as good?

Abstract Study question How do different sperm preparations, such as simple-wash (SW) and density-gradient (DG), impact intrauterine insemination (IUI) outcomes among women seeking fertility treatments? Summary answer Using a population from a large, academic medical center, this study discerned no differences in pregnancy outcomes between SW and DG sperm preparations. What is known already IUI with or without ovulation induction (OI) is often a first-line treatment among couples seeking fertility services. SW and DG are two common methods used to prepare sperm for IUI. In comparison to its latter counterpart, the SW technique is lesser-used, yet is more time-efficient, and cost-effective due to its utilization of only a single centrifugation step. Since the impact of sperm preparation techniques on the post-processing sperm yield and its parameters varies by the method used, the cycle outcomes might differ as well. However, limited data exists on various sperm preparations’ impact on IUI clinical outcomes. Study design, size, duration Data from 3378 IUI+OI cycles (from 1503 women of all diagnoses seeking IUI with fresh-ejaculated sperm) that took place at a large academic fertility center between 9/2014 and 3/2021 were retrospectively reviewed. Cycles were either unstimulated (natural) or stimulated with either oral OI agents (clomiphene-citrate &amp; letrozole) or gonadotropins. Cycles were divided in two groups based on sperm preparation technique: SW (n = 1691) and DG (n = 1687) and outcomes were compared between them. Participants/materials, setting, methods Sperm preparation: SW semen were mixed in 10ml MHM (FujiFilm) and centrifuged for 10min. DG semen were layered over 45:90 gradient of Isolate (FujiFilm), centrifuged for 20min, and washed twice (10min) in 10ml MHM. Outcome measures: hCG-positivity (posHCGR), clinical pregnancy (CPR), spontaneous abortion (SABR), and livebirth rates/cycle (LBR). Statistics: Logistic regression with Odds Ratios (OR) adjusted for both partners’ ages, day-3 FSH, stimulation, and sperm score (poor, fair, good, excellent). Sub-analysis limited cohort to first-cycles only. Main results and the role of chance Groups were comparable in patient [age (maternal, paternal), BMI, day-3 FSH, infertility diagnosis], and cycle characteristics [follicular response (measured as number of preovulatory follicles), and endometrial thickness]. Preprocessing sperm parameters differed slightly with higher mean sperm concentrations and lower total motility among SW cycles (75.3 + 57.0 vs. 71.0 + 51.3 million, p = 0.02; 48.6 + 19.6 vs. 52.5 + 20.2, p &amp;lt; 0.001, for SW and DG, respectively). posHCGR, CPR, SABR, and LBR per cycle did not differ between groups (15.8% vs. 15.4%, p = 0.76;13.7% vs. 13.2%, p = 0.62;18.1% vs. 18.5%, p = 0.93; 9.5 vs. 8.9%, p = 0.56; for SW and DG, respectively). Odds for posHCG, CP, SAB, or LB did not differ between groups [adjOR(95%CI): 1.05(0.87-1.26), p = 0.65; 1.10(0.67-1.83), p = 0.71; 0.98(0.60-1.60), p = 0.94; 1.08(0.85-1.37), p = 0.66, respectively]. When cycles were stratified by type of ovarian stimulation, rather than adjusted for it, no difference was seen in any of the clinical outcomes within individual strata{adjOR(95%CI): [Oral OI: 1.00(0.74-1.37), p = 0.98; 1.78(0.68-4.61), p = 0.25; 0.97(0.40-2.38), p = 0.95; 1.05(0.72-1.53), p = 0.81], [Gonadotropins: 0.99(0.78-1.28), p = 0.96; 0.93(0.49-1.77), p = 0.83; 0.97(0.52-1.80), p = 0.96; 1.03(0.75-1.41), p = 0.87], [Natural: 2.36(0.97-5.76), p = 0.06; 0.08(0.001-6.84), p = 0.26; 0.20(0.003-11.02), p = 0.43; 2.52(0.63-10.00), p = 0.19], for posHCG, CP, SAB, and LB, respectively}. Similarly, no difference was seen in any of the clinical outcomes when cycles were stratified by sperm score or when analysis was limited to first-cycles only. Limitations, reasons for caution LBR were calculated excluding pregnancies with no information after discharge to obstetrics (approximately 16%). Although not significant, there might be minor variations in individual provider’s practices between time frames in which these techniques were implemented. Wider implications of the findings SW is a much simpler, time-efficient, and cost-effective sperm processing technique for IUI compared to DG, however remains infrequently utilized. Adoption of SW, over DG, could yield comparable clinical efficacy, yet optimize teamwork flow and lower healthcare costs, due to its non-labor-intensive and inexpensive nature. Trial registration number not applicable

P-708 Improving the outcome of Intrauterine Insemination by using Dual Trigger for Final oocyte maturation : retrospective study from an Indonesian Fertility Center

Abstract Study question Does dual trigger with co-administration of GnRH agonist and Human Chorionic Gonadotropin (hCG) increase the outcome of Intrauterine Insemination (IUI) compared to hCG alone? Summary answer using the dual trigger for final oocyte maturation increases the clinical pregnancy rate compared to triggering with hCG alone in IUI cycle. What is known already Various techniques are performed to increase the success rates of Intrauterine Insemination (IUI) including sperm preparation, ovarian stimulation, ovulation trigger, and endometrial preparation. The dual trigger of final oocyte maturation with a GnRH-agonist and a standard dosage of hCG increase the outcome of in vitro fertilization (IVF) cycles significantly but this dual trigger has not been used in IUI. Study design, size, duration A single center, retrospective observational study between January 2016 and October 2018 was performed in 639 IUI cycles in Halim Fertility Center (HFC), Division of Reproductive Endocrinology and Infertility, Faculty of Medicine, Universitas Sumatera Utara, Indonesia. Participants/materials, setting, methods Six hundred and thirty-nine IUI cycles were divided into two groups: group I received recombinant hCG alone as the single trigger and group II received GnRH agonist plus recombinant hCG as dual-trigger. Data on patients age,FSH, AMH, total amount of rFSH, sperm quality, endometrial thickness, number of basal antral follicles, number of follicles &amp;gt; 17 mm, clinical pregnancy rate, multiple pregnancy rate and Ovarian hyperstimulation syndrome (OHSS) were assessed and compared between the two groups. Main results and the role of chance Our study included 639 IUI cycles with a dual trigger group (334 IUI cycles) and a single trigger (305 IUI cycles). The age of participants (32 years versus 32 years, P = 0.945), FSH (6.3 mIU/mL versus 6.5 mIU/mL, P = 0.411), AMH (2.7 ng/mL versus 2.4 ng/mL), P = 0.340), total amount of rFSH (900 IU versus 900 IU, P = 0.873), sperm concentration (17.2x106/mL versus 17.3x106/mL, P = 0.488), sperm motility (35% versus 35%, P = 0.847), sperm morphology (5%normal versus 5%normal, P = 0.916), TMSC (13.9x106/ejaculate versus 12.6x106/ejaculate, P = 0.545) were comparable between the two groups. The endometrial thickness (9 mm versus 9 mm, P = 0.337), the number of basal antral follicles (7 versus 7, P = 0.587) and the number of follicles &amp;gt;17mm (2 versus 2, P = 0.974) were also comparable between the two groups. The clinical pregnancy rate (14.1% versus 28.7%, P &amp;lt; 0.001) with RR value 2.524 (95%CI RR 1.681-3.790) was significantly higher in the dual trigger compared to the single trigger group. The multiple pregnancy rate (7% versus 7.3%), P = 0.627) and OHSS rate (2.6% versus 2.7%, P = 0.576) were no significantly difference between the two groups. Limitations, reasons for caution This study is a retrospective study so that data sampling was not well controlled. Data recruitment is based on a period because we modified the ovulation trigger from a single trigger to dual trigger after almost one year then we evaluated the outcome of IUI between the two groups. Wider implications of the findings This is the first study to evaluate the outcome of the dual trigger on ovulation trigger in intrauterine insemination (IUI) in Indonesia. The present study indicates a potential dual trigger might lead to better IUI outcomes and it can be used more widely. Trial registration number Not applicable

P-721 Prediction model of pregnancy after intrauterine insemination: accessibility, relevance for clinical use and patient counseling

Abstract Study question The aim of this study is to develop a prognostic model for the outcome of intrauterine insemination that is useful for daily clinical practice and to develop an app Summary answer Our predictive model is able to make a good distinction between patients with a good or poor pregnancy chance What is known already IUI is a common, accessible and easily accepted method of treating infertile couples with a success rate varying largely between 5% and 70%. The factors that contribute to the successful IUI rate are numerous including the woman's age, type of infertility, the number of follicles obtained by ovarian stimulation, the estradiol concentration on the day of human chorionic gonadotrophin administration, the sperm parameters (concentration, motility), duration of infertility, endometrial thickness, the number of IUI cycles. Several studies have already tried to establish a success rate formula, but no prediction model is largely used. Study design, size, duration This retrospective cohort study has been conducted at an university level fertility clinic from Oradea, Romania. Patients eligible to participate in the study were 426 infertile couples who underwent IUI treatment between January 2015 and October 2020. Participants/materials, setting, methods The 426 couples were classified into three groups: 1. male infertility factor 2. female infertility factor (minimal/mild endometriosis, ovulation disorders, tubal disease, with a single patented Fallopian tube), 3. Unexplained infertility. All couples underwent IUI with/or without ovarian stimulation and we documented several factors: age, type of infertility, infertility duration, number of procedures, ovarian stimulation, number of follicles, endometrial thickness, ovulation induction, day of induction, associated pathology, tubal patency, post wash sperm count. Main results and the role of chance Our pregnancy rate was 10.3%, according to this the couples were divided intro two groups the negative and the positive result group. We found 4 factors to be significantly associated to a positive result: age of the partners (p-value = 0.012), infertility duration (p-value = 0.018), endometrium thickness (p-value = 0.035) and semen preprocess concentration (p-value = 0.046). We calculated a probability function for a woman to get pregnant after IUI procedure: Prob = 1/(1+e-z) Z = -3.36998 + 0.364*Endometrium (mm) – 0.04567*Female Age (years) – 0.049956*Age of partner (years)– 0.17299*Duration of infertility (years) + 0.018562*prewash count (mil) – 0.9933*A (motility) + 2.29085*B(motility)+ 0.03203*post wash count For example, a patient with a score of 1.507 will have a probability of 81.86% of becoming pregnant. Our predictive model in general has a performance that is close to 0.7 AUROC -0.687 (AUROC between 0.7-0.8 has a fair performance) with a value p-0.001 (high statistical significance, CI confidence interval - 99.9%), meaning it is able to make a good distinction between couples with a good pregnancy chance and those with a poor pregnancy chance after IUI. Limitations, reasons for caution In statistical models fertility treatment chances are never 0 or 100%, and the outcome of IUI is a subject to chance and from this point of view the trick would be in repeating the cycles. Another limitation is the small cohort sample and the fact that it needs external validation. Wider implications of the findings Developing an application program that could be used easily by the clinicians in their daily clinical practice and also by the patients in order to better understand their chances at a successful procedure of assisted human reproduction that could also mean the next step after IUI, the in vitro fertilization. Trial registration number not applicable