Intrauterine Insemination Group Research Articles

Infertility and Risk of Autism Spectrum Disorder in Children

Previous studies on the risk of childhood autism spectrum disorder (ASD) following fertility treatment did not account for the infertility itself or the mediating effect of obstetrical and neonatal factors. To assess the association between infertility and its treatments on the risk of ASD and the mediating effect of selected adverse pregnancy outcomes on that association. This was a population-based cohort study in Ontario, Canada. Participants were all singleton and multifetal live births at 24 or more weeks' gestation from 2006 to 2018. Data were analyzed from October 2022 to October 2023. The exposure was mode of conception, namely, (1) unassisted conception, (2) infertility without fertility treatment (ie, subfertility), (3) ovulation induction (OI) or intrauterine insemination (IUI), or (4) in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). The study outcome was a diagnosis of ASD at age 18 months or older. Cox regression models generated hazard ratios (HR) adjusted for maternal and infant characteristics. Mediation analysis further accounted for the separate effect of (1) preeclampsia, (2) cesarean birth, (3) multifetal pregnancy, (4) preterm birth at less than 37 weeks, and (5) severe neonatal morbidity. A total of 1 370 152 children (703 407 male [51.3%]) were included: 1 185 024 (86.5%) with unassisted conception, 141 180 (10.3%) with parental subfertility, 20 429 (1.5%) following OI or IUI, and 23 519 (1.7%) following IVF or ICSI. Individuals with subfertility or fertility treatment were older and resided in higher-income areas; the mean (SD) age of each group was as follows: 30.1 (5.2) years in the unassisted conception group, 33.3 (4.7) years in the subfertility group, 33.1 (4.4) years in the OI or IUI group, and 35.8 (4.9) years in the IVF or ICSI group. The incidence rate of ASD was 1.93 per 1000 person-years among children in the unassisted conception group. Relative to the latter, the adjusted HR for ASD was 1.20 (95% CI, 1.15-1.25) in the subfertility group, 1.21 (95% CI, 1.09-1.34) following OI or IUI, and 1.16 (95% CI, 1.04-1.28) after IVF or ICSI. Obstetrical and neonatal factors appeared to mediate a sizeable proportion of the aforementioned association between mode of conception and ASD risk. For example, following IVF or ICSI, the proportion mediated by cesarean birth was 29%, multifetal pregnancy was 78%, preterm birth was 50%, and severe neonatal morbidity was 25%. In this cohort study, a slightly higher risk of ASD was observed in children born to individuals with infertility, which appears partly mediated by certain obstetrical and neonatal factors. To optimize child neurodevelopment, strategies should further explore these other factors in individuals with infertility, even among those not receiving fertility treatment.

Comparison of Pregnancy Outcomes Between Fresh Embryo Transfer in a Natural IVF Cycle and IUI Cycle Among Infertile Young Women

Background: The purpose of the current study was comparing pregnancy outcomes for natural cycle in vitro fertilization (IVF) per fresh embryo transfer (ET) and oocyte pick-up (OPU) in intrauterine insemination (IUI).
 Methods: This was a retrospective cohort study of women who underwent either IUI (n=246) or OPU with fresh ET for natural cycle IVF (n=291), conducted between April 2017 and February 2018 at the Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan. Patients in both groups did not receive ovarian stimulation and luteal support; gonadotropin-releasing agonist spray was administered 35 hr before OPU or IUI. The clinical pregnancy rate was compared between the IUI and IVF groups. Data analysis was based on the number of cycles. The p≤0.05 was considered significant.
 Results: The clinical pregnancy rate per OPU in the IVF group was higher than the one in IUI group (20.6% vs. 10.1%), and the difference was significant (p<0.01). The pregnancy rate for natural cycle IVF calculated per fresh ET was 36.8%. The miscarriage rate did not significantly differ between the IVF (4.1%) and IUI (8.0%) groups.
 Conclusion: Fresh ET in natural cycle IVF provides a higher implantation rate than IUI.

Does underlying infertility in natural conception modify the epigenetic control of imprinted genes and transposable elements in newborns?

Research questionDoes the epigenetic control of imprinted genes and transposable elements at birth differ according to time to conception in natural conception and after intrauterine insemination (IUI)? DesignA total of 144 singletons were included in four groups: 50 natural pregnancies obtained within 6 months after stopping contraception (group 1); 34 natural pregnancies with infertility period between 6 and 12 months (group 2); 36 pregnancies with an infertility period of more than 12 months (group 3) and 24 pregnancies obtained after IUI (group 4). ResultsThe placental DNA methylation levels of H19/IGF2 and KCNQ1OT1 were lower in groups 2, 3 and 4 than in group 1 (P = 0.025 in the overall comparison). The DNA methylation rate for LINE-1 was higher in placentas from group 2 than in group 1 (P = 0.022). In cord blood, DNA methylation levels were not significantly different between groups except for H19/IGF2 for which the DNA methylation levels were higher in group 2 than in group 1 (H19/IGF2-seq1 and seq2: P = 0.023 and P = 0.002, respectively).In placenta tissue, compared with group 1, relative expression for SNRPN and for LINE-1 was significantly higher in group 2 (P = 0.002 and P < 0.001, respectively). The relative expression of KCNQ1 in placenta was lower in group 4 than in group 1 (P = 0.013). In cord blood, compared with group 1, the relative expression for H19 was significantly higher in group 3 (P = 0.026), and the relative expression of LINE-1 was higher in groups 2 and 3 and in group 4 (P < 0.001). ConclusionsInfertility itself, and not only ART techniques, could contribute to potential epigenetic risks for children.

Comparison of Pregnancy Outcomes Between Fresh Embryo Transfer in a Natural IVF Cycle and IUI Cycle Among Infertile Young Women

Background:The purpose of the current study was comparing pregnancy outcomes for natural cycle in vitro fertilization (IVF) per fresh embryo transfer (ET) and oocyte pick-up (OPU) in intrauterine insemination (IUI).Methods:This was a retrospective cohort study of women who underwent either IUI (n=246) or OPU with fresh ET for natural cycle IVF (n=291), conducted between April 2017 and February 2018 at the Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan. Patients in both groups did not receive ovarian stimulation and luteal support; gonadotropin-releasing agonist spray was administered 35 hr before OPU or IUI. The clinical pregnancy rate was compared between the IUI and IVF groups. Data analysis was based on the number of cycles. The p≦0.05 was considered significant.Results:The clinical pregnancy rate per OPU in the IVF group was higher than the one in IUI group (20.6% vs. 10.1%), and the difference was significant (p<0.01). The pregnancy rate for natural cycle IVF calculated per fresh ET was 36.8%. The miscarriage rate did not significantly differ between the IVF (4.1%) and IUI (8.0%) groups.Conclusion:Fresh ET in natural cycle IVF provides a higher implantation rate than IUI.

Comparative analysis of the pregnancy rate via in vitro fertilization vs. previous artificial insemination in patients with unexplained infertility

ObjectiveTo compare the clinical pregnancy rate among patients undergoing direct in vitro fertilization vs. in vitro fertilization after two cycles of intrauterine insemination in couples with unexplained infertility.MethodsComparative cross-sectional, retrospective study from 2016 to 2019, from the Centro Mexicano de Fertilidad Doctor Alberto Kably. The patients with unexplained infertility were divided into two groups, direct in vitro fertilization and a group of in vitro fertilization after intrauterine insemination, and we compared the rate of pregnancy and live births in both cases.Results89 couples with unexplained infertility were included, the in vitro fertilization after intrauterine insemination group (n=46) and direct in vitro fertilization group (n=43). The direct in vitro fertilization group resulted in a higher clinical pregnancy rate throughout the study compared to the other group (55.8% vs. 34.8%, OR 2.37; 95% CI 1.008 - 5.57, p=0.046). However, there was no difference in the rate of live newborns (p=0.12). When analyzing the data by cycle, we noticed a statistical difference in both, the clinical pregnancy rate in the direct in vitro fertilization group (38.7% vs. 16.7%, OR 3.2; 95% CI 1.50-6.62), as well as the rate of live newborns (32.3 % vs. 14.6%, OR 2.79; 95% CI 1.28-6.07, p=0.008).ConclusionsIn the in vitro fertilization group, as first-line treatment for unexplained infertility, the patients had a higher pregnancy rate.

The Livebirth Rate Per In Vitro Fertilization Cycle Is Higher Than The Cumulative Live Birth Rates of Intrauterine Insemination for Patients of Poseidon Group 3 With Unexplained Infertility.

BackgroundNo studies have been done to examine the efficacy of IVF and intrauterine insemination (IUI) for the treatment of young patients with unexplained infertility and low ovarian reserve, although it is becoming an increasingly significant indication for in-vitro fertilization (IVF). The goal of this research was to compare the efficacy of IVF with IUI on Poseidon group 3 patients with unexplained infertility (PG3&UI).MethodsThis was a retrospective analysis of PG3&UI patients who had IVF/intracytoplasmic sperm injection (ICSI) or IUI at the Third Affiliated Hospital of Guangzhou Medical University between January 1, 2015, and March 31, 2021. To equalize the baseline characteristics of the IVF/ICSI and IUI groups, propensity score matching (PSM) was utilized. Intention-to-treat (ITT) and per-protocol (PP) analyses were used to compare the differences in live births. To discover variations in time to biochemical pregnancy leading to live birth, Kaplan-Meier curves were produced. To evaluate the expenses per live birth between two procedures, a cost-effective analysis was done.ResultsAccording to ITT analysis, the live birth rate for the IVF/ICSI group was substantially higher than the cumulative live birth rate (CLBR) for the IUI group (22.6% (38/168) vs. 11.3% (19/168), RR 2.00, 95% CI 1.20-3.32, P = 0.006). In the PP analysis, the live birth rate was 23.0% (38/165) in the IVF/ICSI group and 11.7% (19/162) in the IUI group (RR = 1.96, 95% CI 1.18-3.26, P = 0.007). When censored at 365 days, the Kaplan-Meier analysis revealed that the IVF/ICSI group had a higher live birth rate than the IUI group (log-rank test χ²= 6.025; P = 0.014). However, when the two groups were censored at 180 days, the live birth rates were not substantially different (log-rank test χ²= 3.847; P = 0.05). The number of hospital visits per live birth in the IUI group was higher than in the IVF/ICSI group (85 vs. 48). The overall cost of a live birth was comparable across the two groups (¥132242 vs. ¥131611), while the medical expenses for a live delivery from IVF/ICSI were higher than those from IUI (¥118955 vs. ¥108279).ConclusionsThe livebirth rate per IVF/ICSI cycle with at most one embryo transfer is higher than the CLBR of IUI, with fewer hospital visits and similar expenses.

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.

The Fertility Outcome of Royal Jelly versus Intra Uterine Insemination: A Pilot Randomized Controlled Trial Study

Background: The popularity of complementary and alternative medicine is on the rise. Objectives: The current study aimed to compare the effect of vaginal royal jelly with intrauterine insemination (IUI) on sub-fertility in men. Methods: The sample size was estimated as 27 subjects, based on a study power and confidence interval of 80% and 95%, respectively. The study was conducted in Mashhad, in the Northeast of Iran, from 2015 to 2017. Men with sub-fertility (asthenozoospermia, defined as total sperm motility below 40% and sperm concentration below 20 million/mL), with healthy wives, based on salpingography, participated in this study. Patients were assigned to the royal jelly group, which received 5 grams of royal jelly, and the IUI group, which received 75 units of Follicle Stimulating Hormone (FSH) from the second day of the menstrual cycle. Semen samples were collected in sterile plastic caps after 72 hours of sexual abstinence by normal sexual intercourse. Samples were prepared using the standard swim-up technique. Results: This study showed no significant difference between groups concerning spousal age, occupation, education (husband and wife), and social class (P = 0.745). Also, no significant difference was found between groups concerning fertility success rate (P = 0.573). Conclusions: Based on similar treatment success rates of royal jelly and IUI, it seems that royal jelly can be considered as an alternative to IUI.

Intrauterine insemination (IUI) with or without letrozole for unexplained or mild male factor infertility: A randomized pilot study

ObjectiveTo study the feasibility of a randomized controlled trial (RCT) comparing intrauterine insemination (IUI) with and without letrozole in couples with unexplained or mild male factor infertility Study designWe performed a randomized pilot study including 100 couples with unexplained or mild male factor infertility in the Reproductive Medicine Centre of Peking University Third Hospital in China. The couples scheduled for IUI were randomized to IUI with or without ovarian stimulation (letrozole) for up to 3 cycles within a time horizon of 4 months. Women in the letrozole group received 5 mg oral letrozole daily starting from cycle day 3–5 for 5 days. Women in the natural cycle IUI group did not receive any ovarian stimulation before IUI. The primary outcome is ongoing pregnancy leading to live birth. The study was registered under trial number NCT03455426 ResultsBetween March 2018 and January 2019, 158 couples were eligible to participate after initial screening and 100 (63.3 %) couples agreed to participate. Of the 100 recruited couples, 50 were randomly allocated to IUI with letrozole and 50 to natural cycle IUI. Live birth occurred in 12 women (24.0 %) in the letrozole group and 10 women (20.0 %) in the natural cycle group (RR 1.20 (95 % CI 0.57–2.52)). Clinical pregnancy rates were 28 % and 26 % in the letrozole group and natural cycle group respectively (RR 1.08 (95 % CI 0.56–2.05). There were no multiple pregnancies in both groups. Patients were willing to be randomized and useful information was gained to plan a definitive trial. ConclusionsWe showed that an RCT comparing IUI with letrozole versus natural cycle IUI in couples with unexplained or mild male factor infertility is feasible and acceptable.

Sexual function and quality of life in Chinese couples undergoing assisted reproductive treatment: a prospective cohort study

Couples undergoing assisted reproductive technologies (ART) are prone to sexual dysfunction and lower quality of life (QoL), but whether the incidence of these problems differs with the type of ART is unknown. As such, we conducted this cross-sectional survey to compare the sexual function and QoL of 75 couples undergoing intrauterine insemination (IUI), and 160 couples undergoing in vitro fertilization (IVF). They completed an anonymous questionnaire which included: (i) demographic characteristics; (ii) female sexual function index (FSFI) or (iii) international index of erectile function-5 (IIEF-5); and (iv) fertility QoL questionnaire (FertiQoL). Overall, 22.6% of wives and 39.1% of husbands were at risk for sexual dysfunction, and the risk was similar in IUI and IVF groups. Mean core/treatment/total FertiQoL scores of husbands were higher than wives: 74.98 vs. 68.24/70.02 vs. 65.87/73.52 vs. 67.54 (all p < 0.001). FertiQoL scores were similar in IUI and IVF groups except wives’ treatment FertiQoL score was significantly higher in the IUI group (68.93 vs. 64.44; p = 0.009). This study confirms that risks for sexual dysfunction were similar in IUI and IVF couples. Wives undergoing IVF had significantly lower treatment FertiQoL score. In both IUI and IVF groups, husbands’ QoL was better than wives’ QoL.

Effects of Vaginal Misoprostol after Intrauterine Insemination IUI

Intrauterine insemination has an important role in the treatment of infertile couples. Usage of vaginal misoprostol therapy at the time of intrauterine insemination has been investigated, and its tolerability and effects on clinical pregnancy rates still questionable. To assess the effectiveness of vaginal misoprostol on some demographic characteristics and hormones level with a success rate of Intrauterine Insemination. the period of collection of patients extended from Sep. 2018 until May 2019. Eighty- one infertile couples who attended Al Nahrain University, High Institute for Diagnostic Infertility and Assisted Reproductive Technologies, and private fertility clinics were enrolled through this study. Divided into two groups, the next group received 100 μg vaginal misoprostol immediately after completion of the IUI procedure, while the control group was subjected to ordinary IUI procedure without adjunctive therapy. The mean of demographic data of body mass index, age, and duration of infertility was statistically insignificant in control, Misoprostol post- intrauterine insemination. The percentage of pregnancy rate in the control group 5.0% and it 19.5% in the Misoprostol post-intrauterine insemination group. Moreover, there are significant differences in pregnancy rates among all study groups. According to this study, there is no significant result of pregnancy occurrences correlated with, female age, male age, and body mass index, duration of infertility or type of infertility, hormone levels. Misoprostol use after intrauterine insemination has a positive impact on pregnancy outcome in the control group 5.0% and it 19.5% in Misoprostol post- intrauterine insemination group. Smaller doses (100 μg) of misoprostol can decrease side effects without affecting the outcome.

Effects of letrozole combined with human menopausal gonadotrophin in ovarian stimulation for intrauterine insemination cycles.

The effects of letrozole plus human menopausal gonadotropin (HMG) on ovarian stimulation (OS) of intrauterine insemination (IUI) cycles were examined. In all, 1,005 IUI cycles were included in this study. Couples underwent natural cycle (NC) IUI (n=150) or IUI after OS with letrozole (n=207) or IUI after OS with letrozole + HMG (n=648). The clinical pregnancy rates were 9.0%, 13.0%, and 17.0%, and the live birth rates were 7.0%, 9.0%, and 14.0% in the NC, letrozole, and letrozole + HMG IUI groups, respectively. The twin pregnancy rate of the letrozole + HMG group (11.0%) was higher than that of the NC (7.0%) and letrozole groups (4.0%). To date, the only triplet pregnancies to occur were in the letrozole + HMG group. On the day of human chorionic gonadotropin (hCG), the number of follicles with an average follicle diameter greater than 18 mm in the letrozole + HMG group (1.21±0.56) and letrozole group (1.14±0.48) was greater than that in the NC group (0.85±0.36). The thickness of the endometrium in the letrozole + HMG group (8.8±2.1 mm) was significantly greater than that in the letrozole group (7.3±1.6 mm). The letrozole + HMG protocol of OS in IUI can improve follicular development, increase the thickness of endometrium, significantly increase the live birth rate, but not significantly increase the multiple pregnancy rate.

Intrauterine insemination versus timed intercourse in ovulation induction cycles with clomiphene citrate for polycystic ovary syndrome: A retrospective cohort study

AimThe aim of this study is to evaluate the effect of intrauterine insemination (IUI) on clinical pregnancy rates in women with polycystic ovary syndrome (PCOS) undergoing ovulation induction (OI) cycles. MethodsWe evaluated the medical records of one hundered and forty-seven infertil anovulatory women with PCOS who attended to the infertility outpatiens clinics of the current hospital. All women underwent either IUI or timed intercourse (TIC) following OI with clomiphene citrate (CC) according to their requests. Some demographic and clinical features, baseline hormone levels and treatment cycle characteristics were recorded for each woman. ResultsOf a total 147 cycles, 56 cycles were with IUI and 91 others with TIC. The IUI and TIC groups were similar in terms of age, BMI, gravidity numbers, parity numbers, number of abortion and infertility duration (p>0.05). There were also no significant differences in hormone parameters (p>0.05). Moreover, no significant difference was observed between the groups regarding semen parameters and weekly coit frequency. However, a significant difference was found in clinical pregnancy rates between the IUI group (48.2%) and the TIC group (11%) (p<0.001). ConclusionCompared to TIC, IUI increases clinical pregnancy rates in infertile women with PCOS who underwent OI with CC.

Ovulation induction: comparing success rates between anovulatory and ovulatory cycles using different treatment protocols

The management of patients with sub-fertility, particularly unexplained sub-fertility, is a sensitive and complex matter. This was a prospective observational study conducted from October 2016 to March 2017 in Galway, Ireland, the aim of which was to identify the clinical pregnancy rates (CPR) in women undergoing ovulation induction (OI) with timed sexual intercourse (TSI) or intrauterine insemination (IUI) and to compare them across two groups: (1) Anovulatory women and (2) ovulatory women with unexplained subfertility. Patients undergoing OI were recruited consecutively and OI regimens were prescribed as per local clinical protocol. The main observation was a higher CPR in the anovulatory group (18%) compared with the ovulatory group (CPR = 10%) (p < 0.05). No difference was observed in the CPR between the TSI and IUI groups. There are many studies to support the use of OI in the treatment of women with anovulatory subfertility, though the use of OI in ovulatory women is a more controversial issue. The treatment options offered to these patients need to be individualized to each couple and should consider their length of infertility, age, and financial means. Due to the lower cost and the less invasive nature of OI-treatment we conclude that a short treatment course could be offered as an acceptable alternative prior to IVF.

Intrauterine insemination: simultaneous with or 36 h after HCG? A randomized clinical trial.

Does intrauterine insemination (IUI) carried out simultaneously with HCG triggering ('simultaneous IUI') increase the ongoing pregnancy rate compared with IUI 32-36 h after HCG triggering ('regular IUI')? An open-label randomized clinical trial was conducted in seven Dutch fertility clinics. One hundred and sixty-six couples were randomized to receive simultaneous IUI and 208 couples to receive regular IUI. Treatment was allocated using a computer-based randomization algorithm using sealed opaque envelopes. Data were analysed according to the intention-to-treat principle. Couples with unexplained or mild-to-moderate male factor subfertility were eligible. Exclusion criteria were female age 42 years or older, female body mass index 35 kg/m2 or over, double-sided tubal pathology or severe male factor subfertility. Mild ovarian stimulation was carried out by subcutaneous FSH self-administration. 'Simultaneous IUI' was carried out at the point of HCG triggering for ovulation. 'Regular IUI' was carried out 32-36 h after HCG triggering. The cumulative ongoing pregnancy rate after a maximum of four cycles was 26.2% for simultaneous IUI (43 ongoing pregnancies) and 33.7% for regular IUI (70 ongoing pregnancies) (RR 0.78 95% CI 0.57 to 1.07). Ongoing pregnancy rates per cycle in the simultaneous IUI group were 6.8%, 10.5%, 9.5% and 7.4% for the first, second, third and fourth IUI cycle. In the regular IUI group, ongoing pregnancy rates were 8.3%, 16.4%, 13.5% and 9.0% for the first, second, third and fourth IUI cycle. This multicentre randomized controlled trial did not demonstrate that IUI carried out at the point of HCG triggering increases pregnancy rates compared with IUI carried out around the time of ovulation.

The association of type D personality and depression with infertility in women

Purpose: Type D personality—defined as the presence of two personality characters, namely negative affectivity (NA) and social inhibition (SI)—is associated with various disorders. The 14-item Type D Scale (DS14), which consists of NA and SI subscales, can be used for the detection of the presence of Type D personality. The aim of our study was to investigate the association of Type D personality and depression with infertility in women.Method: A total of 324 women, 168 primary unexplained infertile women (92 patients undergoing in vitro fertilization (IVF) treatment and 76 undergoing intrauterine insemination (IUI) treatment) and 156 fertile controls were recruited. The 21-item Beck Depression Inventory (BDI-21) and DS14 were completed by all participants. The study was approved by Local Ethics Committee with the protocol number 72867572-050-218.Results: Depression and Type D personality were found to be significantly more prevalent in the infertile group than the fertile group. Type D was positively associated with infertility (OR = 2.34, 95% CI = 1.45–3.78, p < .0001), especially in the younger-aged (<35 years) population (OR = 2.59, 95% CI = 1.48–4.5, p = .001). After adjusting for the duration of marriage, age, obesity, educational level, and the same characteristics of the partner, the association between Type D personality and infertility persisted (OR = 2.56, 95% CI = 1.52–4.29, p < .001). The scores of the BDI-21 and NA subscale were found to be negatively correlated with age and partner’s age. The BDI and SI scores, and the NA, SI, and Type D personality rates were similar between the IUI and the IVF groups; however, the NA score was higher, and depression was found to be more prevalent and severe in the IUI group than the IVF group.Conclusions: Type D personality could be positively associated with infertility, especially in younger-aged women.

Intrauterine insemination with ovarian stimulation versus expectant management for unexplained infertility (TUI): a pragmatic, open-label, randomised, controlled, two-centre trial

Women with unexplained infertility are often offered intrauterine insemination (IUI) with ovarian stimulation as an alternative to in-vitro fertilisation (IVF). However, little evidence exists that IUI is an effective treatment. In 2013, the UK National Institute for Health and Care Excellence recommended that IUI should not be routinely offered for couples with unexplained infertility. For this pragmatic, open-label, randomised, controlled, two-centre study, we enrolled women attending two fertility clinics in New Zealand with unexplained infertility and an unfavourable prognosis of natural conception. Participants were randomly assigned (1:1) using a computer-generated randomisation sequence, prepared by an independent statistician, to either three cycles of IUI with ovarian stimulation (with either oral clomifene citrate [50-150 mg, days 2-6] or oral letrozole [2·5-7·5 mg, days 2-6], with choice of ovarian stimulation made by the clinic) or three cycles of expectant management (couples advised to be sexually active around the likely time of ovulation and provided with a diary to record the first day of each menstrual cycle and dates of sexual activity) in blocks of four, six, and ten, without stratification. The participating couple and the clinicians were informed of treatment allocation. The primary outcome was cumulative livebirth rate in the intention-to-treat population. The safety analyses were done in the intention-to-treat population. This study was prospectively registered with the Australian and New Zealand Clinical Trials Register, number ACTRN12612001025820. Between March 12, 2013, and May 12, 2016, we randomly assigned 101 women to IUI with ovarian stimulation and 100 to expectant management, all of whom were included in the primary efficacy analysis and safety analyses. Women assigned to IUI had a higher cumulative livebirth rate than women assigned to expectant management (31 [31%] livebirths among 101 women vs nine [9%] livebirths among 100 women; risk ratio [RR] 3·41, 95% CI 1·71-6·79; p=0·0003). Of 31 livebirths in the IUI group, 23 resulted from IUI cycles and eight were conceived without assistance before or between IUI cycles. Of nine livebirths in the expectant management group, one patient was pregnant from IUI with ovarian stimulation at study entry and one had received off-protocol treatment (IVF). Two sets of twins were born, both in the IUI group (one from a cancelled cycle for over-response). IUI with ovarian stimulation is a safe and effective treatment for women with unexplained infertility and an unfavourable prognosis for natural conception. Auckland Medical Research Foundation, Evelyn Bond Fund of Auckland District Health Board, Mercia Barnes Trust of Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Maurice and Phyllis Paykel Trust, and The Nurture Foundation for Reproductive Research.

Maternal and Early Perinatal Outcomes of Triplet Pregnancy: Study of 82 Triplets from a Single Perinatal Centre in South India.

To study the recent trends in maternal and perinatal outcomes of triplet pregnancy from a perinatal centre in South India. All triplet pregnancies booked at Fernandez hospital, Hyderabad (a tertiary care perinatal centre in South India), or those referred between 2000 and 2014 were included in the study. The maternal, fetal and neonatal outcome and any interventions like cerclage, steroid administration were studied. There were 82 triplet deliveries over the study period of 15 years (82 per 69,584 live births). Most of them (78%) conceived with assistance and 83% of the triplets were trichorionic triamniotic. Anaemia and pregnancy induced hypertension were the commonest medical disorders (40.2 and 22%, respectively). Mean gestational age at delivery was 32 ± 2.8 weeks and 91% were delivered by caesarean section. Preterm labour and preterm pre-labour rupture of membranes were present in 29 and 15%, respectively. Antenatal steroids were administered in 87.8 and 53.7% had a cerclage. There were 20.7% growth restricted fetuses and 5.6% still births among the triplets. The mean birthweight among the live born neonates was 1.5kg, and birthweight discordancy of >25% was seen in 14%. Among the live born neonates, 80% required admission to the neonatal intensive care unit, 11% had culture positive sepsis, 3% had bronchopulmonary dysplasia, and 4% died during the hospital stay. None of them had periventricular leukomalacia or retinopathy requiring LASER. Mothers in the spontaneous conception group were younger and had more monochorionic triamniotic pregnancies than in the assisted conception groups (11.8 vs. 2.9%, p=0.001). The incidence of PPROM was significantly more in the spontaneous conception group than in the ovulation induction, intrauterine insemination groups (29.4 vs. 2.9%, p=0.03), we do not have an explanation for this. There was no difference in the other maternal, fetal or neonatal parameters based on the mode of conception. Though triplet pregnancies are encountered infrequently, obstetricians should be familiar with their management. Appropriate antenatal, perinatal care with neonatal support can result in optimal outcome.

The effectiveness of intrauterine insemination: A matched cohort study

ObjectiveTo study the effectiveness of an intrauterine insemination (IUI) program compared to no treatment in subfertile couples with unexplained subfertility and a poor prognosis on natural conception. Study designA retrospective matched cohort study in which ongoing pregnancy rates in 72 couples who voluntarily dropped out of treatment with IUI were compared to ongoing pregnancy rates in 144 couples who continued treatment with IUI. Couples with unexplained subfertility, mild male subfertility or cervical factor subfertility who started treatment with IUI between January 2000 and December 2008 were included. Couples were matched on hospital, age, duration of subfertility, primary or secondary subfertility and diagnosis. Primary outcome was cumulative ongoing pregnancy rate after three years. Time to pregnancy was censored at the moment couples were lost to follow up or when their child wish ended and, for the no-treatment group, when couples re-started treatment. ResultsAfter three years, there were 18 pregnancies in the stopped treatment group (25%) versus 41 pregnancies in the IUI group (28%) (RR 1.1 (0.59–2.2)(p=0.4)). The cumulative pregnancy rate after three years was 40% in both groups, showing no difference in time to ongoing pregnancy (shared frailty model p=0.86). ConclusionsIn couples with unexplained subfertility and a poor prognosis for natural conception, treatment with IUI does not to add to expectant management. There is need for a randomized clinical trial comparing IUI with expectant management in these couples.

Anxiety Effect in the Success Rate of Intrauterine Insemination (IUI) and In vitro Fertilization (IVF)

Background: Infertility has a tendency to become potential physical and emotional stressors. The current progressive advances in fertility technology have encouraged more infertile couples to seek for the cause of infertility and take measures to improve their fertility. It is not uncommon that these couples experience emotional distress when they are undergoing fertility treatments. Although it is controversial, some experts argue that this emotional distress affects the success of fertility programs, such as intrauterine insemination and In vitro fertilization programs. Objective: The aim of the study was to investigate the relationship between successful pregnancy and anxiety in patients undergoing intrauterine insemination (IUI) and In vitro fertilization (IVF) programs. Material and method: A total of 39 patients undergoing intrauterine insemination and In vitro fertilization program in Aster clinic of Dr. Hasan Sadikin General Hospital during period of September-November 2016 were measured for their anxiety level using Zung Self-Rating Anxiety Scale. The results were then categorized as not anxious (score of 20-44) and anxious (45-80). Data were then compared against successful pregnancy after each program. Results: Of 39 patients, 23 underwent IUI and 16 underwent IVF. In the IUI group, 10 patients were not anxious (43.48%) and 13 people were anxious (56.52%) while in the IVF group 9 were not anxious (56.25%) and 7 were anxious (43.75%). Three patients (18%) who successfully conceived in the insemination program were those who were not anxious. Meanwhile, in the IVF group 3 patients (18.8%) also got pregnant with 2 of them were not anxious and 1 was anxious. A statistical calculation was performed using Fisher test, resulting in p = 0.068 and p = 1.000 for IUI and IVF, respectively. Conclusion: There is no significant correlation between the success of the fertility program and anxiety in patients undergoing IUI and IVF programs.