Intrauterine Insemination Pregnancy Research Articles

P-032 Prospective and multi-site analysis of pregnancy outcomes in 488 patients who completed the Sperm Quality Test (SpermQT) measuring the utility of sperm epigenetics

Abstract Study question Do SpermQT results prospectively correlate with fertility outcomes of couples undergoing intrauterine insemination (IUI)? Summary answer We observe a decrease in IUI pregnancy rates in men with Abnormal compared to Normal SpermQT results irrespective of their sperm total motile count (TMC). What is known already As the mainstay of male infertility diagnosis, the standard semen analysis provides limited value for predicting pregnancy outcomes. New technologies are needed for a more comprehensive assessment of male fertility. A novel, epigenetic assessment of sperm quality, SpermQT, was implemented clinically in 2022. Retrospective studies have shown that sperm health, as identified through DNA methylation patterns, is predictive of IUI outcomes in a subset of infertile men. Additional prospective research is needed for validation of these data. Study design, size, duration Over an 18-month period (June 2022 - January 2024), 23 reproductive endocrinologists over eight clinics ordered 488 SpermQT tests on male patients. For these patients, physicians and clinical support staff were asked to provide the sperm total motile count (TMC) from the semen analysis, male and female ages, procedure information and outcomes. SpermQT results were categorized as Normal or Abnormal. Associations between SpermQT results, outcomes, age, and TMC were analyzed. Participants/materials, setting, methods The selection of patients for SpermQT assessment was based on the clinical decision of the ordering physician. SpermQT requires a semen sample which was collected by the patient either at the andrology laboratory or at home using an at-home collection kit. All sample types were shipped directly to the vendor’s laboratory for analysis and report generation. Following the completion of the epigenetic analysis, all SpermQT results were provided to the ordering physician for patient consultation. Main results and the role of chance 488 patients received a SpermQT result. 83.6% of men had a Normal SpermQT (n = 408), and 16.4% had an Abnormal SpermQT (n = 80). 180 couples had pregnancy outcomes from at least one IUI. Of the 180, 14% of men had an Abnormal SpermQT (n = 25) and 86% had a Normal SpermQT (n = 155). Analysis of pregnancy outcomes from all 180 couples who completed one, two, or three IUI cycles showed a 15% IUI cumulative pregnancy rate. The men with a Normal SpermQT had a 17.42% cumulative IUI pregnancy rate within the first three IUI cycles while men with an Abnormal SpermQT (N = 25) had no reported pregnancies and a 0% cumulative IUI pregnancy rate. Within this patient cohort, 338 patients had reported TMC where 82% had a TMC ≥20 million (n = 276). 72% of men with an Abnormal SpermQT had a TMC ≥20M, while 84% of men with a Normal SpermQT had a TMC ≥20M. Median male and female ages in the Normal SpermQT category were both 34, while median male and female ages in the Abnormal SpermQT category were 32 and 33 respectively, indicating age did not play a role in IUI pregnancy outcomes. Limitations, reasons for caution Limitations within this study include the sample size of men with an Abnormal SpermQT result. In order to identify a statistical significance between IUI pregnancy outcomes, a total sample size of 500 patients will be needed. Data and outcomes will continue to be collected to continue the validation of SpermQT. Wider implications of the findings There is strong data showing that sperm epigenetics play an important role in IUI outcomes. Here we show in a prospective and multi-site population that a new assessment of sperm epigenetics (SpermQT) identifies men less likely to achieve an IUI pregnancy, and also identifies subfertile men with normal TMC. Trial registration number Non Applicable

Development of a machine learning-based prediction model for clinical pregnancy of intrauterine insemination in a large Chinese population.

This study aimed to evaluate the effectiveness of a random forest (RF) model in predicting clinical pregnancy outcomes from intrauterine insemination (IUI) and identifying significant factors affecting IUI pregnancy in a large Chinese population. RESULTS: A total of 11 variables, including eight from female (age, body mass index, duration of infertility, prior miscarriage, and spontaneous abortion), hormone levels (anti-Müllerian hormone, follicle-stimulating hormone, luteinizing hormone), and three from male (smoking, semen volume, and sperm concentration), were identified as the significant variables associated with IUI clinical pregnancy in our Chinese dataset. The RF-based prediction model presents an area under the receiver operating characteristic curve (AUC) of 0.716 (95% confidence interval, 0.6914-0.7406), an accuracy rate of 0.6081, a sensitivity rate of 0.7113, and a specificity rate of 0.505. Importance analysis indicated that semen volume was the most vital variable in predicting IUI clinical pregnancy. The machine learning-based IUI clinical pregnancy prediction model showed a promising predictive efficacy that could provide a potent tool to guide selecting targeted infertile couples beneficial from IUI treatment, and also identify which parameters are most relevant in IUI clinical pregnancy.

A prospective study on the colour doppler indices of follicular and endometrial blood flow as a predictor of pregnancy in intrauterine insemination (IUI) cycles

A prospective study on the colour doppler indices of follicular and endometrial blood flow as a predictor of pregnancy in intrauterine insemination (IUI) cycles

Analysis of factors associated with IUI pregnancy outcomes in elderly and young patients

ObjectiveThe objective of this study was to investigate the correlation between various factors and the clinical outcomes of Intrauterine Insemination (IUI) in both young and aged patients, aiming to provide a theoretical basis for clinical consultations.MethodsThis retrospective analysis examined a total of 4,221 IUI cycles conducted at the Reproductive Center of Changzhou Maternal and Child Health Hospital between January 2016 and December 2020. The patients were categorized into two groups based on age: the elder group (≥ 35 years) and the young group (< 35 years).ResultsThe findings of this study revealed a significant association between woman’s age and BMI with pregnancy outcomes (0.93, 95% CI: 0.89–0.97) (1.04, 95% CI: 1.01–1.06). Moreover, in young women, both age and Body Mass Index (BMI)were found to be related to pregnancy outcomes (0.97, 95% CI: 0.89–0.97) (1.08, 95% CI: 1.01–1.06). Additionally, BMI and the number of cycles in aged IUI patients were found to be associated with pregnancy outcomes. The pregnancy rate in the second cycle was approximately 1.9 times higher than that in the first cycle (1.9, 95% CI: 0.97–3.77), and in the third cycle, it was approximately 3 times higher than that in the first cycle (3.04, 95% CI: 1.43–6.42).ConclusionsIn conclusion, there is an association between woman’s age and BMI and the clinical outcomes of IUI. However, the number of cycles did not affect the pregnancy outcomes in young women. Conversely, in elder women, the number of cycles was found to be related to the IUI pregnancy outcomes, with significantly higher pregnancy rates observed in the second and third cycles compared to the first cycle.

Epigenetic determinants of reproductive potential augment the predictive ability of the semen analysis

To investigate the power of DNA methylation variability in sperm cells in assessing male fertility potential. Retrospective cohort. Fertility care centers. Male patients seeking infertility treatment and fertile male sperm donors. None. Sperm DNA methylation data from 43 fertile sperm donors were analyzed and compared with the data from 1344 men seeking fertility assessment or treatment. Methylation at gene promoters with the least variable methylation in fertile patients was used to create 3 categories of promoter dysregulation in the infertility treatment cohort: poor, average, and excellent sperm quality. After controlling for female factors, there were significant differences in intrauterine insemination pregnancy and live birth outcomes between the poor and excellent groups across a cumulative average of 2-3 cycles: 19.4% vs. 51.7% (P=.008) and 19.4% vs. 44.8% (P=.03), respectively. Live birth outcomes from invitro fertilization, primarily with intracytoplasmic sperm injection, were not found to be significantly different among any of the 3 groups. Methylation variability in a panel of 1233 gene promoters could augment the predictive ability of semen analysis and be a reliable biomarker for assessing intrauterine insemination outcomes. Invitro fertilization with intracytoplasmic sperm injection appears to overcome high levels of epigenetic instability in sperm.

The Effect of Probiotic Supplementation in Intrauterine Sperm Insemination Pregnancy Rate

Background: By using probiotic products, such as Lactovag, which contain high amounts of a safe and beneficial bacterial strain, the vaginal microbiome can be near healthy in infertile women, and as a consequence, the reproductive outcomes are improved. Objectives: The present study was done to assess the effect of Lactovag on pregnancy outcomes in IUI cycles. Methods: This single-blind clinical trial was conducted on 194 infertile women who underwent IUI in the infertility clinic of Yas Hospital between December 2021 and March 2022. In the intervention group, two weeks before IUI, Lactovage suppository was prescribed once per night, while in the control group, no extra interventions were done. All the patients underwent IUI in the same way. The primary outcomes of the study were biochemical and clinical pregnancy rates. Results: The average age of women was 30.51 ± 4.6 years, ranging from 22 to 43 years. The average age of the women’s partner was 34.89 ± 4.41 years, ranging from 24 to 49 years. There were no significant differences regards the basic information of the two study groups. The most common infertility cause was polycystic ovary syndrome (40.7%). The biochemical and clinical pregnancy rate was 12.4% in the Lactovage group and 10.3% in the control group. Although the pregnancy rate improved with a Lactovage prescription, this difference was insignificant (P-value = 0.651). Conclusions: While the pregnancy rate in women with probiotic therapy was higher, it was insignificant. Future randomized studies are needed to definitively examine probiotic therapy and establish its benefit in women candidates for IUI.

MP43-15 MICROSURGICAL VARICOCELE REPAIR IMPROVES SPERM CAPACITATION AND PROBABILITY OF GENERATING A PREGNANCY, AS MEASURED BY PRE- AND POST-OPERATIVE TESTING WITH CAP-SCORE

You have accessJournal of UrologyCME1 Apr 2023MP43-15 MICROSURGICAL VARICOCELE REPAIR IMPROVES SPERM CAPACITATION AND PROBABILITY OF GENERATING A PREGNANCY, AS MEASURED BY PRE- AND POST-OPERATIVE TESTING WITH CAP-SCORE Muhamed Qalawena, Eric Seaman, Jared Johnson, Ahmed El-Sakka, and Joshua Bodie Muhamed QalawenaMuhamed Qalawena More articles by this author , Eric SeamanEric Seaman More articles by this author , Jared JohnsonJared Johnson More articles by this author , Ahmed El-SakkaAhmed El-Sakka More articles by this author , and Joshua BodieJoshua Bodie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003289.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Infertility is a worldwide problem, with up to 40-50% of cases involving male infertility. Varicocele represents the most common correctable cause of male infertility. While semen analysis (SA) remains the primary diagnostic tool of infertility, it does not provide information about sperm function. The Cap-Score is designed to assess sperm capacitation via localization patterns of ganglioside GM-1, which has been shown to be a viable surrogate of capacitation-competent human sperm. The predicted probability of generating a pregnancy (PGP) is a validated metric based on semen volume, concentration, and Cap-Score. PGP is defined as the percent chance of obtaining a pregnancy within three consecutive rounds of intrauterine insemination (IUI). The objective of this study was to determine the effect of microscopic varicocelectomy on sperm capacitation and the probability of generating a pregnancy. METHODS: Data were collected prospectively of 40 consecutive adult men who presented with infertility confirmed by SA and found to have a varicocele on exam or ultrasound who underwent unilateral or bilateral subinguinal microscopic varicocelectomy. We recorded pre and post-operative SA, Cap-Score, and PGP with a 3-month follow up. Values were compared using paired t-test and Wilcox rank-sum test. RESULTS: Of the 40 men enrolled, 29 (72.5%) demonstrated improved Cap-Score with an average increase of 4% (p=0.001). The absolute change in probability of generating a pregnancy was 6% higher (p=0.001) after varicocelectomy, which represents a 25% relative increase in PGP. The change in Cap-Score was not associated with the grade of varicocele (p=0.0703) or whether the patient had a unilateral or bilateral repair (p=0.9682). There were no differences in semen volume (p=0.061) or morphology (p=0.091), however, there was improvement in sperm motility (p=0.021), total sperm count (p=0.030) and concentration (p=0.004). CONCLUSIONS: It is known that varicocelectomy improves semen parameters and chances of conception in the majority of cases, including pregnancies via intercourse or via assisted reproduction. This study confirms that varicocelectomy augments male fertility by improving sperm capacitation, and that varicocele repair improves the probability of generating an IUI pregnancy to a statistically-significant degree. The improvement in sperm capacitation ability may explain how varicocele repair may improve the chance of pregnancy, regardless of standard semen parameter improvements. Source of Funding: This study did not receive industry support. The only external funding for the study came from doctor M. Qalawena, a scholar visiting the University of Minnesota from the faculty of Medicine Suez Canal University, Egypt, whose personal educational grant by the Egyptian ministry of higher education funded the sixteen tests for the eight patients contributed from the University of Minnesota. Patients from the New Jersey site had received Cap-Score testing by Androvia LifeSciences Lab at patient expense. Physicians received no funding from Androvia for running the study, and the Androvia Labs did not have editorial control of the study results © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e607 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Muhamed Qalawena More articles by this author Eric Seaman More articles by this author Jared Johnson More articles by this author Ahmed El-Sakka More articles by this author Joshua Bodie More articles by this author Expand All Advertisement PDF downloadLoading ...

Live birth associated with peak serum estradiol levels in letrozole intrauterine insemination cycles

To identify whether the serum estradiol (E2) level on the day of human chorionic gonadotropin (hCG) trigger or luteinizing hormone (LH) surge (hCG-LH) was associated with the live birth rate (LBR) during ovulation induction (OI) or controlled ovarian hyperstimulation with letrozole followed by intrauterine insemination (IUI). Retrospective cohort study. Large, multicenter private practice. A total of 2,368 OI-IUI cycles in patients treated with letrozole followed by IUI were evaluated from January 1, 2014, to July 31,2019. Ovulation induction with letrozole, followed by autologous IUI. The primary outcome measure was the LBR as a function of the serum E2 level at the time of hCG administration or LH surge, adjusting for age, body mass index, the largest follicle diameter, and the number of follicles ≥14 mm in diameter. The clinical pregnancy rate as a function of the E2 level, pregnancy rate as a function of the lead follicle diameter, and pregnancy loss rates were the secondary outcome variables. A total of 2,368 cycles met the inclusion criteria. Outcomes were evaluated at the 25th (E2 level, 110 pg/mL), 50th (157 pg/mL), 75th (225 pg/mL), and 90th (319 pg/mL) percentiles. The LBRs ranged from 9.4% to 11.1% in the lower E2 cohorts and from 12.5% to 13.5% in the higher E2 cohorts. The LBR was significantly greater in the cohort of women with higher E2 levels in all percentile comparisons except for the 90th percentile. The mean periovulatory follicle diameter of ≥20 or <20 mm was not independently associated with the LBR or clinical pregnancy rate, despite a significantly higher mean E2 level in the larger follicle group. In letrozole OI cycles followed by IUI, lower LBRs and clinical pregnancy rates were found in women with lower E2 levels than in those with higher E2 levels at the 25th, 50th, and 75th percentile E2 level quartiles. Where possible, delaying hCG trigger until the E2 level increases after aromatase inhibition and approaches the physiologic periovulatory level may improve the pregnancy rates with letrozole followed by IUI.

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.

İntrauterin İnseminasyon (IUI) Sonrası Olan İntrauterin İkiz Gebelik ve Sağ Tubal Ektopik Gebelik Olgusu

ÖZET&#x0D; Amaç: Nadiren doğal gebeliklerde oluşan heterotopik gebelikte sıklıkla rüptür sonrası cerrahi tedavi gerekli olduğunda tanı konur. Bu sebeple erken tanı hasta için hayati önem taşımaktadır. Burada rüptüre tubal gebelik ve intrauterin canlı dikoryonik-diamniyotik ikiz gebelik ile prezente olan heterotopik gebelik vakası sunmayı amaçladık.&#x0D; Olgu: 30 yaşında, nullipar, son adet tarihine göre 6 hafta 3 günlük intruterin inseminasyon ile ( IUI ) gebeliği olan hasta, karın ağrısı ile kliniğimize başvurdu. Yapılan fizik muayenesinde akut batın bulguları mevcuttu. Transvaginal ultrasonografisinde intrauterin yerleşimli 6 hafta 5 gün ve 6 hafta 6 gün ile uyumlu fetal kalp atımı ( FKA ) pozitif olan dikoryonik - diamniyotik ikiz gebelik tespit edildi. Batın içi douglusta yaklaşık 6-7 cm serbest mayi izlendi. Sağ adneksial alanda ektopik odak olabilecek oluşum izlendi. Yapılan tetkiklerinde Hemoglobin: 10.5 gr/dl, β-hcg: 15.000 m IU / ml olarak gelen batın muayenesinde rebaund ve defansı olan hastaya laparotomi planlandı. Laparotomik eksplorasyonda sağ tubal rüptüre ektopik odak izlendi. Batında ortalama 500-600 cc kan ve koagulum izlendi. Uterus ve her iki over normal görünüm ve cesamette izlendi. Sağ total salpenjektomi yapıldı, batın yıkanmasının ardından laparotomiye son verildi. Sağ tubanın patolojik değerlendirme sonucu ektopik gebelik, hematosalpenks olarak geldi. Postoperatif 2. gününde bakılan kontrol ultrason bakısında intrauterin dikoryonik-diamniyotik fetal kalp atımı olan 6 hafta 5 gün ve 6 hafta 6 gün ile uyumlu ikiz gebeliğin devam ettiği görüldü. Hasta postop 4. günde sorunsuz poliklinik kontrolüne gelmek üzere taburcu edildi. &#x0D; Sonuç: Heterotopik gebelik nadir görülmesi sebebi ile tanı ve tedavide gecikmeler olabilmektedir. Özellikle intrauterin gebelik ultrason bakısında görülen ek yakınması olamayan hastalarda ektopik gebelik atlanabilmektedir. Bu vakamızda buna özellikle dikkat çekmek istedik.&#x0D; Anahtar kelimeler: Heterotopik gebelik; ikiz gebelik; tubalektopik gebelik

Impact of prolonged one or more natural menstrual cycles on the outcomes of ovulation induction intrauterine artificial insemination pregnancy: a single-centre, retrospective study in China

ObjectivesWe determined if the time interval between two ovulation induction intrauterine artificial insemination (IUI) treatment cycles should be extended by one or more natural menstrual cycles in patients undergoing successive...

The effect of semen collection at home on intrauterine insemination outcomes

The WHO 2010 guidelines recognize at-home semen collection as an acceptable alternative to standard collection at the clinic in "exceptional circumstances." There is lack of sufficient data to determine the need for revisiting these recommendations for treatment purposes. To determine whether at-home semen collection has any effect on intrauterine insemination (IUI) cycle outcomes. This is a retrospective cohort study of 729 IUI treatment cycles (382 patients) performed at an academic fertility center from September 19, 2019 to December 31, 2020. Semen collected at the "clinic" was used for 343 cycles before the Coronavirus Disease 2019 (COVID-19) pandemic (September 19, 2019 to March 21, 2020), and "at-home" collected specimens were used for 386 cycles following revised protocols with COVID-19-driven changes (May 30, 2020 to December 31, 2020). Logistic regression models were performed to evaluate the effect of "at-home" semen collection on achieving a positive pregnancy test (PPT) and a clinical pregnancy (CP). Male and female partners' age, ovarian reserve biomarkers, and stimulation regimens used were similar in the "clinic" and "at-home" groups. In unadjusted models, "at-home" collection had no significant effect on the odds for a PPT [OR (95%CI): 0.733 (0.503-1.069)] or CP [0.816 (0.543-1.226)]. These results persisted even when adjusting for maternal age and anti-Müllerian hormone: PPT [0.739 (0.505-1.081)] and CP [0.826 (0.547-1.248)]. Of the semen analysis parameters under evaluation, only motility appeared to significantly impact the odds of achieving a PPT [1.014 (1.004-1.025)] and a CP [1.017 (1.006-1.029)]. This effect was slightly attenuated for samples collected "at-home" [1.012 (0.997-1.027) and 1.015 (0.999-1.031), respectively, for PPT and CP]. This study adds important information to the limited literature regarding the effect of at-home semen collection on IUI outcomes. Under adequate protocols, at-home semen collection should be considered a safe alternative. Additional research is needed to optimize such protocols. Our data suggest that at-home semen collection does not negatively impact IUI pregnancy outcomes.

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

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

Comparison of RNA content from hydrophobic interaction chromatography-isolated seminal plasma exosomes from intrauterine insemination (IUI) pregnancies.

Male factors account for roughly half of infertility cases, with most male infertility diagnosed as idiopathic. Researchers predicting intrauterine insemination success rates have identified multiple prognostic factors, including semen parameters and seminal fluid composition. Seminal plasma contains extracellular exosomes, which contain RNAs and proteins involved in spermatogenesis. The contents of seminal plasma exosomes may be an indicator of overall sperm quality or fertility potential; therefore, analysis of exosomes may provide a measure for sperm viability and fertilization potential. In our study, exosomes were isolated and purified from seminal plasma obtained from IUI treatments with known pregnancy outcomes. We used a unique method to isolate the exosomes which made use of the hydrophobic interaction chromatography method. RNASeq was performed on RNAs from the purified exosomes. This analysis revealed holistic trends, including increased expression associated with RNA originating from chromosomes 1, 10, 12, 16 and 21. Overall, total RNA was significantly decreased and rRNA was significantly increased in successful IUI attempts. Furthermore, we found specific mRNAs and lincRNAs associated with positive versus negative pregnancy outcomes. Our study isolated and purified seminal plasma exosomes without ultracentrifugation, and it provides further evidence for differences in seminal plasma exosome molecular contents associated with pregnancy status.

Predictive value of sperm motility before and after preparation for the pregnancy outcomes of intrauterine insemination.

ObjectiveThis study aimed to investigate sperm motility and its changes after preparation as predictors of pregnancy in intrauterine insemination (IUI) cycles.MethodsIn total, 297 IUI cycles from January 2012 to December 2017 at a single tertiary hospital were retrospectively analyzed. Patient and cycle characteristics, and sperm motility characteristics before and after processing were compared according to clinical pregnancy or live birth as outcomes.ResultsThe overall clinical pregnancy rate per cycle was 14.5% (43/297) and the live birth rate was 10.4% (30/289). Patient and cycle characteristics were similar between pregnant and non-pregnant groups. Sperm motility after preparation and the total motile sperm count before and after processing were comparable in terms of pregnancy outcomes. Pre-preparation sperm motility was significantly higher in groups with clinical pregnancy and live birth than in cycles not resulting in pregnancy (71.4%±10.9% vs. 67.2%±11.7%, p=0.020 and 71.6%±12.6% vs. 67.3%±11.7%, p=0.030, respectively). The change in sperm motility after processing was significantly fewer in the non-pregnant cycles, both when the comparison was conducted by subtraction (post-pre) and division (post/pre). These relationships remained significant after adjusting for the female partner’s age, anti-Müllerian hormone level, and number of pre-ovulatory follicles. According to a receiver operating characteristic curve analysis, an initial sperm motility of ≥72.5% was the optimal threshold value for predicting live birth after IUI.ConclusionInitial sperm motility, rather than the motility of processed sperm or the degree of change after preparation, predicted live birth after IUI procedures.

Factors Affecting Artificial Insemination Pregnancy Outcome.

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

Predictors of pregnancy after intrauterine insemination in women with polycystic ovary syndrome.

ObjectiveTo evaluate the effects of body mass index (BMI) in patients with polycystic ovary syndrome (PCOS) undergoing controlled ovarian stimulation (COS) with intrauterine insemination (IUI).MethodsThis retrospective study evaluated couples with PCOS undergoing COS and IUI. The relationship between cumulative IUI pregnancy outcomes and BMI, treatment cycles, treatment schemes, number of dominant follicles, endometrial thickness, infertility duration and type of infertility was analysed.ResultsThe study evaluated 831 IUI cycles in 451 couples with PCOS. Compared with normoweight women, overweight and obese women required more human menopausal gonadotropin (hMG) doses and more days of COS. Gestational diabetes mellitus occurred more frequently in the obese group than in the other BMI groups. The clinical pregnancy and live birth rates in the hMG, clomiphene citrate (CC) + hMG and letrozole (LE) + hMG groups were significantly higher than those in the CC and LE groups. The clinical pregnancy rate was higher in the secondary infertility group compared with the primary infertility group.ConclusionObese women might require more hMG doses and more days of COS to overcome the effects of weight. As BMI increases, the incidence of gestational diabetes might also increase. The number of cycles and type of infertility may have a predictive value for pregnancy outcomes.

Clarifying the relationship between total motile sperm counts and intrauterine insemination pregnancy rates

To study the relationship between postwash total motile sperm count (TMSC) and intrauterine insemination (IUI) outcomes. Retrospective review SETTING: Large fertility clinic PATIENT(S): A total of 92,471 insemination cycles from 37,553 patients were included in this study. All stimulated clomiphene citrate, letrozole, and/or injectable gonadotropin IUI cycles performed at a single institution from 2002 through 2018 were reviewed. Generalized estimating equations (GEE) analysis was used to account for multiple cycles by individual patients and to adjust for female partner age, body mass index, and stimulation protocol. Successful clinical pregnancy was defined as ultrasound confirmation of an intrauterine gestational sac with fetal cardiac activity. A total of 92,471 insemination cycles were available to evaluate the relationship between postwash TMSC and clinical pregnancy. Pregnancy rates were highest with TMSC of ≥9 × 106 and declined gradually as TMSC decreased. Complete data for the adjusted GEE analysis were available for 62,758 cycles. Adjusted GEE analysis among cycles with TMSC of ≥9 × 106 (n = 46,557) confirmed that TMSC in this range was unrelated to pregnancy. Conversely, TMSC was highly predictive of pregnancy (Wald χ2 = 39.85) in adjusted GEE analysis among cycles with TMSC of <9 × 106 (n = 16,201), with a statistically significant decline. IUI pregnancy is optimized with TMSC of ≥9 × 106, below which the rates gradually decline. Although rare, pregnancies were achieved with TMSC of <0.25 × 106. Since the decline in pregnancy is gradual and continuous, there is no specific threshold above which IUI should be recommended. Rather, these more specific quantitative predictions can be used to provide personalized counseling and guide clinical decision making.

Prewash and postwash total progressively motile sperm counts have poor predictive value for clinical pregnancy after intrauterine insemination.

To evaluate the predictive value of the prewash and postwash total progressively motile sperm counts (TPMSC) on clinical pregnancy after intrauterine insemination (IUI) . A review of medical records of women undergoing 2064 IUI cycles in a university hospital between April 2010 and October 2018. No pregnancies were seen when the prewash TPMSC was less than 9million or the postwash TPMSC was less than 2million. There was no correlation between TPMSC and clinical pregnancies. Further analysis was made in pregnancies after prewash TPMSC of 3-10million and more than 10million, and after postwash TPMSC of 10-100million and more than 100million. No correlation was found between TPMSC and clinical pregnancy in different strata of female age, infertility duration, type of infertility, type of IUI treatment, and the number of treatment cycles. A negative relationship was found for unstimulated IUI treatment and the number of treatment cycles. The prewash and postwash TPMSC showed no predictive value. Prewash and postwash TPMSC have poor predictive value for clinical pregnancy in IUI. Cycles with a prewash TPMSC of 10-100 million or postwash TPMSC of 3-10 million could achieve acceptable pregnancy rates with IUI.

Isolation, purification and initial RNA sequence analysis of seminal fluid exosomes between pregnant and non-pregnant intrauterine insemination pregnancies

Objective To compare the RNA content in exosomes purified from seminal fluid associated with intrauterine insemination (IUI) pregnancies with known pregnancy status. Design Retrospective analysis of exosome RNA from seminal fluid from patients undergoing IUI and pregnancy outcomes. Materials and methods Seminal fluid was collected following semen washing for IUI. Exosomes were isolated and purified by hydrophobic interaction chromatography using a polyester, capillary-channeled polymer phase. Exosome purification was verified by TEM. Small RNAs were isolated from purified exosomes and libraries prepared. Following Illumina NextSeq500 library sequencing, sequences were aligned to the human genome, RNA copy numbers determined, and profiled based on type (i.e. miRNA, lincRNA, RefSeq, exons). RNA copy numbers were compared by analysis of variance (ANOVA) and Students’ t-test. Results Exosomes were successfully purified from seminal fluid samples using hydrophobic interaction chromatography and confirmed with TEM. ANOVA revealed a significant difference (P Conclusions This study provides further evidence that exosomes are present in seminal fluid and the RNA content is different in those that successfully enabled a pregnancy versus those that did not. Identifying the molecules within seminal fluid provides a snapshot into the males’ spermatogenesis past. Specific proteins must be expressed at the correct level, time and location for spermatogenetic processes to precisely occur. Therefore, any pathway disruption may render spermatozoa as unsuitable for fertilization. Further analysis of specific gene expression differences between the two groups may reveal signaling pathways associated with positive or negative pregnancy outcomes. Disclosures Nothing to disclose. Funding Supported in part by University of South Carolina School of Medicine Greenville Development Funds and Development Funds from the Department of Surgery at Prisma Health, Greenville, SC (RJC and WER).