Number Of Intrauterine Insemination Cycles Research Articles

Factors Affecting the Success Rate of Intrauterine Insemination in the Treatment of Subfertility Following Controlled Ovarian Hyperstimulation

Objectives: To determine the success rate of Intrauterine Insemination following Controlled Ovarian Hyperstimulation inpatients with subfertility and to determine the frequency of prognostic factors affecting the success rate of this treatment modality.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Obstetrics & Gynecology, Pak-Emirates Military Hospital, Rawalpindi Pakistan, rom Feb to Aug 2019.
 Methodology: A total number of 135 sub-fertile patients, aged 18 to 40 years, with a duration of subfertility > 2 years, were included in the study. Couples with bilateral tubal blockade, smoking, combined male and female factor infertility and previous ovarian surgery were excluded. Controlled ovarian hyperstimulation was done with Clomiphene Citrate for five days, followed by ovulation triggered by recombinant human chorionic gonadotropin (HCG) and standard insemination with a prepared sample of the husband’s semen after 36 hours.
 Results: Success of the procedure was seen in 23(17.04%) patients, while the remaining 112(82.96%) were unsuccessful. The mean age was 29.20±4.90 years. Of 135 patients, 83(61.48%) had primary subfertility, and 52(38.52%) had secondary subfertility. The mean duration of subfertility was 5.60±3.35 years. The mean basal FSH was 5.76±2.54 IU/l. The mean number of IUI cycles was 1.39±0.49.
 Conclusion: This study concluded that the success rate of intrauterine insemination following controlled ovarian hyperstimulation in the treatment of subfertility was 17.04%, and the duration and type of subfertility, aetiology of subfertility, basal Follicle-stimulating hormone levels and the number of Intrauterine insemination cycles are the prognostic factors affecting the success of the procedure.

Effect of estrace on pregnancy rates for women with thin endometrial lining undergoing intrauterine insemination

To evaluate the effect of exogenous estradiol on pregnancy rates for women with thin endometrial lining undergoing intrauterine insemination (IUI) as compared to women who did not receive estradiol for endometrial support; we hypothesize that there was no difference in pregnancy rates between the two groups. Retrospective chart review. All IUI cycles completed at Stanford University Clinic for Reproductive Medicine from March-December 2017 were reviewed. All monitored IUI cycles were included. Cycles with the addition of exogenous estradiol given vaginally or orally were compared to those without exogenous estradiol. Differences in endometrial parameters, pregnancy rates, miscarriage rates and live birth rates were compared between both groups. A total of 885 IUI cycles were included. In 85 cycles, exogenous estradiol was initiated for thin endometrium. Baseline characteristics including maternal age, body mass index, ethnicity, number of IUI cycles per patient, type of IUI cycle, and total motile sperm count were similar between the two groups. Mean baseline endometrial lining was thicker in the non-estradiol group, and the non-estradiol group was more likely to have a diagnosis of unexplained infertility whereas the estradiol group was more likely to have a diagnosis of diminished ovarian reserve. Despite initiation of estradiol, the mean endometrial thickness at trigger scan remained significantly thinner in estradiol group as compared to the non-estradiol group (6.4±1.3 cm vs. 8.4±1.9 cm, respectively, p <0.001), although the change in thickness in the estradiol group from baseline to trigger scan did increase on average by 2.2 cm. Pregnancy, miscarriage and live birth rates were similar between the estradiol and non-estradiol groups (see Table 1).Table 1OutcomesEstradiol (n=85)No Estradiol (n=800)P-valueEndometrial Lining thickness (cm), mean±standard errorBaseline4.2±1.34.9±1.7<0.001Estradiol initiation4.9±0.86.4±1.7<0.001Trigger6.4±1.38.4±1.9<0.001Pregnancy Rate, n (%)14 (20%)81 (10%)0.12Spontaneous Abortions, n (%)8 (10%)30 (4%)0.08Live births to date, n (%)5 (10%)42 (10%)0.78 Open table in a new tab Although there is limited data supporting the use of exogenous estradiol to improve outcomes during IUI cycles, this low risk intervention is often employed in the setting of a thin endometrial lining in the late follicular phase. In women undergoing IUI with exogenous estradiol supplementation due to thin endometrial lining, pregnancy, miscarriage and live birth rates were similar to women undergoing IUI without exogenous estradiol use.

Assisted reproductive technology in Beijing, 2013-2015.

Why are comprehensive and detailed reports of local or national utilization outcomes of assisted reproductive technology (ART) lacking in China? Retrospective collection of data on intrauterine insemination (IUI) and IVF and intracytoplasmic sperm injection (ICSI) in Beijing, including all 12 registered institutions with cycles, started between 1 January 2013 and 31December 2015. Clinical pregnancy rates (CPR) per aspiration and fresh embryo transfer were 39.1% and 43.2% in 2013, 40.1% and 45.4% in 2014, and 37.8% and 44.5% in 2015; live birth rates (LBR) per aspiration and per fresh embryo transfer were 31.7% and 35.0%, 32.3% and 36.6%, and 30.3% and 35.6%, respectively. In frozen embryo transfer (FET) cycles, the CPR per thawed transfer was 43.4%, 47.2% and 46.2%, respectively, resulting in LBR of 34.3%, 37.4% and 36.5%. The prevalence of multiple pregnancies was 28.0-31.3% for fresh embryo transfer, and 23.5-25.9% for FET. The LBR was 8.8-9.1% after IUI with husband or partner's semen (IUI-H), and 16.7-19.7% after IUI with donor semen (IUI-D). The birth defect rate among live born infants was 1.52%, 0.42% and 0% after IUI-H, 1.05%, 0.39% and 0.66% after IUI-D, 0.71%, 0.56% and 0.46% after fresh embryo transfer, and 0.73%, 0.20% and 0.18% after FET in 2013, 2014 and 2015, respectively. In Beijing over 3 years, the number of IVF-ICSI cycles has increased and the number of IUI cycles has decreased; IVF-ICSI outcomes are better and safer. Further effort should be made to lower the multiple pregnancy rates. A Chinese nationwide ART registry should be promoted.

Effects of piroxicam administration on pregnancy outcome in intrauterine insemination (IUI) cycles: a randomized clinical trial

Background: Uterus contractibility is considered a powerful prognostic factor in predicting the embryo transfer outcome. Moreover, uterine contractions are known to be stimulated by prostaglandins which are produced by cyclooxygenase from arachidonic acid. As such, suppressing the inflammatory response and contractions using anti-inflammatory and relaxant agents is expected to result in increased success rate of embryo transfer and artificial insemination. Objective: To investigate the effect of piroxicam administration on the success rate in intrauterine insemination (IUI) cycles in patients presenting with unexplained infertility. Materials and Methods: This randomized, placebo-controlled clinical trial included 260 women with unexplained infertility undergoing IUI cycles. Patients were randomly assigned to receive either piroxicam ten mg/day on days 4-6 after IUI or placebo (control group). The main outcome measures were number of IUI cycles, pregnancy, abortion, and multiple pregnancy rates. Results: The pregnancy rate was found to be 25 (19.2%) and 16 (12.3%) in piroxicam and control groups, respectively (p = 0.039). Five patients (3.8%) in piroxicam group experienced twin pregnancy whereas only three patients (2.3%) in control group had twin pregnancy (p = 0.361). The pregnancy rate per cycle was also significantly higher in those who received piroxicam as compared to controls (11.16 vs. 6.66; p = 0.021). Conclusion: Administration of piroxicam after IUI is associated with decreased number of cycles, as well as increased pregnancy rate and pregnancy rate per cycle in IUI cycles. However, piroxicam did not have any effect on abortion, multiple pregnancy, and ongoing pregnancy rates.

Endometrial thickness and pregnancy outcome after intrauterine insemination

To investigate whether endometrial thickness on the day of hCG administration is a predictor of intrauterine insemination (IUI) success. A retrospective study. Two hundred forty-nine women undergoing IUI cycles. University hospital-based infertility center. Endometrial thickness on the day of hCG administration, cycle parameters, and sperm quality were compared between pregnant and nonpregnant patients. A similar comparison was made between ongoing pregnancies and those that resulted in a loss. Endometrial thickness versus IUI outcome. The overall pregnancy rate was 15%. Mean (+/- standard deviation) endometrial thickness on the day of hCG administration was significantly greater in cycles where pregnancy was achieved (10.1 +/- 3.0 vs. 7.7 +/- 3.5). In the univariate analysis, the following variables affected the pregnancy rate: the woman's age, duration of infertility, the number of IUI cycles, the number of follicles, the diameter of the dominant follicle, the duration of follicle maturation, and sperm count, motility, and morphology. In the multivariate analysis, the strongest predictor of IUI success was the number of IUI cycles. The woman's age was negatively associated with pregnancy outcome, while endometrial thickness and the total motile sperm count were positively associated with pregnancy outcome. The results of the present study suggest that clinicians providing IUI for infertile couples must pay close attention to endometrial development as well as to follicle growth and sperm motility.

Patients' preferences for intrauterine insemination or in-vitro fertilization

Patients' preferences for intrauterine insemination (IUI) relative to IVF were assessed using trade-off interviews, and the number of IUI cycles they would undergo before changing to IVF. A total of 73 couples undergoing IUI with a total of 111 interviews were included. Scenarios were offered where pregnancy chance after IUI was varied against a fixed pregnancy rate after IVF. The impact of multiple pregnancy risk on the couple's preference was also investigated. Interviews were held before starting IUI, after three or four IUI cycles and after six IUI cycles. With decreasing probability of ongoing pregnancy after IUI, an increasing number of couples switched their preference from IUI to IVF. This switch occurred after six cycles at a significantly higher (P = 0.01) mean cumulative pregnancy rate (53%) compared with other groups (31%). With increasing risk of multiple pregnancy, preference for IUI declined only slightly, with mean risks of 73, 78 and 83% of a multiple pregnancy for the three groups respectively. In conclusion, at baseline and after three cycles of IUI the majority of couples undergoing IUI preferred continuation of IUI over IVF. A clear shift in preference towards IVF occurred after six cycles. Risk of multiple pregnancy did not affect preference for IUI with ovarian stimulation.

Antisperm antibody production following intrauterine insemination

Fifty-one infertile women were studied prospectively to assess whether intrauterine insemination (IUI) led to the development of antisperm antibodies in cervical mucus and/or serum. All women were tested for the presence of antisperm antibodies in cervical mucus and serum before and after IUI treatment. Each woman underwent between 1 and 9 cycles of IUI (mean: 4.0 cycles). Five women (9.8%) developed serum antisperm antibodies after IUI treatment. Three of 49 women (6.1%) developed cervical mucus antisperm antibodies and three other women demonstrated disappearance of antibodies following IUI treatment. IUI did not increase mucus or serum antibody titres in women who presented with antisperm antibodies. The number of IUI cycles did not correlate with the development of antisperm antibodies. We conclude that IUI increases the risk of the female partner developing systemic antisperm antibodies but the clinical significance of this finding in unclear.