Outcome Of Intrauterine Insemination Research Articles

Unlocking fertility success: A comprehensive exploration of age and intrauterine insemination outcomes

Unlocking fertility success: A comprehensive exploration of age and intrauterine insemination outcomes

The impact of estradiol supplementation on endometrial thickness and intrauterine insemination outcomes

The impact of estrogen supplementation during the follicular/proliferative phase on the endometrial lining thickness (EMT) prior to intrauterine insemination (IUI) remains largely unstudied. Our study examined changes in EMT and rates of clinical pregnancy, miscarriage, and live birth for all patients who completed an IUI cycle at Stanford Fertility Center from 2017–2023 (n = 2281 cycles). Cycles with estradiol supplementation (n = 309) were compared to reference cycles without supplementation (n = 1972), with the reference cohort further categorized into cycles with a pre-ovulatory EMT of < 7 mm (“thin-lining”, n = 536) and ≥ 7 mm (“normal-lining”, n = 1436). The estradiol group had a statistically significant greater change in EMT from baseline to ovulation compared to the thin-lining reference groups (2.4 mm vs 1.9 mm, p < =0.0001). Similar rates of clinical pregnancy and live birth were observed. After adjusting for age, BMI, race/ethnicity, infertility diagnosis, and EMT at trigger, the estradiol cohort had a significantly increased odds of miscarriage versus the entire reference cohort (2.46, 95 % confidence interval [1.18, 5.14], p = 0.02). Thus, although estradiol supplementation had a statistically significant increase in EMT compared to IUI cycles with thin pre-ovulatory EMT (<7 mm), this change did not translate into improved IUI outcomes such as increased rates of clinical pregnancy and live birth or decreased rate of miscarriage. Our study suggests that supplemental estradiol does not appear to improve IUI outcomes.

Effect of follicle size on pregnancy outcomes in patients undergoing first letrozole-intrauterine insemination.

Letrozole has been proven to be an effective method for inducing ovulation. However, littleattentionhasbeenpaidto whether the lead follicle size will affect the success rate of intrauterine insemination (IUI) with ovulation induction with alone letrozole. Therefore, we hope to investigate the effect of dominant follicle size on pregnancy outcomes on human chorionic gonadotropin (hCG) day of the first letrozole-IUI. A retrospective cohort study design was employed. We included patients with anovulation or unexplained infertility undergoing first IUI treatment with letrozole for ovarian stimulation. According to the dominantfolliclesize measured on the day of hCG trigger, patients were divided into six groups (≤ 18mm, 18.1-19.0mm, 19.1-20.0mm, 20.1-21.0mm, 21.1-22.0mm, > 22mm). Logistic models were used for estimating the odds ratios (ORs) with their 95% confidence interval (CIs) for achieving aclinicalpregnancyor alivebirth. A restricted cubic spline was drawn to explore the nonlinear relationship between follicle size and IUI outcomes. A total of 763 patients underwent first letrozole-IUI cycles in our study. Fisherexact test showed significant differences among the six follicle-size groups in the rates of pregnancy, clinical pregnancy and live birth (P < 0.05 in each group). After adjusting the potential confounding factors, compared with the follicles ≤ 18mm in diameter group, 19.1-20.0mm, 20.1-21.0mm groups were 2.3 or 2.56 times more likely to get live birth [adjusted OR = 2.34, 95%CI (1.25-4.39); adjusted OR = 2.56, 95% CI (1.30-5.06)]. A restricted cubic spline showed an invertedU-shaped relationship between the size of dominant follicles and pregnancy rate, clinical pregnancy rate, and live birth rate, and the optimal follicle size range on the day of hCG trigger was 19.1-21.0mm. When the E2 level on the day of hCG trigger was low than 200pg/mL, the clinical pregnancy rates of 19.1-20.0mm, 20.1-21.0mm groups were still the highest. The optimal dominant follicle size was between 19.1 and 21.0mm in hCG-triggered letrozole-IUI cycles. Either too large or too small follicles may lead to a decrease in pregnancy rate. Using follicle size as a predicator of pregnancy outcomes is more meaningful when estrogen on the day of hCG trigger is less than 200pg/ml.

The relationship between duration of infertility and clinical outcomes of intrauterine insemination for younger women: a retrospective clinical study

BackgroundThe objective of this research was to elucidate the association between the length of infertility and the outcomes of intrauterine insemination (IUI) in women of varying ages - a topic that has been the subject of investigation for numerous years, yet lacks a definitive consensus.MethodsA retrospective cohort investigation involving 5268 IUI cycles was undertaken at the Reproductive Medicine Center of Nanjing Drum Tower Hospital from 2016 to 2022. Utilizing the smooth fitting curve along with threshold and saturation effect analysis, the correlation between infertility duration and IUI clinical pregnancy rates was discerned. Moreover, patients were bifurcated into two cohorts based on their respective infertility durations. A secondary examination was also performed employing propensity-score matching to mitigate the impact of confounding variables. Subsequent threshold and saturation effect analysis was carried out across various subgroups, segmented on the basis of age differentiation.ResultsWhen the duration of infertility was more than 5 years, the clinical pregnancy rate decreased with the increase of infertility duration (aOR: 0.894, 95%CI: 0.817–0.991, p = 0.043). The multivariate regression analysis suggested that longer duration of infertility (≥ 5 years) was significantly correlated with the lower clinical pregnancy rate (aOR: 0.782, 95% CI: 0.643–0.950, p = 0.01). After the propensity-score matching, the clinical pregnancy rate of women with longer infertility duration were also higher. When the duration of infertility was more than 5 years, the clinical pregnancy rate of women younger than 35 years old decreased with the increase of infertility duration (aOR: 0.906, 95%CI: 0.800–0.998, p = 0.043).ConclusionsThe clinical pregnancy rate and live birth rate of IUI in young women (< 35 years old) who have been infertile for more than 5 years significantly decrease with the prolongation of infertility time. Therefore, for young women who have been infertile for more than 5 years, IUI may not be the best choice.

Outcome of intrauterine insemination in couples with unexplained or male factor infertility at National Referral Hospital of Bhutan

Objectives: Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) is the only facility offering intrauterine insemination (IUI) services in the country. In this study, we aim to study the success rate of IUI for the year 2022. Material and Methods: This retrospective study utilized secondary data extracted from the medical records of a cohort of 57 patients who underwent IUI procedures at the infertility clinic between January and December 2022. Ethical clearance and site approval were obtained from the Institutional Review Board at Khesar Gyalpo University of Medical Sciences of Bhutan and JDWNRH, respectively. The Statistical Package for the Social Sciences version 26.0 by IBM Corp in Armonk, NY, was used to calculate frequencies, percentages and create statistical diagrams. Results: In the year 2022, the overall success rate of IUI was 5.3%. A majority of infertile men, representing 78.9%, fell within the age range of 30–39 years, and oligozoospermia emerged as the most common semen abnormality, affecting 45.6% of the infertile men in this study. Conclusion: Our study revealed that the IUI success rate in the country was 5.3%. This success rate of IUI in the country was found to be low compared to the success rate in neighboring countries. This is important information for patients to make informed decisions, aids fertility specialists in devising treatment plans, directs the allocation of resources, drives research and development initiatives, and informs policy and strategic adjustments at the national level.

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.

The Effect of Intra-Catheter Air Volume on the Outcome of Intrauterine Insemination (IUI): A Clinical Trial Study

The Effect of Intra-Catheter Air Volume on the Outcome of Intrauterine Insemination (IUI): A Clinical Trial Study

Impact of current and previous sperm findings on outcomes of intrauterine insemination.

To examine the association between semen characteristics and outcomes of intrauterine insemination (IUI). This retrospective analysis examined 1380 IUI procedures involving 421 couples. The association of clinical pregnancy with pre- and post-wash sperm characteristics was assessed. Pre- and post-wash sperm characteristics did not differ between IUI cycles that resulted in pregnancy and those that did not. When the motility of pre-wash sperm was below the normal range (<42%) established by the World Health Organization (WHO), the pregnancy rate was significantly lower. In the IUI cycles when post-wash sperm motility was below the WHO standard, pregnancy was not achieved. The frequency of improvement in post-wash sperm motility in repeated IUI cycles appeared to correlate with the success of future IUI cycles. At the fourth IUI cycle, pregnancy was not achieved unless the post-wash sperm motility was normal in at least two of three attempts. When post-wash sperm concentration was below the normal range, the woman's age did not affect the IUI outcomes. Sperm motility above the lower limit of the WHO criteria in post-wash semen samples is an important factor in IUI outcomes.

#317 : The Clinical Outcome of Ovarian Stimulation Undergoing Intrauterine Insemination with Follitropin Delta in Indonesian Women

Background and Aims: Intrauterine insemination (IUI) has been widely used as a common treatment for infertile couples due to its simplicity and low cost. Numerous studies have shown that IUI cycles with controlled ovarian stimulation (COS) result in higher pregnancy rates compared to those without COS. Follitropin delta, a novel recombinant FSH (rFSH) can be used for controlled ovarian stimulation in women undergoing assisted reproductive technologies (ART) and was dosed individually based on serum anti-Müllerian hormone (AMH) concentration and body weight. In this study, we used a simplified dosage equivalent method. The aim of this study was to compare the efficacy and safety of follitropin delta in its simplified dosage equivalent regimen with follitropin alfa in a conventional dose regimen in Indonesian women undergoing intrauterine insemination. Method: A single-center, retrospective observational study from January 2020 to December 2022 was performed in 228 IUI cycles in Halim Fertility Center, Indonesia. Controlled Ovarian Stimulation was performed during IUI cycles and divided into two groups: group I received follitropin delta with a simplified dosage equivalent regimen, and group II received follitropin alfa with a conventional dose. The baseline characteristics, cycle parameters, and IUI outcomes of both groups were compared. Results: Our study included 228 IUI cycles with the follitropin delta group (114 IUI cycles) and the follitropin alfa group (114 IUI cycles). The clinical pregnancy rate was higher in the follitropin delta than the follitropin alfa but there was no significant difference between the groups (p&gt;0.05). The multiple pregnancy rate and Ovarian Hyperstimulation Syndrome (OHSS) rates were lower in follitropin delta than follitropin alfa but there was no significant difference between the groups (p&gt;0.05). Conclusion: Follitropin delta with a simplified dosage equivalent regimen showed higher efficacy and similar safety compared with follitropin alfa in conventional dosing regimen in Indonesian women undergoing Intrauterine insemination.

Effect of female body mass index on intrauterine insemination outcomes: a systematic review and meta-analysis

The prevalence of women with a raised body mass index (BMI) seeking assisted conception treatment is increasing. Findings of existing studies evaluating the effect of female BMI on intrauterine insemination (IUI) treatment outcomes remain inconsistent. This systematic review and meta-analysis evaluate the effect of female BMI on IUI treatment outcomes. Two authors independently conducted data extraction and assessed study quality. Risk ratios (RR) and 95% confidence intervals were calculated using the Mantel-Haenszel approach for dichotomous outcomes. 11 studies involving 23,145 IUI treatment events, comprising 21,211 cycles from 8 studies, and 1,934 participants in three studies, met the inclusion criteria for the meta-analysis. Two cohorts of women undergoing IUI treatment were compared - women with normal BMI < 25 kg/m2 were compared with a second cohort of women with a BMI category ≥ 25 kg/m2. There was no statistically significant difference in live birth rate (LBR) (RR 1.06, 95% CI 0.86–1.307); clinical pregnancy rate (CPR) (RR 0.94, 95% CI 0.78–1.13); miscarriage (RR 0.92, 95% CI 0.31–2.74) or ectopic pregnancy rate (RR 2.20, 95% CI 0.78–6.23). Our meta-analysis showed that a raised female BMI did not affect IUI treatment outcomes. Nevertheless, weight loss counselling should be offered to women with a raised BMI undergoing IUI, to reduce the associated obstetric morbidity.

Should IUI replace IVF as first-line treatment for unexplained infertility? A literature review

BackgroundUnexplained infertility accounts for 25% of infertility causes in the UK. Active intervention methods, such as intrauterine insemination (IUI) or in vitro fertilisation (IVF), are often sought. Despite the National Institute for Health and Care Excellence (NICE) recommending IVF for unexplained infertility, this recommendation has generated an ongoing debate, with few fertility clinics discontinuing the use of IUI as the first-line management of choice. In contrast to NICE, recent guidance released from the European Society for Human Reproduction and Embryology (ESHRE) in August 2023 supports the use of IUI as first-line. High-quality evidence behind such interventions is lacking, with current literature providing conflicting results.AimsThis review aims to provide a literature overview exploring whether IUI or IVF should be used as first-line treatment for couples with unexplained infertility, in the context of current guidelines.MethodsThe primary outcome used to assess efficacy of both treatment methods is live birth (LB) rates. Secondary outcomes used are clinical pregnancy (CP) and ongoing pregnancy (OP) rates. A comprehensive literature search of 4 databases: Ovid MEDLINE, EMBASE, Maternity & Infant Care and the Cochrane Library were searched in January 2022. Upon removal of duplications, abstract screening, and full-text screening, a total of 34 papers were selected.Discussion/conclusionThis review highlights a large discrepancy in the literature when examining pregnancy outcomes of IUI and IVF treatments. Evidence shows IUI increases LB and CP rates 3-fold compared to expectant management. Literature comparing IUI to IVF is less certain. The review finds the literature implies IVF should be used for first-line management but the paucity of high-quality randomised controlled trials (RCTs), coupled with heterogeneity of the identified studies and a lack of research amongst women > 40 years warrants the need for further large RCTs. The decision to offer IUI with ovarian stimulation (IUI-OS) or IVF should be based upon patient prognostic factors. We suggest that IUI-OS could be offered as first-line treatment for unexplained infertility for women < 38 years, with good prognosis, and IVF could be offered first to those > 38 years. Patients should be appropriately counselled to enable informed decision making.

Pregnancy outcomes of intrauterine insemination in young patients with diminished ovarian reserve: a multicenter cohort study

BackgroundTo date, there is no consensus on whether intrauterine insemination (IUI) treatment is required in young patients with diminished ovarian reserve (DOR). Pregnancy outcomes in young DOR patients undergoing IUI are controversial. The existing studies are all single-center studies, with no existing multicenter cohort studies. The purpose of this multicenter study was to investigate the pregnancy outcomes of young DOR patients undergoing IUI.MethodsThis multicenter cohort study included a total of 4600 cycles in 2204 infertile patients who underwent IUI treatment in three reproductive medical centers between September 2018 and January 2022. The research subjects were divided into two groups according to their serum anti-Müllerian hormone (AMH) levels. Propensity score matching (PSM) was used to match the research subjects at a ratio of 1:4. The pregnancy outcomes in the two groups were compared.ResultsThere was no significant difference in the clinical pregnancy rates (CPR), biochemical rates, and ectopic pregnancy rates between the two groups (P > 0.05). There were, however, significant differences in the miscarriage rates between the groups (P < 0.05). The live birth rates (LBR) were 6.6 vs. 9.9 between the two groups. The multivariable logistic regression models reveal that body mass index, AMH were significantly correlated with CPR; AMH were significantly correlated with LBR; BMI, follicle stimulating hormone were significantly correlated with miscarriage rate.ConclusionsThe clinical pregnancy rate of DOR patients was not significantly different from that of NOR patients; however, the miscarriage rates were significantly different from those of NOR patients.

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.

P-033 Impact of the sperm reactive oxygen species on Intrauterine Insemination outcome

Abstract Study question Does sperm reactive oxygen species values affect the pregnancy rate after Intrauterine Insemination (IUI)? Summary answer Sperm reactive oxygen species values affect pregnancy rate and can be used as a predictive marker for IUI outcome. What is known already Oxidative stress resulting from excessive production of reactive oxygen species (ROS) can profoundly affect the sperm and subsequent functional sperm integrity. Diagnostics to measure semen oxidative stress have been added to the 6th edition of the WHO laboratory manual for examining and processing of human semen, under advanced examinations. Although a semen analysis has classically been used as the gold standard for determining a man’s fertility, basic sperm analysis alone cannot accurately predict infertility since between 6 and 27 % of men with normal semen parameters are infertile. Determination of oxidative stress in diagnosing infertility may contribute to better outcomes. Study design, size, duration This study was based on semen analyses of 50 male patients whose samples were used for IUI treatment between November 2022 and January 2023. The oxidation-reduction potential was measured using novel galvanostat-based technology, the MiOXSYS System. Briefly, 30 μL of liquefied semen at room temperature were applied to the MiOXSYS sensor. Both absolute ORP (mV) and normalized sORP values ( mV/10 6 sperm/ml) based on sperm concentration were calculated. Participants/materials, setting, methods Sperm analysis were performed according to the WHO laboratory manual sperm criteria (Sixth edition 2021). All participants followed a period of 3–5 days of sexual abstinence and had a diagnosis of unexplained infertility (normozoospermia). Ovarian stimulation for IUI cycle was initiated on the 5th day of menstruation by using recombinant gonadotropins. Clinical pregnancy was determined based on the Beta-hCG values. For statistical comparison between group values the Mann-Whitney U test was used. Main results and the role of chance According to the guidelines of the World Health Organization, all participants included in the study had normal BMI (21.85±3.80 kg/m2). The average age of the female patients included in the study was 33.9 ± 3.1 years while the average age of the male patients was 37.8 ± 4.8 years. Out of the 50 patients, 32% (N = 16) got pregnant. For the study propose sperm ORP and sORP values were compared between patients based on the pregnancy outcome. Statistical analysis showed a significant difference in ORP values. Patients with a positive pregnancy outcome after IUI had a lower ORP value compared to patients where IUI was not successful [25.65 [6.7-52.6] mV vs. 40.2 [6.3-109.8] mV, respectively, p = 0.02]. Additionally, normalized values according to the sperm concentration (sORP) were also significantly different between those groups [ 0.37(0.17-1.44) mV/10 6 sperm/ml vs. 0.88(0.13-20.81) mV/10 6 sperm/ml, respectively p = 0.006]. Due to the above-mentioned significant difference logistic regression analysis were performed, and the obtained results confirm that sperm ORP (p = 0.02) as well sORP (p = 0.016) significantly affects the pregnancy rate after the IUI procedure. Limitations, reasons for caution The limitation of the presented study was a relatively small patient cohort. Additionally, pregnancy was determined based on the beta hCG values, therefore future research should link ORP values and live birth rate as well. Wider implications of the findings In the present study suggests ORP as an additional parameter with diagnostic value to identify the best therapeutic approach concerning IUI in couples that show minimal or no impairments of the WHO semen parameter. Trial registration number not applicable

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.