Pregnancy Rates In Intrauterine Insemination Cycles Research Articles

P-652 RCT to evaluate the necessity of routine luteal phase support after ovarian stimulation by oral ovulogens in intrauterine insemination (IUI) cycles

Abstract Study question 1. Is it beneficial to provide luteal phase support in each IUI cycle stimulated by oral ovulogens ? Summary answer 1. Luteal phase support with progesterone makes no significant difference in clinical pregnancy rate in oral ovulogen stimulated IUI cycles. What is known already ART (assisted reproductive techniques) involves superovulation to achieve the development of multiple follicles. This produces supraphysiological E2 levels that causes feedback inhibition of FSH and LH in luteal phase leading to luteal phase defect. In IUI,only few follicles develop ,so the above phenomenon is rarely seen. Today widespread use of progesterone in clinical practice has become a habit, instead of the need, adding to burden of medication and cost to the patient without much evidence to recommend it. Study design, size, duration Prospective Randomized control over 1 year 200 IUI cycles randomized to either supplementing luteal phase with tab dydrogesterone (Group A ,no.100) or not supplementing (Group B, No. 100) as per inclusion(Unexplained infertility,Mild male factor,Donor sperm IUI, PCOD,Coital factors,Mild endometriosis) and exclusion criteria(IUI with gonatotropin, age more than 38 years, thin endometrium ,previous two or more IUI failures, history suggestive of luteal phase defect, recurrent pregnancy loss, structural uterine anomaly, history of endocrine or autoimmune diseases) Participants/materials, setting, methods Transvaginal scan was conducted on day 2 , followed by ovarian stimulation with letrozole 2.5 mg for 5 days. HCG trigger (10000IU) was given When follicle reached 18- 24mm with endometrium >7mm and IUI timed 36 hours after. Computer generated random allocation was done with one group receiving luteal phase support with tab dydrogesterone 10mg twice a day(Group A)and other not receiving LPS(Group B).Outcome of study was studied in terms of clinical pregnancy on USG. Main results and the role of chance Among the patients recruited, infertility was observed to be primary infertility in 74% cases in Group B and 72% in Group A , whereas secondary infertility was observed in 26% cases in group B and 28% in group A (P = 0.75). Group B included mild male factor in 29%, 24% of polycystic ovarian syndrome, 17 % tubal, 15% poor ovarian reserve, 9% of unexplained and 6% had endometriosis. Whereas in group A, PCOS (25%),male factor (21%),poor ovarian reserve and unexplained in 20%, endometriosis in 8% and 6% had tubal infertility. Among patients, mean endometrium thickness on trigger day of group Band group A were 8.46 ± 1.36mm and 8.44 ± 1.17mm respectively. Conception was reported by a positive urine pregnancy test . Among Group B , 23% had a positive urine pregnancy test. Whereas, in controls Group A 21% had a positive test, the difference being statistically non-significant (p value = 0.733) Outcomes were expressed terms of clinical pregnancy described as the presence of intrauterine sac with foetal heart rate. Clinical pregnancy rate was 22% of group B and 21% in group A , difference was statistically nonsignificant (p = 0.755). Limitations, reasons for caution Due to limited period of study and hence restricted sample size, the trial needs to be extended over a larger sample size for further interpretation. Further subgroup analysis needs to be conducted when a larger study group is recruited. Wider implications of the findings This study suggested that luteal support does not significantly affect the clinical pregnancy rate in IUI cycles with oral ovulogens .Our study could be a basis for further analysis to determine whether treatment burden in the form of luteal phase support can be reduced in such patients. Trial registration number not applicable

Relationship between Number of Mature Follicles and Pregnancy Rates in IUI Cycles in Women 38 to 43 Years Old

Background: Although the number of follicles at intrauterine insemination (IUI) is associated with the pregnancy rates and multiple pregnancy rates. Multiple pregnancy rates are low in older women. Therefore, this study was undertaken to determine the clinical pregnancy rate of IUI in women 38–43 years of age based on the number of stimulated mature follicles. Methods: A retrospective cohort study was performed including all the first to third stimulated IUI cycles conducted after the age of 38 years in a single academic fertility center between January 2011 and March 2018. Results: A total of 1574 IUI cycles were included in the study. The patients were divided according to the number of mature follicles (>14 mm in diameter) at the last ultrasound before the human chorionic gonadotropin (hCG) trigger. The total pregnancy rate was 9.1% and only 5 multiple pregnancies occurred. The parity (p = 0.049), the number of follicles 10–14 mm (p = 0.002), and the peak endometrial thickness (p = 0.003) were significantly different between the groups. No statistical difference was observed between the groups regarding pregnancy rates (p = 0.93) and clinical pregnancy rates (p = 0.21). Multivariate logistic regression controlling for confounding effects comparing clinical pregnancy rates with the standard as 1 follicle 14 mm or greater as benchmark did not alter the results. Conclusions: In women 38 to 43 years of age undergoing controlled ovarian hyperstimulation (COH)/IUI, one mature follicle yielded similar pregnancy and clinical pregnancy rates compared to multiple follicles, possibly due to the aneuploidy rate at this age.

Impact of the sexual abstinence period on the production of seminal reactive oxygen species in patients undergoing intrauterine insemination: A randomized trial.

To evaluate whether the duration of sexual abstinence has impact on oxidative stress in semen samples. Oxidative reaction was tested for different levels of reactive oxygen species (ROS) by nitro blue tetrazolium assay in 90 patients with the diagnosis of unexplained or male factor infertility that were grouped into 3 groups as 0-2 (group 1), 3-4 (group 2) and >4 days (group 3) of duration of sexual abstinence. Subsequently, the remaining semen was prepared by gradient method for ovarian stimulation and intrauterine insemination (IUI) cycles to compare pregnancy rates in terms of different levels of ROS and different abstinence periods. Increased staining pigment intensity was related to higher level of ROS in >4 days' group as compared to groups 0-2 and 3-4 days (70% vs 43.3% and 50%, P = 0.013 and P = 0.014, respectively). Pregnancy rates significantly decrease with prolonged abstinence period (26.7%, 16.7% and 6.7% in groups 1, 2 and 3, respectively, P = 0.039). Progressive motile sperm count after gradient method of sperm preparation for IUI was highest in 3-4 days of abstinence period than shorter and longer abstinence groups. Longer duration of sexual abstinence causes higher oxidative stress and decreases pregnancy rates in IUI cycles.

The Effect of Sperm DNA Fragmentation Index on the Outcome of Intrauterine Insemination and Intracytoplasmic Sperm Injection.

Context:Elevated sperm DNA fragmentation index (DFI) is found to affect normal embryonic development, implantation and fetal development after intrauterine insemination (IUI), in vitro fertilization and intracytoplasmic sperm injection (ICSI). Estimation of DFI by terminal deoxynucleotidyl transferase-mediated fluorescent deoxy uridine nucleotide nick end labeling (TUNEL) assay was found to have a high predictive value for pregnancy after fertility treatments.Aim:This study aims to find the effect of increased sperm DNA fragmentation by TUNEL assay on reproductive outcome after IUI and ICSI.Primary Objective:To find the association of DFI and pregnancy rate in IUI and ICSI.Secondary Objectives:To find the association of DFI with fertilization and implantation in ICSI. To find the association of DFI with miscarriage rate.Settings and Design:A prospective observational study performed at a tertiary care university teaching hospital.Subjects and Methods:105 male partners of infertile couple planned for IUI and ICSI underwent estimation of sperm-DFI by TUNEL assay. The treatment outcomes were compared between the DFI-positive (≥20%) and DFI-negative (<20%) groups.Statistical Analysis Used:Statistical analysis was performed by SPSS version 17, Software. P < 0.05 was considered statistically significant.Results:The men with abnormal semen analysis were significantly higher in the DFI-positive group (77.15% vs. 22.85%). There was no significant difference in the pregnancy rate in IUI cycles (17.6% vs. 11.8%); but in the ICSI, the pregnancy rate was significantly reduced in the DFI-positive group (16.7% vs. 47.4%).Conclusions:Elevated DFI significantly affects the pregnancy rate in ICSI cycles.

Endometrial scratch injury before intrauterine insemination: is it time to re-evaluate its value? Evidence from a systematic review and meta-analysis of randomized controlled trials

To assess the impact of endometrial scratch injury (ESI) on the outcomes of intrauterine insemination (IUI) stimulated cycles. Systematic review and meta-analysis. Not applicable. Infertile women undergoing one or more IUI stimulated cycles. Randomized controlled trials (RCTs) were identified by searching electronic databases. We included RCTs comparing ESI (i.e., intervention group) during the course of IUI stimulated cycle (C-ESI) or during the menstrual cycle preceding IUI treatment (P-ESI) with controls (no endometrial scratch). The summary measures were reported as odds ratio (OR) with 95% confidence-interval (CI). Clinical pregnancy rate, ongoing pregnancy rate, multiple pregnancy rate, ectopic pregnancy rate, miscarriage rate. Eight trials were included in the meta-analysis, comprising a total of 1,871 IUI cycles. Endometrial scratch injury was associated with a higher clinical pregnancy rate (OR 2.27) and ongoing pregnancy rate (OR 2.04) in comparison with the controls. No higher risk of multiple pregnancy (OR 1.09), miscarriage (OR 0.80), or ectopic pregnancy (OR 0.82) was observed in patients receiving ESI. Subgroup analysis based on ESI timing showed higher clinical pregnancy rate (OR 2.57) and ongoing pregnancy rate (OR 2.27) in patients receiving C-ESI and no advantage in patients receiving P-ESI. Available data suggest that ESI performed once, preferably during the follicular phase of the same cycle of IUI with flexible aspiration catheters, may improve clinical pregnancy and ongoing pregnancy rates in IUI cycles. Endometrial scratch injury does not appear to increase the risk of multiple pregnancy, miscarriage, or ectopic pregnancy.

The Effects of Endometrial Scratch on Pregnancy Rate in IUI Cycles

Objectives: Infertility is considered as a major issue all over the world. All the studies in this field focus on how to develop successful methods of turning infertile couples into fertile ones. Endometrial mechanical injury in order to augment the probability of implantation of embryo and pregnancy rate has been particularly noted in recent years. Considering the controversies in the use of methods and results of the previous studies, we decided to compare the pregnancy and abortion rates in the intrauterine insemination (IUI) cycles with and without intervention, by employing a new method. Materials and Methods: This interventional study was performed on 150 infertile couples who referred to the infertility treatment clinic of Al-Zahra hospital, Tabriz (from April 2016 to March 2017) and were randomly divided into two groups. The IUI procedure was carried out in the first group after the endometrial scratch on the first to fifth days of the menstrual cycle, while the control group underwent only IUI without any intervention. The pregnancy and abortion rates were compared in study groups. Results: Pregnancy rate in the intervention group was significantly higher compared to the control group. No relationship was observed between the abortion rate and the intervention. There was no statistically significant difference between type and cause of infertility, maternal age and body mass index (BMI), duration of infertility, number of dominant follicles and pregnancy or abortion rates. Conclusions: The endometrial scratching performed on the first to fifth days of the menstrual cycle, preceding IUI procedure, leads to a significant increase in pregnancy rate. On the other hand, this method can be employed with lower costs in comparison to other fertilization methods.

Pregnancy after endometrial scratching in infertile couples undergoing ovulation induction and intrauterine insemination cycles-a randomized controlled trial.

To study the effect of endometrial scratching in infertile couples undergoing ovulation induction and intrauterine insemination (IUI) cycles. A prospective randomized controlled trial was conducted in the Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India. One hundred forty-four women with primary/secondary infertility were recruited. Couples were either unexplained or male factor infertility. Subjects were randomized into intervention (scratching) and control group. All patients received ovulation induction with clomiphene citrate (day 2-6) 50mg/day +75IU HMG on days 6 and 7. In addition, endometrial scratching was done on day 8 of ovulation induction cycle in intervention group. All couples were planned for three cycles of ovulation induction and IUI over 6months. After each failed cycle, couple was advised to try for natural conception for one cycle. Those who conceived were excluded from further analysis. Primary outcome was clinical pregnancy rate. Secondary outcome measures included conception rate, ongoing pregnancy, abortion and ectopic rate. Baseline characteristics were comparable in both groups. Clinical pregnancy rate was significantly higher in intervention group (31.9%; 23/72) as compared to control group (16.7%; 12/72) (p value 0.030). On per cycle analysis, first IUI cycle had significantly high pregnancy rate (18.1%; 13/72) as compared to control group (5.6%; 4/72). Three patients in intervention group and one in control group conceived in wash out cycle. Ongoing pregnancy rate was significantly higher in scratching group (30.0%; 21/70) as compared to control group (15.7%; 11/70) (p value0.044). Endometrial scratching can be used as a low cost-effective tool to improve clinical pregnancy and ongoing pregnancy rate in IUI cycles. Further large number studies are required to document its role in improving live birth rate. CTRI/2015/12/006419.

Systematic evaluation of the influence of endometrial stimulation on pregnancy outcome in the patients with artificial insemination

Objective: The association between endometrial stimulation and the intrauterine insemination outcome remains to be a controversial issue, for there being all kinds of conflicting data in the existing literatures. We conducted a Meta-analysis case to verify the relations between endometrial stimulation and intrauterine insemination (IUI). Methods: The articles had been searched in the following online databases: MEDLINE, CNKI, VIP, Wan Fang, EMBASE and the Cochrane Library. All of the statistics quoted for our studies have been published in English or Chinese from Jan, 2000 to May, 2016. Among the 6 studies included in this Meta-analysis, all of them used a case - control design. All the 6 studies evaluated a total of 1349 participants, including 734 cases of endometrial injury. Results: The results of the Meta-analysis showed that patients with endometrial stimulation were more likely to receive clinical pregnancy than those who did not. Compared with the control group, the clinical pregnancy rate of experiment group was higher (RR=0.88, 95% CI: 0.82-0.95, P=0.001), while the differences between their abortion rate (RR=0.72, 95% CI: 0.37-1.4, P=0.33) and multiple pregnancies rate (RR=0.78, 95% CI: 0.3-2.01, P=0.60) were insignificant. Conclusions: Endometrial stimulation could help increase the pregnancy rate in IUI cycles, while the abortion rate and multiple pregnancies rate would not be raised.

The effect of preserving prepared sperm samples at room temperature or at 37 °C before intrauterine insemination (IUI) on clinical pregnancy rate.

Objective:The comparison of the effect of preserving prepared sperm samples at room temperature or at 37 °C before intrauterine insemination (IUI) on clinical pregnancy rate.Materials and Methods:Retrospective clinical research. University hospital, infertility clinic. Patients with one or two follicles, between the ages of 20 and 40, whose infertility period was less than 6 years and the injected total motile sperm count was more than 10 million. Preserving sperm samples prepared for IUI at 37 ºC or at room temperature before IUI.The clinical pregnancy rate of IUI cycles between 1st of January 2004 and 1st of December 2011 in which prepared sperm samples were preserved at 37 ºC and the clinical pregnancy rate of IUI cycles between 1st of December 2011 and 31st of May 2014 in which prepared sperm samples preserved at room temperature.Results:Clinical pregnancy rates were similar in IUI cycles in which prepared sperm samples were preserved at 37 ºC and at room temperature (9.3% vs. 8.9%). Clinical pregnancy rates in IUI cycles with 2 follicles were higher than IUI cycles with 1 follicle (10.8% vs. 7.6%) (p=0.002). Further statistical analysis after splitting data according to the number of the follicles revealed that there was no statistical difference between clinical pregnancy rates after IUI cycles in which prepared sperm samples were preserved at 37 ºC or at room temperature in both one follicle (7.6% vs. 7.6%), and two follicle cycles (11.5% vs. 10.1%).Conclusions:Preserving prepared sperm samples at room temperature had no negative effect on clinical pregnancy rates when compared with reserving prepared sperm samples at 37 ºC during IUI cycles.

Hyaluronan binding assay does not predict pregnancy rates in IUI cycles in couples with unexplained infertility

To investigate the relationship between hyaluronan binding (HB) assay and pregnancy rates in intrauterine insemination (IUI) cycles. This prospective cohort study was done in Hacettepe University, a tertiary care center for reproductive medicine. Seventy-one consecutive couples who suffered from unexplained infertility and underwent controlled ovarian hyperstimulation (COH) and IUI were enrolled into the study. From the 71 IUI patients, the clinical pregnancy rate was 14.1% (10 of 71). HB ratio from the overall patient number was 48.6±25.9. The mean HB ratio in pregnant and non-pregnant groups was comparable (50.2±25.2 vs. 48.3±26.2, respectively, p>0.05). Hyaluronan binding assay does not predict pregnancy rates in IUI cycles in couples with unexplained infertility.

Can endometrial movements affect the pregnancy rate in IUI cycles?

OBJECTIVE: This study was aimed to assess the effect of the endometrial movement on pregnancy achievement in women receiving ovulation induction by clomiphene citrate followed by intrauterine insemination (IUI).

Pre-hCG 3D and 3D power Doppler assessment of the follicle for improving pregnancy rates in intrauterine insemination cycles

BACKGROUND:The assessment of follicular maturity at the time of human chorionic gonadotropin (hCG) is one of the key factors for the success of all assisted reproductive techniques.AIM:To assess follicles by three dimensional (3D) and 3D power Doppler (PD) before giving hCG to improve pregnancy rates in intrauterine insemination (IUI) cycles.DESIGN:Prospective randomized study.MATERIALS AND METHODS:Ultrasound for pre-hCG follicular assessment was performed over a period of 10 months for all 1000 cycles of IUI. Follicular assessment was performed using a transvaginal multifrequency volume probe. Follicles considered mature by 2D US and color Doppler were assessed by 3D and 3D PD. These values were independently evaluated for the conception and the non-conception groups.RESULTS:Conception rates were 32.3 and 27% respectively and individually when the perifollicular resistance index was < 0.50 and the peak systolic velocity was > 11 cm/s 10-12 h before hCG. Conception rates of 32% were achieved with a follicular volume between 3 and 7 cc. The conception rate was 32.3% in the cumulus group. A perifollicular vascularity index of between six and 20 gave conception rates of 35% and perifollicular flow index of 27-43 gave conception rates of 33%.CONCLUSIONS:3D ultrasound is much more accurate for volume assessment of the follicle. Presence of cumulus increases the surety of the presence of a mature ovum in the follicle. 3D and 3D PD when used with 2D US and color Doppler for pre-hCG follicular assessment would definitely improve pregnancy rates in IUI cycles.

Does ovarian hyperstimulation in intrauterine insemination for cervical factor subfertility improve pregnancy rates?

Intrauterine insemination (IUI) can be performed with or without controlled ovarian hyperstimulation (COH). Studies in which the additional benefit of COH on IUI for cervical factor subfertility is assessed are lacking. We assessed whether COH in IUI improved pregnancy rates in cervical factor subfertility. We performed a historical cohort study among couples with cervical factor subfertility, treated with IUI. A cervical factor was diagnosed by a well-timed, non-progressive post-coital test with normal semen parameters. We compared ongoing pregnancy rate per cycle in groups treated with IUI with or without COH. We tabulated ongoing pregnancy rates per cycle number and compared the effectiveness of COH by stratified univariable analysis. We included 181 couples who underwent 330 cycles without COH and 417 cycles with COH. Ongoing pregnancy rates in IUI cycles without and with COH were 9.7% and 12.7%, respectively (odds ratio 1.4; 95% confidence interval 0.85-2.2). The pregnancy rates in IUI without COH in cycles 1, 2, 3 and 4 were 14%, 11%, 6% and 15%, respectively. For IUI with COH, these rates were 17%, 15%, 14% and 16%, respectively. Although our data indicate that COH improves the pregnancy rate over IUI without COH, IUI without COH generates acceptable pregnancy rates in couples with cervical factor subfertility. Since IUI without COH bears no increased risk for multiple pregnancy, this treatment should be seriously considered in couples with cervical factor subfertility.

Intrauterine insemination after ovarian stimulation as a treatment for subfertility because of subnormal semen: a prospective randomized controlled trial

To determine whether intrauterine insemination (IUI) after ovarian stimulation with human menopausal gonadotropin (hMG) gives a better pregnancy rate (PR) than natural intercourse in couples with subfertility because of subnormal semen. Prospective randomized controlled trial. University based subfertility clinic. Couples with subnormal semen as the only identifiable cause of subfertility. In control cycles, the couples had natural intercourse. In IUI cycles, IUI was performed after ovarian stimulation with hMG and human chorionic gonadotropin. The clinical PRs and complications of IUI cycles and control cycles were compared. There were six clinical pregnancies in the 42 IUI cycles, whereas there was no clinical pregnancy in the 42 control cycles. The clinical PR in IUI cycles (14.3% per cycle) was significantly higher than that in control cycles (0%). Six patients (14.3%) developed moderate degree of ovarian hyperstimulation syndrome in IUI cycles. Intrauterine insemination after ovarian stimulation with hMG is useful in treatment of subfertile couples with subnormal semen.