Pregnancy Rates In Intrauterine Insemination Research Articles

P-051 Results of Intrauterine Insemination (IUI) with donor semen in women with poor ovarian reserve

Abstract Study question If we have a woman with a poor ovarian reserve, will she have a lower chance of pregnancy after a cycle of IUI? Summary answer A woman with a poor ovarian reserve has a lower chance of pregnancy, although in donor IUI we have an acceptable rate of pregnancy. What is known already Actually, the better predictor to define a poor ovarian reserve is a low antimullerian hormone (AMH). AMH is a well-known predictor of ovarian reserve, which allow to predict a response after an in vitro fecundation (IVF) cycle. Nevertheless, we also know that a low AMH does not mean to be not able to get pregnant. Few studies have compared different markers of ovarian reserve as predictors of pregnancy after an IUI cycle, and those which have done it have conflictive results. Maternal age seems to be strongly linked with the chance of pregnancy. Study design, size, duration We designed a retrospective cohort study with longitudinal follow-up upon the patients who undergo an IUI cycle in a public hospital of third level (Hospital Virgen del Rocio, Seville, Spain). We included 1059 cycles of IUI (383 with conjugal and 676 with donor semen) between 2015 and 2021. These cycles belong to 390 patients (64 with poor ovarian reserve and 326 with normal ovarian reserve). Participants/materials, setting, methods We collected data from clinical history which is completed during the visit of the patients. Cohort was stratified between patients with a low AMH (<1.1 ng/ml) and normal AMH (>1.1 ng/ml). We used this cut point following the definition of our regional guideline that includes when we can practice fertility treatments. Our main variable was pregnancy rate, defining pregnancy as an echography at 7 weeks with at least one embryo with cardiac activity. Main results and the role of chance When we compared pregnancy rate between normal ovarian reserve against poor ovarian reserve, we did not find statistically significant results in conjugal IUI independently that we compared by cycle (11.2% in normal ovarian reserve vs 3.8% in poor reserve (p = 0.2)) or by couple (27.97% in normal ovarian reserve vs 8.3% in poor ovarian reserve (p = 0.1)). We found differences with the same comparison in donor IUI by cycle (20.2% normal reserve vs 6.8% in poor reserve (p = 0.001)) and by couple (56.83% in normal ovarian reserve vs 21.15% in poor reserve (p = 0.001)). Nevertheless, pregnancy rate in IUI was similar to what we will get with an IVF cycle with only one oocyte. We compared pregnancy rate between normal ovarian reserve patients who undergo a conjugal IUI cycle, with low reserve patients who undergo a donor IUI cycle. When we compared by cycle normal ovarian reserve patients had 11.2% pregnancy rate, while poor ovarian reserve patients had a 6.8% (p = 0.1). When we compared by couple normal ovarian reserve patients had a pregnancy rate of 27.97% while poor ovarian reserve patients had a 21.15% (p = 0.3). Actually, our regional guide excludes poor ovarian reserve woman of an IVF cycle in the public system. Limitations, reasons for caution We had the proper limitations of an observational retrospective study. As we are a public center, we must follow our regional guide which defines whether we can do a treatment or not. Wider implications of the findings Patients with a poor ovarian reserve have a lower pregnancy rate during IUI with donor semen. Nevertheless, this rate could be acceptable especially when we cannot offer them an IVF cycle in public healthcare. Trial registration number Not applicable

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

AMH, induction protocols, age and total motile sperm count do not affect the pregnancy rates in intrauterine insemination: a single center retrospective study

AMH, induction protocols, age and total motile sperm count do not affect the pregnancy rates in intrauterine insemination: a single center retrospective study

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.

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.

Does luteal Phase Support with Vaginal Micronized Progesterone Effect on Pregnancy Rates in Intrauterine Insemination (IUI) Cycles in Two Infertility Center During Six-Year Follow-up?

Introduction: Husband artificial intrauterine insemination (IUI) is a standard method of assisted reproduction for patients with mild male infertility, anovulation, endometriosis, and unknown infertility. In this study, we evaluated the effect of luteal phase support on the success rate of IUI cycles with vaginal micronized progesterone compared to the control. Material and Methods: This retrospective cohort study included 94 infertile women referring to two infertility centers in Sari, Iran, from 2015 to 2021. In these women, Clomiphene citrate or Letrozole was used, follicular monitoring continued, and human Gonadotropin was added based on ultra-sonographic findings. Intramuscular HCG was added when one or two follicles were to 17 mm. IUI was done 36 hours later, and micronized vaginal progesterone 400mg once daily was added on the day after insemination (n=114). IUI outcomes were evaluated with a serum Beta-HCG test and vaginal ultrasound two and five weeks later. Pregnant women were followed up until the end of the pregnancy. Data were analyzed with SPSS25 and STATA14 software. Results: Progesterone consumption had no significant relationship with pregnancy rates but a significant correlation with the number of antral follicles. Pregnancy occurrence was significantly associated with patient satisfaction, FSH, and AMH levels but not correlated with the duration and kinds of infertility. Conclusion: Vaginal micronized progesterone as luteal phase support is not effective in increasing pregnancy occurrences in IUI cycles like IVF cycles, but patients’ satisfaction may be increased among women impregnated undergoing IUI and progesterone support.

Estimation of follicular growth—widely used, seldom studied

We assessed whether estimation of follicular growth, rather than actual measurement of follicular size on the day of hCG trigger, affected pregnancy rates in intrauterine insemination (IUI) cycles. Patient and cycle characteristics were extracted from an existing database. Comparisons were made between the pregnant (defined as a positive beta hCG) and non-pregnant groups for the following variables: patient’s age, number of previous IUI cycles, type of ovarian stimulation, endometrial thickness, number of follicles measuring 14 mm and above, pre and post wash sperm parameters, cycle day when IUI was done and number of days between last ultrasound scan and ovulation trigger. A total of 7302 cycles were included in the final analysis. In 4055 cycles (55.5%) the hCG trigger was on the day of the last ultrasound, in 2285 cycles (31.3%) the hCG trigger was 1 day after the last ultrasound, in 850 (11.6%) it was 2 days after the last ultrasound and in 112 (1.5%) it was 3 or more days after the last ultrasound. Sperm parameters, younger maternal age, and the number of follicles above 14 mm were all associated with pregnancy. No association was found between positive pregnancy test rates and the time from last ultrasound to hCG trigger. Planning IUI based on the estimation of follicular growth 1–4 days before trigger, does not affect pregnancy rates.

The Effect of the Time Interval From Sperm Processing to Intrauterine Insemination on the Pregnancy Outcomes of Infertile Women.

Objective: Intrauterine insemination (IUI) is the first-line treatment in couples suffering from various causes of subfertility and infertility. Considering the relatively low rate of pregnancy achieved with each cycle in this method, optimizing various steps in the process including the time interval from sperm collection to IUI may result in an increased rate of success. The goal of this study was to assess the impact of time intervals from the end of sperm processing to IUI (SP-IUI) on the pregnancy rate in IUI. Materials and methods: This single-center prospective cohort study evaluated couples with normal male partner sperm analysis and idiopathic female infertility undergoing IUI from 2018 to 2021. Cycles were stimulated using subcutaneous recombinant FSH and oral Letrozole. Ovulation was triggered using GnRH antagonist when the leading follicle's size reached greater than 14mm. The participants were placed in one of the three groups based on SP-IUI: group 1 (0-60 min), group II (60-90 min), and Group III: (>90 min). Results: 269 couples were included in the study. Sperm processing expectedly resulted in an increased concentration of total sperm count and sperm motility (P<0.001). The rate of chemical or clinical pregnancy, abortion, IUFD, multigestation, pregnancy, term birth, and ectopic pregnancy was not significantly different across study groups (P>0.05). Conclusion: The results of this study suggest that SP-IUI intervals evaluated in this study do not vary in terms of pregnancy rate or adverse pregnancy outcomes in IUI with normal male partner semen analysis. Hence, infertile couples can be flexible in the collection of semen specimens without time and site (at home or hospital) limitations.

Effect of Blood Homocysteine on the Outcome of Artificial Insemination in Women with Polycystic Ovary Syndrome.

Background Polycystic ovary syndrome (PCOS) is the major reason for women's low fertility and the most frequent endocrine disorder in women of childbearing age. Homocysteine is an amino acid that contains sulfur that has been negatively correlated with the reproductive outcome of polycystic women treated with IVF/ICSI. However, the impact of blood homocysteine levels on the outcome of artificial insemination in polycystic ovary syndrome women is unknown. The goal of this study is to examine the impact of serum homocysteine on the result of intrauterine insemination in females who have polycystic ovary syndrome (PCOS). Methods 96 infertile women (129 cycles) treated with artificial insemination were collected, including 66 cases (87 cycles) in the case group (PCOS group) and 30 cases (42 cycles) in the control group (male factor infertility). The differences in general data amongst two groups, such as BMI, Hcy, and age, were compared. The case group has been classified into two groups based on serum Hcy level: LHcy group (Hcy < 15) and HHcy group (Hcy ≥ 15). The relationship among pregnancy and serum Hcy level outcome in PCOS women was compared. Results The PCOS group had substantially increased serum homocysteine levels in comparison to the control group (P = 0.019). Among PCOS women, the clinical pregnancy rates of artificial insemination in the HHcy group and LHcy group were 14.29% and 37.88%. The difference among the two groups was substantial (P = 0.044). Artificial insemination frequency, ovulation induction, BMI, infertility years, AMH, serum testosterone, HOME IR, TSH, TPOAb, hCG, daily follicle size, intimal thickness, and other factors did not differ greatly between the two groups. Conclusion Serum homocysteine levels are increased in women having PCOS. Their levels above the threshold will lower the clinical pregnancy rate of intrauterine insemination in PCOS women.

Pregnancy rate in intrauterine insemination, is uterine biophysical profile of predictive value? A prospective study.

This study aimed at evaluating the value of uterine biophysical profile (UBP) scoring to predict the pregnancy rate after IUI. This prospective study was carried out on 85 women who were referred to our tertiary teaching center with infertility of male factor or unknown etiology infertility in 2018. To measure the uterine biophysical criteria, transvaginal ultrasonography (TVS) was performed on the day of beta-human chorionic gonadotropin (B-hCG) injection, and the results were evaluated based on positive B-hCG. 85 patients were included with a mean age of 30years; of those 12 (14.1%) were able to conceive. UBP (p = 0.151) and it's parameters (including endometrial thickness, number of endometrial layers, myometrial echogenicity, uterine artery pulsatility index, myometrial blood flow internal to arcuate vessels, endometrial blood flow in the third zone of endometrium, myometrial contraction frequency, and ovarian follicle (OF) size [p = 0.05, 0.89, 0.59, 0.79, 1, 1, 0.59, and 0.77, respectively]) were not significantly associated with pregnancy rate. 91.7% of the cases with positive pregnancy test results, had a UBP score of > 13; however, UBP score was not meaningfully associated with IUI treatment success rate (p = 0.15). UBP scoring system seems to need more data for external validation, or it might require modifications before implementation, as it may cause false reassurance.

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.

Experience of our clinic in intrauterine insemination cycles made with microfluidic sperm sorting chips

Objective: Determination of the clinical pregnancy rate in intrauterine insemination (IUI) cycles performed with microfluidic sperm sorting chips.&#x0D; Material and Methods: In Giresun University Obstetrics and Pediatrics Hospital Infertility Clinic, 133 patients who underwent IUI after ovarian stimulation with gonadotropins in unexplained infertility, mild to moderate male factor, ovulatory dysfunction, mild endometriosis were retrospectively analyzed between January 2016-January 2020. Microfluidic sperm sorting chip was used for sperm preparation.&#x0D; Results: The number of cycles was found to be 133. Mean female age was; 29.9±4.7 years, mean total motile sperm count was; 72.9±63.7 million, mean antral follicle count was; 18.1±10.1, the mean total gonadotropin dose used was 897.6±366 IU. Considering the causes of infertility; 54.1% unexplained, 8.3% mild male factor, 31.6% polycystic ovary syndrome (PCOS) and 6% endometriosis. The clinical pregnancy rate was found to be 19.5% (26/133).&#x0D; Conclusion: Microfluidic sperm sorting chips provide an increase in clinical pregnancy rates compared to conventional methods in IUI cycles and allow for a practical and rapid sperm preparation.&#x0D; Key Words: IUI, microfluidic sperm sorting chip, clinical pregnancy rate.

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.

Study on Pregnancy Outcomes in Intrauterine Insemination Cycles with Motile Spermatozoa Insemination

Background: Intrauterine Insemination (IUI) is one of the most common assisted reproductive technology methods in the world to treat various forms of infertility. The influence of number of IUI applied with the percentage of motile spermatozoa during insemination is critical on the likelihood of a successful pregnancy. The aim of our study is to assess the results of IUI as a function of the number of IUI applied with motile spermatozoa inseminated during intrauterine insemination in couples with infertility.&#x0D; Materials and methods: This is a prospective study conducted in Surgiscope Fertility Centre, Chattogram, Bangladesh over 21 months on 596 couples who underwent IUI from 01/12/2017 to 30/09/2019. We performed semen analysis of the male partner from the couples who underwent IUI, calculated the sperm motility and the relationship between number of IUI applied with motile spermatozoa and the pregnancy rate of IUI. Multiple variables were selected such as, patient parameters like age of female, number of IUI, percentage of motile spermatozoa inseminated, endometrial thickness and ovulation induction protocol which were recorded and statistically analyzed.&#x0D; Results: Among the 596 patients, the overall success rate was 11%. The maximum number of successes were observed in patients with 3 IUI applications whereas the success rate was lower in comparison with decreasing IUI applications. The regression between the success and number of insemination and age indicate that there is a statistically significant positive relationship between number of inseminations completed and the rate of successful pregnancy, but no significant relationship between the number of prewash sperm and successful pregnancy. These could be due to lower population size. As an ovulation inducing agent, a 12.42% success rate was observed among the patients administered with FSH whereas 9.28% was observed for patients administered with GONAL F. The mean endometrial thickness was observed to be 8.914 mm with a minimum thickness of 4.5 mm and a maximum thickness of 19 mm.&#x0D; Conclusion: The rationale for the use of insemination is to increase gamete density at the site of fertilization. This revealed that intrauterine insemination should be a firstchoice treatment rather than more invasive and expensive techniques of assisted reproduction in cases of cervical, unexplained and moderate male factor subfertility.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.19 (2); July 2020; Page 41-45

Pregnancy rate of intrauterine insemination (IUI) - is it affected by inseminated motile sperm count and stimulation protocol?

Objective To compare IUI pregnancy rate by partner and donor sperm according to inseminated motile sperm count and ovulation induction protocol Design Retrospective study by a private IVF center Materials and methods 3,028 IUI cycles (2,284 cycles with partner sperm and 744 cycles with donor sperm) were analyzed. Ovulation induction was done using 5 mg of letrozole (Let) on cycle days 3 through 7, with 250 mcg recombinant hCG injected as instructed after follicle monitoring is done on day 12. A sequential (Seq) stimulation involves Let protocol, followed by 150 IU FSH daily from cycle day 7. Ultrasound monitoring is done on day 10 to determine further medication dosing, GnRH antagonist initiation, and monitoring. A controlled ovarian hyperstimulation (COH) cycle involves daily FSH injections at doses between 150 and 300 IU FSH, with monitoring beginning on day 7 to determine further medication dosing, GnRH antagonist initiation, and monitoring. All IUI procedures were performed approximately 36 hours after trigger. Pre-washed frozen sperm was thawed by agent's thawing protocol. Total motile sperm for insemination was counted after finishing sperm wash process. The statistical analysis was performed using t-test, chi-square, or z-test. A p value of Results IUI pregnancy rate by using partner sperm was significantly lower (n=106, 3.8%) when inseminated motile sperm is Conclusions IUI pregnancy rate is not affected by sperm count if at least 3 million motile sperm are inseminated. Pregnancy rate from natural cycle is low in both partner sperm and donor sperm cycle. There is no significant difference of pregnancy rate between ovulation induction protocols although the pregnancy rate in Let group is slightly lower than that in COH or Seq group.

Ultrasound guidance versus the blind method for intrauterine catheter insemination: A randomized controlled trial.

ObjectiveThe primary objective of this study was to compare clinical pregnancy rates in intrauterine insemination (IUI) treatment cycles with transabdominal ultrasound guidance during intrauterine catheter insemination (US-IUI) versus the “blind method” IUI without ultrasound guidance (BM-IUI). The secondary objective was to compare whether US-IUI had better patient tolerability and whether US-IUI made the insemination procedure easier for the clinician to perform compared to BM-IUI.MethodsThis was a randomized controlled trial done at the Reproductive Medicine Unit of General Hospital Kuala Lumpur, Malaysia. We included women aged between 25 and 40 years who underwent an IUI treatment cycle with follicle-stimulating hormone injections for controlled ovarian stimulation.ResultsA total of 130 patients were recruited for our study. The US-IUI group had 70 patients and the BM-IUI group had 60 patients. The clinical pregnancy rate was 10% in both groups (p> 0.995) and there were no significant difference between the groups for patient tolerability assessed by scores on a pain visual analog scale (p= 0.175) or level of difficulty for the clinician (p> 0.995). The multivariate analysis further showed no significant increase in the clinical pregnancy rate (adjusted odds ratio, 1.07; 95% confidence interval, 0.85–1.34; p= 0.558) in the US-IUI group compared to the BM-IUI group even after adjusting for potential covariates.ConclusionThe conventional blind method for intrauterine catheter insemination is recommended for patients undergoing IUI treatment. The use of ultrasound during the insemination procedure increased the need for trained personnel to perform ultrasonography and increased the cost, but added no extra benefits for patients or clinicians.

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.

Comparison of the effects of variables in sperm preparation techniques on pregnancy rates in intrauterine insemination

Aim: To investigate the effects of two sperm preparation techniques, density gradient centrifugation (DGC) and swim-up, on the pregnancy rates per cycle and per group in two intrauterine (IUI) cycles. Material and Methods: The retrospective study reviewed 634 patients who presented to Firat University Medical School Hospital and underwent a total of 1,032 IUI cycles. Group I consisted of 306 (48.3%) patients who underwent a total of 524 IUI cycles between January 2012 and January 2016 and Group II included 328 (51.7%) patients who underwent a total of 508 IUI cycles between April 2015 and January 2019. The study investigated the effects of technical changes applied to sperm preparation techniques on pregnancy rates in both groups. Results:A significant difference was found between the clinical pregnancy rates of the two groups with regard to the numbers of patients and IUI cycles (p0.001). The technique used in Group II increased the pregnancy rate by 3.195 times compared to the technique used in Group I. A logistic regression analysis revealed that the pregnancy rate in the first cycle was 3.530 times higher than that of the second cycle in both groups.Conclusion: The results indicated that the application of suitable alterations in sperm preparation techniques by taking into account the potential effect of all factors is likely to affect clinical pregnancy rates in IUI.

Intravaginal embryo culture: more than just a novelty?

Intravaginal culture (IVC) devices offer a novel assisted reproductive technology (ART) treatment option at a significantly reduced cost from traditional in-vitro fertilization (IVF) cycles. This study aimed to assess the efficacy of the INVOcell (INVO Bioscience) intravaginal culture device with day 5 blastocyst transfers in our center compared with intrauterine insemination (IUI) cycles. Retrospective study. Patients were initially informed that IVC had unknown success rates in our clinic prior to starting their cycle. These cycles were offered at a discounted cost. Patient were only offered IVC as a potential treatment option if they met the following criteria: normal semen analysis, normal uterine cavity, anti-mullerian hormone value of 1 - 6 ng/mL, follicular stimulating hormone value of <10 mIU/mL, estradiol level <60 pg/mL, no previous IVF cycle failures, and no plastic allergies or history of toxic shock. Following oocyte retrieval, cumulus oocyte complexes were trimmed and inseminated for 5 minutes before being placed in an IVC device loaded with pre-equilibrated continuous culture media overlaid with mineral oil. The device was inserted into the patient’s vagina for incubation and carried for 5 days before she returned to have embryo development evaluated and an embryo transfer. IUI’s were performed with gradient prepared semen per standard protocols. Data was collected for a single calendar year in 2017. A total of 36 patients, between ages 27 and 42, opted to have IVC cycles performed. All patients were able to tolerate the device well, with no adverse events requiring premature removal of the device. The per-start positive biochemical pregnancy rate was 52% and the ultrasound confirmed pregnancy rate was 47%. The per-transfer pregnancy rates were 69% and 63% respectively with a total of 28 transfers performed (a 22% non-transfer rate). The pregnancy rates for IUI performed in the same calendar year were 13% and 12% respectively for patients in the same age bracket with a total of 869 cycles performed. IVC with day 5 blastocyst transfers appears to offer an appreciable pregnancy rate increase when compared with IUI cycles. While IVC cannot compete with full IVF cycles, due to inherent treatment limitations, it may offer a more efficacious first treatment option for infertility patients that meet the selection criteria than several rounds of IUIs. However, despite success for a large percentage of patients, we observed a high non-transfer rate of 22% due to either no fertilization or poor embryo progression. Although disappointing, these patients can now progress to full IVF cycles sooner than if they had continued with IUI cycles as IVC cycles offer more diagnostic value than IUIs. More research is needed to understand if IVC can effectively, in terms of cost and patient success, be added to most center’s treatment repertoires and become an additional standard of care.

Comparing the effect of gonadotropin-releasing hormone agonist and human chorionic gonadotropin on final oocytes for ovulation triggering among infertile women undergoing intrauterine insemination: An RCT

The purpose of triggering in ovulation induction is to induce the final maturation of oocytes and their release from the ovary for fertilization. The aim of the present study was to compare the effectiveness of gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (HCG) on the final maturation of oocytes and pregnancy rates in intrauterine insemination (IUI) cycles. In this randomized clinical trial, 110 infertile women who were selected for IUI entered the study. Ovulation induction was performed. Group I received 0.1 mg GnRH agonist as triggering and group II received 10,000 IU of HCG. The serum E2, LH, and FSH levels were measured at 12 and 36 hr after injection. LH surge was detected in all patients. LH levels at 12 and 36 hr after triggering was higher in Group I and it washed out earlier than group II (p=0.00). The pregnancy rate was higher in Group I, but the difference was not statistically significant (26.9% vs. 20.8%, respectively p=0.46). Also, the incidence of ovarian hyperstimulation syndrome was not different between the two groups (p=0.11). There was a significant difference regarding the estradiol levels at 36 hours after triggering (p=0.00). Effects of GnRH on endogenous LH surge is sufficient for oocyte releasing and final follicular maturation. Pregnancy rates and ovarian hyperstimulation syndrome incidence were not different between the groups. We suggest that GnRH agonists might be used as an alternative option instead of HCG in IUI cycles.