IUI Success Research Articles

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.

371 Improving iui success after modified slow-release insemination: a prospective cohort study

Introduction: Previous studies also showed a higher IUI success rate after slow-release insemination instead of bolus injection. Aim of the study: To examine whether a modified slow-release insemination (SRI) increases the clinical pregnancy rate (CPR) after intrauterine insemination with partner semen (IUI-P) and donor semen (IUI-D) Methods: We studied the data of an ongoing prospective cohort study. During the period of July 2011 until December 2018, data from 2565 IUI-Ps in 989 women and 1995 IUI-Ds in 606 women were collected prospectively. As from January 2016 (period 2), the insemination procedure was performed by midwives instead of medical doctors. Instead of bolus injection of sperm a slow-release IUI was performed. Instead of ordinary logistic regression analysis we used a cluster-weighted generalized estimating equations (GEEs) for statistical analysis. Results of two periods (2011-2015 and 2016-2018) were examined for both homologous and donor inseminations. Results: Clinical pregnancy rates (presence of fetal heart beat at 7-8 weeks of gestation) ollowing IUI-P increased significantly from 9.0 % (period 1) to 13.4 % (period 2) (p = 0.001). In case of donor inseminations, clinical pregnancy rates increased from 16.5 % to 20.8 % (p = 0.088), a non-significant increase. Conclusion: The CPR after modified slow-release inseminations increased significantly after IUI with homologous semen. After using donor sperm the CPR increased from 16.6 % to 20.8 % per cycle with donor semen, a non-significant increase. Although our results were analysed in a prospective cohort study, a prospective randomised trial is needed to confirm our findings. We also have to examine whether our better results can be explained by the slow-release IUI, the patient-centred approach or both.

Series of 9386 IUI Cycles: The Impact of the Number of Motile Spermatozoa Inseminated Varies According to the Female Age

Many authors have studied the effects of the NMSI on the success of IUI, but a real consensus has not yet been achieved, and NMSI and female age have rarely been studied together. In addition, the upper limit of NMSI has rarely been studied while some fertility centers perform a dilution of the sperm sample to obtain a NMSI between 1 × 106 and 10 × 106. What is the impact of the number of motile spermatozoa inseminated (NMSI) on clinical pregnancy rates (CPR) in IUI with partner sperm according to female age?

The sperm parameters and prediction of IUI success

Aim: We aimed to compare the different sperm motility parameters in pregnant and non-pregnant patients who underwent IUI in our tertiary center. Material and Methods: Total of 110 gonadotrophin plus IUI patients were evaluated between 2017 January and January 2020 in this retrospective study. Some demographic features and infertility time, post-wash sperm parameters and basal hormone levels were compared between pregnant and non-pregnant patients and the regression analysis method was used to evaluate IUI success between other parameters.Results: Endometrial thickness (9.1±1.4 vs.7.6±1.4 ) on hCG triggering day and , post-wash progressive sperm motility value together with the a ratio and infertility time were correlated well with IUI success (ie pregnacy result ) between 38 pregnant and 72 non pregnant patients.Conclusion: After wash progressive sperm ratio may predict IUI success with infertility time and endometrial thickness.

The impact of the modified speculum application technique on the success rates of intrauterine insemination: A randomized controlled study

ObjectiveIntrauterine insemination (IUI) is frequently used to treat patients with ovulation disorders, cervical factor, mild male infertility and unexplained infertility. The aim of this study was to investigate the impact of modified speculum application on the success of IUI in patients with unexplained infertility. Materials and methodsThis prospective randomized study reviewed 219 women who had undergone controlled ovarian hyperstimulation (COH)-IUI treatment. In the modified speculum application group (109 patients with 124 cycles), the screw of the vaginal speculum was loosened after passing the internal os with catheter and the vaginal speculum remained in this position to ensure closure of the cervix during the procedure. In the conventional speculum application group (110 patients with 132 cycles), the screw of the vaginal speculum was not loosened to close the lips of cervix after passing the internal os with the catheter and the vaginal speculum was removed after withdrawal of the insemination catheter. The primary outcome was live birth rate. ResultsThe modified and conventional speculum application groups had statistically similar demographic and clinical characteristics. There were no significant differences between the study and the control groups in terms of the clinical pregnancy rate per cycle and per patient (24.1% vs 18.9% and 26.6% vs 22.7%, respectively), as well as the live birth rate per cycle and per patient (19.3% vs 15.1% and 22% vs 18.1% respectively). ConclusionApplying gentle mechanical pressure on the portio vaginalis of the cervix using a vaginal speculum during IUI does not improve pregnancy and live birth rates in patients with unexplained infertility.

The relationship between semen parameters in processed and unprocessed semen with IUI success rate

The relationship between semen parameters in processed and unprocessed semen with IUI success rate

Validating semen processing for an intrauterine program should take into consideration the inputs, actions and the outputs of the process.

To validate semen preparation via density gradient centrifugation, we took into account the input via the semen sample, the action generated by technical and equipment characteristics and the output measured by the level of performance. Longer periods of abstinence reduced % yield, but increased viscosity and incomplete samples collected had no effect. Under controlled technical and equipment characteristics, precision and reproducibility were validated for density gradient. Additionally, as a good laboratory practice, internal and external quality control measures were implemented to guarantee the level of performance. Inseminating motile sperm count is an important predictive parameter for IUI success. In our group of patients, a yield of an absolute lower limit of 2 million motile spermatozoa was sufficient to contemplate IUI. Pregnancy rate of 13.8% where >2 million rapid progressive spermatozoa were inseminated was significantly higher than the pregnancies (4.4%) obtained with <2 million rapid progressive spermatozoa. This percentage was even higher than the national data registered for IUI (12.2%). To make IUI an attractive first-line treatment, standardization and proper validation of semen preparation procedure are mandatory.

Success of IUI in Women with Unexplained Infertility: Evaluation of Predictive Factors

Success of IUI in Women with Unexplained Infertility: Evaluation of Predictive Factors

Effect of Gonadotropin Types and Indications on Homologous Intrauterine Insemination Success: A Study from 1251 Cycles and a Review of the Literature.

Objective To evaluate the IUI success factors relative to controlled ovarian stimulation (COS) and infertility type, this retrospective cohort study included 1251 couples undergoing homologous IUI. Results We achieved 13% clinical pregnancies and 11% live births. COS and infertility type do not have significant effect on IUI clinical outcomes with unstable intervention of various couples' parameters, including the female age, the IUI attempt rank, and the sperm quality. Conclusion Further, the COS used seemed a weak predictor for IUI success; therefore, the indications need more discussion, especially in unexplained infertility cases involving various factors. Indeed, the fourth IUI attempt, the female age over 40 years, and the total motile sperm count <5 × 106 were critical in decreasing the positive clinical outcomes of IUI. Those parameter cut-offs necessitate a larger analysis to give infertile couples more chances through IUI before carrying out other ART techniques.

The Effect of Processed Total Motile Sperm Counts and Twenty Four Hour Sperm Survival on the Efficacy of Intrauterine Insemination in Male Infertility

Objective: To compare the effectiveness of IUI, based on Pre-treatment Semen analysis results, in treating male factor infertility.Design: A retrospective cohort design of 1,768 infertile couples undergoing 5,219 IUI cycles, who had pretreatment advanced semen analysis were evaluated. An advanced semen analysis consists of a basic semen analysis and processed total motile sperm counts through a density gradient sperm prep and recording 24 hours sperm survival of these sperm culture media in an incubator. Logistic regression analysis was used to assess the significance of prognostic factors in sperm parameters to predict the pregnancy rates with IUI.Results: No basic semen analysis parameter accurately predicted IUI success. Clinical pregnancy rate for first cycle of IUI was 15.6% when >10 × 106 processed total motile sperm was available and 13.7% in all cycles. This group contained 1264/1768 (71.5%) of couples in the study. The pregnancy rate in the first cycle was 18.2% if their 24 hour survival was >70% and 15.9% in all cycles and 1008/1264 (57%) of couples were in this group. No pregnancy was achieved for processed total motile sperm counts <5 × 106 (168/1768) or 9.5% of couples and 3.6% for those with 24 hour survivals <30% in first cycle and 2.0% for all cycles for 601/1768 (34%) of the couples. Strong positive correlations between processed total motile sperm counts and PR (r=0.83; p<0.001) and between 24 hours survival and PR (r=0.79; p<0.001) were seen by linear regression analysis. High correlations were also noted between processed total motile sperm counts (r=0.71; p<0.001) and 24 hours survivals (r=0.76; p<001) in the advanced semen analysis and those in the IUI samples.Conclusion: Both processed total motile sperm counts and 24 hour survival are useful predictors of whether a couple should be treated with levels below threshold levels have a very poor prognosis with IUIs.

Intrauterine Insemination—Our Results between the Years 2008-2012

The purpose of this retrospective study was to determine whether or not there was a significant relationship between women’s age as a cause of sterility and pregnancy after IUI. Furthermore, we evaluated the effect of stimulation of antiestrogens and time of hCG administration on the success of IUI in relation to the age of women. During the period between 2008 and 2012, we performed a total number of 793 IUI. Patients were prepared for IUI in the natural cycle and stimulation with antiestrogens (clomiphene citrate-CC). Ovulation was induced by hCG (Ovitrelle) 40 hours before IUI or immediately after the procedure. Sperm was processed through density gradients. The average success rate of IUI was 10.2% of pregnant women per cycle. Significantly the highest number of pregnant women 16.3% was women with a diagnosis of anovulation. Significantly the lowest success rate of IUI was at the immunological cause of infertility and endometriosis. There was no evidence of age dependence for women on the success of IUI. Stimulation of CC did not significantly increase the chance of becoming pregnant. There was also no statistically significant difference in hCG before and after IUI pregnancy success. The most important group of women for whom IUI is a suitable form of assisted reproduction consists of patients of 35 years old with anovulation cause of sterility. Those patients with an immunological cause of infertility and endometriosis have significantly lower chances of conceiving after IUI and it is preferable for them to choose other techniques of assisted reproduction and embryo transfer.

Intra uterine insemination an experience in rural population

Objective:1) To find out efficacy of various ovulation induction protocols in IUI 2) To find out the efficacy of IUI in treatment of infertility Method: All infertility patients of our OPD underwent a standard investigation protocol The infertility work-up included patients’ history, physical examination, conformation of ovulation by follicular monitoring, tubal patency test by diagnostic laparoscopy, and semen analysis of male partner & PCT. All women underwent a standard treatment protocol that included either natural cycle or ovulation induction to achieve superovulation by clomiphene citrate alone, or combined with gonadotrophins. Follicula monitoring using transvaginal sonography was done from D6-8 onwards and all women were given injection Human chorionic gonadotrophin 5000 U for LH surge when the dominant follicle was ≥18 mm. IUI was Performed at 18 hours and 40 hours from the time of HCG injection. Semen for IUI was prepared by the standard Swim Up technique, or by the Density Gradient method. Progesterone (Transvaginal micronized progesterone 200mg/day) for luteal phase support for 14 days following IUI was given to patients who were affording. Results: Majority of couples were having primary infertility (60.97%) Patients of secondary infertility were of 39.03% only. In our study only 11.82% patients were having multiple factors contributing to infertility. Male factor was in 42.59% of couples as against 30.34% of couples were having only anovulation as causative factor for infertility. Unexplained infertility was present in 13.82% patients only. The outcome variable for success of IUI was occurrence of pregnancy. This was defined by delay in menses associated with presence of positive pregnancy test or a detectable rise in serum beta HCG levels. In our study overall pregnancy rate per cycle was 8.01% & per couple it was 21.65%. Per cycle fecundity according to the factor responsible for infertility, the highest success rate was observed in cervical factor (33.33%). For male factor it was 7.74% and for combined factors overall it was 5.92%. Out of 152 pregnancies that occurred during study 108 had Full Term live birth of the baby (71.05% Miscarriage was there in 9.87% patients only. Only three patients had multiple pregnancies (1.97%) and one patient had ectopic pregnancy. Per cycle fecundity was little better in patients with only anovulation( 10.51%). When we compared various regimen used for ovulation induction for IUI we found that though percentage of pregnancies achieved by Low dose HMG either with (13.89%) or without Clomiohene (15.58%), pregnancy rate achieved with clomiphene alone was 7.43% . This was promising at low affordable cost. In our study, we achieved 40.13% pregnancy with second attempt and collectively with first two attempts pregnancy rate achieved was 71.71%.

Intrauterine insemination confers limited benefit for conception in infertile couples with female age over 38 and low sperm quality

OBJECTIVE: Advancing female age is associated with diminishing outcomes from all infertility treatments. We hypothesize that male sub-fertility disproportionately impacts outcomes of IUI cycles in couples with increasing female age. We sought to examine the effect of female age on IUI success within a subset of infertile couples with low sperm quality.

Perfiles de expresión génica en hombres infértiles que se someten a reproducción asistida

Introduction Basic sperm analysis has insufficient predictive power on pregnancy achievement in assisted reproductive techniques (ARTs). Molecular parameters such as as mRNA present within spermatozoa are not assessed. Our group listed differentially expressed genes (DEG) from sperm samples (SS) from that achieve pregnancy (group P) vs. those that do not (group NP) using microarray technology in couples undergoing homologous IUI and ICSI. The aim is to use microarray technology to characterise the different gene expression profiles (EP) between SS that achieve pregnancy or not in ICSI and IUI cycles. Material and methods Ten SS (5 that achieved and 5 that did not achieve pregnancy) were obtained from IP undergoing ICSI and 20 (10 that achieved and 10 did not achieve pregnancy) IAH cycles with oocytes from young donors and their healthy female partners respectively. After freezing aliquots of the SS employed for both treatments and their respective mRNA expression profiles were compared. Finally 4 microarrays were performed in duplicate with sperm samples from group P vs. NP from both techniques and those DEG were evaluated at least twice, with statistically significant differences between P and NP SS for each group. Results Total number of genes (TNG) in IUI microarray was 19938 and 19229 in ICSI. The total number of DEG (950) in the IAH group was much greater than in the ICSI group (49). Conclusions These data reveal that molecular features required for pregnancy are different in IUI and ICSI procedures. These differences could be potentially employed to detect ICSI and IUI success markers or to improve pregnancy rates in these procedures.

P783 Effect of aspirin on endometrial receptivity and success of IUI

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S635-S635 Poster presentations P783 Effect of aspirin on endometrial receptivity and success of IUI A. Agarwal, A. AgarwalSearch for more papers by this authorV. Das, V. DasSearch for more papers by this authorA. Pandey, A. PandeySearch for more papers by this authorV. Jain, V. JainSearch for more papers by this authorS. Agarwal, S. AgarwalSearch for more papers by this authorA. Ara, A. AraSearch for more papers by this author A. Agarwal, A. AgarwalSearch for more papers by this authorV. Das, V. DasSearch for more papers by this authorA. Pandey, A. PandeySearch for more papers by this authorV. Jain, V. JainSearch for more papers by this authorS. Agarwal, S. AgarwalSearch for more papers by this authorA. Ara, A. AraSearch for more papers by this author First published: 20 November 2009 https://doi.org/10.1016/S0020-7292(09)62273-6AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S635-S635 RelatedInformation

P793 Evaluation of role of sildenafil in improving IUI success rates

P793 Evaluation of role of sildenafil in improving IUI success rates

The transcriptome of spermatozoa used in homologous intrauterine insemination varies considerably between samples that achieve pregnancy and those that do not

To differentiate transcripts' expression in the sperm from patients who achieved pregnancy in their first IUI cycle from those who did not. Basic sperm analysis is limited to forecasting pregnancies by means of assisted reproduction. New assays, such as microarray analysis, are potential predictive tools for this purpose. Nested case-control study. University-affiliated private setting. Twenty sperm samples were obtained from infertile males undergoing their first IUI cycle with healthy partners. Sperm samples with which pregnancy was achieved (P; n=10) and those with which it was not achieved (NP; n=10) were identified and their respective messenger RNA expression profiles were compared. None. Using microarrays, global genome expression was compared in pooled samples from each group. Results were evaluated to detect differentially expressed transcripts (TDEs; FC>2; P<0.05) and to identify those transcripts that were expressed in only one of the groups (exclusive transcripts [ETs]). In group P, 756 TDEs presented increased expression, whereas 194 in group NP were found to be overexpressed. Furthermore, we found 741 ETs that were expressed only in group P and 976 that were expressed only in group NP. Results reveal profound differences between expression profiles of sperm samples that impregnate successfully and those that do not. These differences might improve the predictive power of sperm evaluation to estimate IUI success by complementing the basic sperm analysis.

Total motile sperm × strict morphology predicts pregnancy following intrauterine insemination in severely teratozoospermic men

OBJECTIVE: Appropriate counseling for teratozoospermia is controversial. In vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) has been suggested for the treatment of couples with <5% normal sperm strict morphology. Our goal was to determine whether the number of total motile sperm × strict morphology (TM×SM) was a significant predictor of IUI success and whether TM×SM would predict couples who needed ICSI.

RETRACTED: Effect of sperm morphology and number on success of intrauterine insemination

To assess the effects of the number of motile spermatozoa inseminated and percentage of morphologically normal spermatozoa on the success of IUI. A prospective observational study. University teaching hospital and private practice setting. The study comprised 393 couples who underwent 714 IUI cycles. All IUI cycles were preceded by ovarian superovulation with clomiphene citrate 50 mg tablets orally twice daily for 5 days starting on the second day of menses and one hMG ampule 75 IU IM daily for 5 days starting day 5 of the cycle. Cycles were monitored by transvaginal ultrasound. The IUI was performed with a catheter 36 +/- 4 hours after hCG injection. Clinical pregnancy. A total of 79 clinical pregnancies were obtained, for a pregnancy rate per cycle of 11.06%. The pregnancy rate per cycle was 5.55% when the number of motile spermatozoa was <5 x 10(6) and 24.28% with normal motile sperm >5 x 10(6). For patients <25 years old, with number of motile spermatozoa >5 x 10(6), the pregnancy rate per cycle was 28.2%, which is significantly higher than that of other age groups. Above the age of 35 years, no pregnancies were reported with number of motile spermatozoa <5 x 10(6), and the pregnancy rate was very low (0.84%) with number of motile spermatozoa >5 x 10(6). When the normal sperm morphology was >30% and number of motile spermatozoa inseminated >5 x 10(6), the pregnancy rate was 20.77%. Intrauterine insemination used for treating male factor infertility has little chance of success when the woman is older than 35 years, the number of motile spermatozoa inseminated is <5 x 10(6), or normal sperm morphology is <30%.

Intrauterine insemination practice in the UK

SummaryIntrauterine insemination (IUI) is a recognised treatment for infertility. The overall success rate of IUI remains controversial and depends on several factors. There is a wide variation in the practice of IUI across the country. A postal survey was conducted to determine the attitudes to the factors influencing IUI practice. A questionnaire containing 22 factors was sent to 150 reproductive medicine units in the UK. Practitioners were requested to rate each parameter on the scale of 1–10, where 1 was least important and 10 very important. A total of 101 practitioners replied. Over 50% of the corresponding practitioners were Consultants, 32% were Infertility Nurse Specialists and 12% were other clinicians. The factor with the highest rating was the number of the follicles on the day of human chorionic gonadotrophin (hCG) injection, followed by the size of the follicle and the total sperm count. The fourth critical factor voted was the need for a standardised protocol for all the unit staff. The wide variation in the approach to IUI probably explains the great variance in pregnancy rates. Further properly designed studies are needed to ascertain the role of the factors in determining the success of IUI and the most successful protocols.