Success Rate Of Intrauterine Insemination Research Articles

Role of genetic variations and protein expression of β-Microsemino protein in intrauterine insemination outcome of unexplained infertile men: A case-control study.

Intrauterine insemination (IUI) is often the first-line treatment for unexplained infertility. -Microsemino protein (MSMB) is an abundant protein in seminal plasma that has an inhibitory effect on spontaneous acrosome reaction. The present study aimed to evaluate MSMB gene variations and protein expression on IUI success rate in unexplained infertile men. A case-control study was performed on 100 unexplained infertile Iranian men referred to the Royan Institute, Tehran, Iran for IUI (50 men with IUI positive result [IUI+], and 50 men with IUI negative result [IUI-]). Couples with female infertility factors (such as hormonal disorders, infrequent menstrual period, abnormality in uterus, fallopian tubes, or ovaries) and men with infections of the male accessory glands, hypogonadotropic hypogonadism, clinical varicocele, retractile testis, genital trauma, drug use, or concurrent hormonal treatment Y chromosome microdeletions, and abnormal karyotype were excluded from the study. The polymerase chain reaction sequencing was performed for the promoter and the coding regions of MSMB functional domains. To study the protein expression, the total protein of sperm was extracted, and sandwich enzyme-linked immunosorbent assay was performed. 4 variations were detected (rs12770171, rs10993994, rs2075894, and rs4517463). None of them showed significant differences between the IUI+ and IUI- groups. The mean value of protein expression did not show any differences between the groups. In conclusion, there is no association between genetic variations of promoter and coding regions of MSMB functional domains as well as its expression with IUI success in unexplained infertile men.

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.

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.

Gene Sequence of Rubella Virus Infection in Serum of Wives That Correlate to Intrauterine Insemination Success Rate in Baghdad's Population Couples

The current study focused on the prevalence of Rubella virus disease among wives who underwent the process of artificial insemination (IUI) and its relationship to the elevated proportion of free radicals in the blood plasma and its correlation with water pollution in the spreading of the disease for the period from 15/2/2022 to 1/2/2023 in private laboratory for IUI procedure (AL- Amal). The study included 60 women who underwent (IUI) procedure and have positive results for Rubella virus (IgG and IgM) compared to wives who tested negative for Rubella virus for ages groups from 20 to 35 years.

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

Objectives: To determine the success rate of Intrauterine Insemination following Controlled Ovarian Hyperstimulation inpatients with subfertility and to determine the frequency of prognostic factors affecting the success rate of this treatment modality.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Obstetrics &amp; Gynecology, Pak-Emirates Military Hospital, Rawalpindi Pakistan, rom Feb to Aug 2019.&#x0D; Methodology: A total number of 135 sub-fertile patients, aged 18 to 40 years, with a duration of subfertility &gt; 2 years, were included in the study. Couples with bilateral tubal blockade, smoking, combined male and female factor infertility and previous ovarian surgery were excluded. Controlled ovarian hyperstimulation was done with Clomiphene Citrate for five days, followed by ovulation triggered by recombinant human chorionic gonadotropin (HCG) and standard insemination with a prepared sample of the husband’s semen after 36 hours.&#x0D; Results: Success of the procedure was seen in 23(17.04%) patients, while the remaining 112(82.96%) were unsuccessful. The mean age was 29.20±4.90 years. Of 135 patients, 83(61.48%) had primary subfertility, and 52(38.52%) had secondary subfertility. The mean duration of subfertility was 5.60±3.35 years. The mean basal FSH was 5.76±2.54 IU/l. The mean number of IUI cycles was 1.39±0.49.&#x0D; Conclusion: This study concluded that the success rate of intrauterine insemination following controlled ovarian hyperstimulation in the treatment of subfertility was 17.04%, and the duration and type of subfertility, aetiology of subfertility, basal Follicle-stimulating hormone levels and the number of Intrauterine insemination cycles are the prognostic factors affecting the success of the procedure.

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.

The success rate of intrauterine insemination in sperm preparation swim-up method at room temperature compared to the incubator temperature

HIGHLIGHTS There were no significant differences in TMSC, sperm motility, sperm morphology, and DFI in sperm preparation using the swim-up method at 27°C and 37°C. However, this study provided an overview of the average improvement of DFI at 27°C compared to 37°C. There was no significant difference in the pregnancy rate of IUI in sperm preparation using the swim-up method at 27°C and 37°C. ABSTRACT Objective: This study aimed to determine the effect of temperature during sperm preparation on total sperm motile count (TMSC), sperm motility, sperm morphology, DNA fragmentation index (DFI), and pregnancy rate. Materials and Methods: A quasi-experimental laboratory study with pre- and post-test control group was conducted at Sekar Fertility Clinic, Dr. Moewardi General Hospital, Surakarta, Indonesia. A total of 20 sperm samples from infertile patients were prepared using the swim-up method at 27°C (group 1) and 37°C (group 2). TMSC, motility, morphology, and DFI examinations were performed. In addition, IUI was performed to confirm pregnancy rate. Sperm DNA fragmentation was determined using Sperm Chromatin Dispersion/SpermFunc DNAf test. Sperm DNA fragmentation was characterized by a halo &lt;30% of the volume of the sperm head. Results: Group 1 had mean TMSC of 13.77 ± 9.30, while group 2 had 14.82 ± 8.82; p=0.218. Group 1 had a motility value 82.25+12.77 and group 2 had 82.55 ± 11.69; p=0.968. The morphological value for group 1 was 11.25 ± 5.15 and group 2 was 11.6 ± 5.34; p=0.626. The mean DFI for group 1 was 17.79 ± 10.88 and group 2 was 18.18 ± 12.95; p=0.765. Pregnancy rate in group 1 was 10% and group 2 was 20%; p=1.000. Conclusion: There were no significant differences in TMSC, sperm motility, sperm morphology, DFI, and pregnancy rate in sperm preparation using the swim-up method at 27°C and 37°C.

Do sperm motility, morphology or associated factors predict the success rate of intrauterine insemination?

Objective: Infertility is a global health issue among couples of reproductive age. Intrauterine insemination (IUI) is a fertility treatment method where the processed sperms are deposited in the female uterus during the time of ovulation. The aim of this study was to explore the factors predicting the success rate of IUI (IUI-SR). Materials and Methods: A descriptive retrospective study was conducted analysing SFA and corresponding IUI reports of couples who underwent IUI from January 2017 to August 2021 at the Professorial unit of Colombo South Teaching Hospital, Sri Lanka. The data were analysed using SPSS version 22.0. Results: A total of 140 SFA and corresponding IUI reports were used. The IUI-SR was 18.57% (n=26). A significantly high IUI-SR was noted when the female partner aged &lt;30 years compared to &gt;30 years (p=0.000, OR=1.87), with first two IUI attempts compared to multiple IUI attempts (p=0.017, OR=0.271), pre-processed sperm concentration &gt;30M/ml compared to &lt;30M/ml (p=0.019, OR=3.12), and pre-processed sperm motility (progressive and non-progressive)&gt;40% compared to &lt;40% {p=0.039, OR=5.31). The period of abstinence (p-value=0.222), pre-processed sperm parameters such as total count (p-value=0.093), normal form morphology (p-value=0.082), viability (p-value=0.093), or post-processed sperm parameters such as concentration, progressive motility did not significantly influence the IUI-SR. Conclusion: A significantly high success rate of IUI can be achieved when the female partner is aged &lt;30 years and with the first two IUI attempts. Pre-processed sperm concentration &gt;30M/ml, and pre-processed sperm motility of progressive &gt;32% and non-progressive &lt;15% also predict a higher success rate of IUI.

Sperm processing techniques for Intra-Uterine Insemination

Intrauterine insemination (IUI) remains safe, simple relatively cost effective and a valuable initial treatment option, especially in low resource settings for selected group of patients before embarking to assisted reproduction technology treatment. Assisted reproductive technology (ART) does not include assisted insemination by sperm from either a woman’s partner or a donor. Numerous factors are influencing the success rate of IUI. However, sperm processing method is a modifiable factor in an induvial basis to achieve good success rate. Aim of sperm processing methods are to target analogously and effectively filter progressively motile and morphologically normal sperm from the overall sample population resulted an enriched sperm population with higher fertilizing potential. WHO recommended sperm processing methods are usually adopted in Sri Lanka and major categories are Sperm Migration Method, Density Gradient Centrifugation Method and Column Adherence Method. Each methods have advantages and limitations in clinical practice. Therefore, andrologist and fertility specialist need to decide the best possible sperm processing method for a particular couple for optimal success rate of IUI treatment according to the clinical assessment and sperm quality and quantity.

P-122 Optimising IUI; a systematic review and network meta-analysis

Abstract Study question What is the effectiveness of add-on interventions to the standard intra-uterine insemination (IUI) protocol in improving reproductive outcomes? Summary answer Amongst the add-ons studied only luteal phase support and endometrial scratch were found beneficial for (LBR)/ongoing pregnancy rate (OPR) in IUI cycles. What is known already IUI is a fertility treatment offered to couples and single women for varied indications worldwide. Although cheaper and less invasive than in-vitro fertilization (IVF), it has received less attention and success rates remain low. Various add-ons have been introduced to boost IUI outcomes. However, their use remains largely empirical and is not standardized. Exploring the effectiveness of different protocol add-ons in comparisons with each other and with the standard protocol, could help develop evidence-based recommendations and optimize IUI treatment. Study design, size, duration We conducted a systematic review and meta-analysis aiming to assess the value of various IUI add-ons on clinical outcomes (PROSPERO registration number CRD42022300857). A computerized literature search was performed using EMBASE, MEDLINE, CINAHL and the Cochrane Central from database inception to October 2021. Two authors independently assessed the studies for quality and risk of bias. Studied add-ons included use of hydrotubation, endometrial scratch, trigger, double insemination, ultrasound guidance, bed rest, tocolysis and luteal phase support. Participants/materials, setting, methods Randomized controlled trials (RCTs) were included, reporting on one or more cycles of IUI with any protocol and indication using partner’s or donor sperm. We summarized the LBR or OPR when LBR was not available. We calculated odds ratios with 95% confidence intervals (CI) using random effects meta-analysis after transforming data using Freeman-Tukey double arcsine transformation. Heterogeneity was reported as I2 and Tau2 estimates. Main results and the role of chance Sixty one RCTs were included in the analysis. Amongst the add-ons studied, luteal phase support and endometrial scratch were found to increase chance of LBR/OPR by 1.48 times (CI 1.1243-1.9402, I2= 13.3%, Tau2= 0,0156 p = 0.330) and 1.58 times (CI 1.0992-2.2685, I2= 0.0%,Tau2=0,00 p = 0.510) respectively. No statistically significant difference was found for the use of hydrotubation (pooled OR 1.4192, CI 0.4936 - 4.0804, I2= 67.3%, Tau2=0,57 p = 0.047), trigger (pooled OR 0.6649, CI 0.2422- 1.8257, I2= 74.7%, Tau2=0,3972, p = 0.047), hCG versus agonist trigger (pooled OR 1.1570, CI 0.7501- 1.7847, I2=0.0%, Tau2=0.00, p = 0.502), ultrasound guidance (pooled OR 2.119, CI 0.8289-5.3809, p = 0.437), double IUI (pooled OR 0.9718, CI 0.5721-1.6508, I2=0.0%, Tau2=0.00, p = 0.567), and bed rest (pooled OR 1.1459, CI 0.4789-2.7418, I2=0.0%, Tau2=0.00, p = 0.005). No eligible studies were found on tocolytic agents. Two studies were identified for the use of misoprostol but the authors do not report results on the outcomes of interest. Limitations, reasons for caution The risk of bias was considered as “high”/“some concerns” for all included studies and the overall quality of evidence is low. Included studies randomized both per woman and per cycle and significant differences were noticed in ovarian stimulation protocols. More well-designed RCTs are needed in order to reach sound conclusions. Wider implications of the findings This meta-analysis provides evidence that luteal phase support and endometrial scratch provide clinical benefit for IUI success rates. However, it is possible that different add-ons could benefit specific patient groups. There is place for more research in the field to explore the value of add-ons in relation to subfertility background. Trial registration number n/a

A study on outcome of controlled ovarian hyperstimulation and intrauterine insemination (husband) in a medical college in Kolkata

Background: A combination of controlled ovarian hyperstimulation and intrauterine insemination (IUI) remains an important treatment option for couple having infertility. Success rate of IUI with ovulation induction ranges from 8-20% depending on many factors. Aims and Objectives: To assess the factors affecting the success rate of IUI and to evaluate the success of ovulation Induction by different methods of controlled stimulation protocol. Materials and Methods: It is a duration-based prospective cross-sectional study where total of 67 couples were included by inclusion and exclusion criteria. They underwent 90 cycles of IUI with each couple having a maximum of three cycles. Ovulation induction was done by clomiphene citrate or letrozole or gonadotrophins. Semen preparation was done by density gradient method. The outcomewas measured by positive urine pregnancy test. Range, percentage, confidence interval, mean with standard deviation, median, range, and P-value were calculated. P&lt;0.05 was taken as statistically significant. Results: Out of 90 IUI cycles 8 were successful resulting in a success rate of 8.8% per cycle and 11.9% per couple. Factors that had a positive impact were follicle size &gt;21 sqmm, endometrial thickness &gt;9 mm, post wash count &gt;15 million/ml, &gt;2 cycles of IUI and on the number of follicles 2 or more on the day of trigger. Conclusion: The study concluded that IUI after ovulation induction can be a simple and safe cost-effective procedure in selected group of infertile couple. Clinical significance IUI following ovulation induction can be a successful approach for specific indications in a low-resource setting where options for other ART interventions are absent or limited.

Using artificial intelligence to predict the intrauterine insemination success rate among infertile couples

BackgroundTo evaluate the use of artificial intelligence (AI) in predicting the success rate of intrauterine insemination (IUI) treatment among infertile couples and also to determine the importance of each of the parameters affecting IUI success. This study was a retrospective cohort study in which information from 380 infertile couples undergoing IUI treatment (190 cases resulting in positive pregnancy test and 190 cases of failed IUI) including underlying factors, female factors, sperm parameters at the beginning of the treatment cycle, and fertility results were collected from 2013 to 2019 and evaluated to determine the effectiveness of AI in predicting IUI success.ResultsWe used the most important factors influencing the success of IUI as a neural network input. With the help of a three-layer neural network, the accuracy of the AI to predict the success rate of IUI was 71.92% and the sensitivity and specificity were 76.19% and 66.67%, respectively. The effect of each of the predictive factors was obtained by calculating the ROC curve and determining the cut-off point.ConclusionsThe morphology, total motility, and progressive motility of the sperm were found to be the most important predictive factors for IUI success. In this study, we concluded that by predicting IUI success rate, artificial intelligence can help clinicians choose individualized treatment for infertile couples and to shorten the time to pregnancy.

Comparison of RNA content from hydrophobic interaction chromatography-isolated seminal plasma exosomes from intrauterine insemination (IUI) pregnancies.

Male factors account for roughly half of infertility cases, with most male infertility diagnosed as idiopathic. Researchers predicting intrauterine insemination success rates have identified multiple prognostic factors, including semen parameters and seminal fluid composition. Seminal plasma contains extracellular exosomes, which contain RNAs and proteins involved in spermatogenesis. The contents of seminal plasma exosomes may be an indicator of overall sperm quality or fertility potential; therefore, analysis of exosomes may provide a measure for sperm viability and fertilization potential. In our study, exosomes were isolated and purified from seminal plasma obtained from IUI treatments with known pregnancy outcomes. We used a unique method to isolate the exosomes which made use of the hydrophobic interaction chromatography method. RNASeq was performed on RNAs from the purified exosomes. This analysis revealed holistic trends, including increased expression associated with RNA originating from chromosomes 1, 10, 12, 16 and 21. Overall, total RNA was significantly decreased and rRNA was significantly increased in successful IUI attempts. Furthermore, we found specific mRNAs and lincRNAs associated with positive versus negative pregnancy outcomes. Our study isolated and purified seminal plasma exosomes without ultracentrifugation, and it provides further evidence for differences in seminal plasma exosome molecular contents associated with pregnancy status.

Factors affecting success in intrauterine insemination cycles; 2-year single center experience

Abstract&#x0D; Objective: The aim of this study is to evaluate the success rates of intrauterine insemination cycles due to ovulation induction with clomiphene citrate and gonadotropins, and to identify factors associated with successful outcomes in women with unexplained infertility and ovulatory dysfunction.&#x0D; Material and Methods: Between June 2017 and October 2019, 223 intrauterine insemination cycle records were scanned retrospectively in 152 infertile couples diagnosed with ovulatory dysfunction or unexplained infertility. &#x0D; Result: A total of 33 positive pregnancy test results were obtained, which had shown a pregnancy success rate of 14.8%. Pregnancy success rate in Gonadotropin IUI (Intrauterine Insemination) cycles was found as 16.6% and pregnancy success rate in CC (Clomiphene Citrate) IUI cycles was found as 9.3%. While it has been detected that smoking has had a negative effect on IUI success rate for the infertile population with ovulatory dysfunction and unexplained infertility (p=0.012); factors such as female age, BMI (Body mass index), infertility span, basal FSH (Follicle Stimulating Hormone), basal LH (Luteinizing Hormone), basal estradiol levels and trigger-day endometrial thickness were found to have no correlation with IUI success rate at all.

Study on demographic variables of controlled ovarian Hyperstimulation and Intrauterine Insemination (husband) in a tertiary medical college and hospital in Kolkata

Background: Intrauterine Insemination (IUI) is anage old reliable and safe procedure for couples having infertility. Success rate of IUI with ovulation induction ranges from 8-20% depending on many factors.&#x0D; Aims and Objectives: The current study was to assess the factors which are responsible for favourable outcome of IUI after ovulation induction.&#x0D; Materials and Methods: Total 67 couples were included fulfilling inclusion and exclusion criteria. They underwent 90 cycles of IUI with each couple having maximum of 3 cycles. Ovulation induction was done byeitherclomiphene citrate or letrozole or gonadotrophins. Semen preparation was done by density gradient method. The participant’s demographic parameters were analyzed.&#x0D; Results: Out of 90 IUI, 8 were successful resulting in a success rate of 8.8% per cycle and 11.9% per couple. Factors which had positive impact were age less than 35 years, less than 10 years of infertility, normal and overweight BMI. Anovulation and unexplained infertility had better outcome. Type of infertility did not have any impact on the outcome.&#x0D; Conclusion: The study concluded that IUI after ovulation induction is more useful in cases like unexplained infertility and anovulation in a patient aged less than 35 years with less than 10 years of infertility and normal or overweight BMI.

Role of the total progressive motile sperm count (TPMSC) in different infertility factors in IUI: a retrospective cohort study

ObjectiveThe objective of this retrospective cohort study was to explore the optimal range of the total progressive motile sperm count (TPMSC) for live birth in couples with varying infertility diagnosis...

The Use of Pooled Consecutive Ejaculates in Moderate Male Factor Infertility to Increase Intrauterine Insemination Success.

Background:Male factor is a predominant cause of infertility. Success rates of intrauterine insemination(IUI) for male factor depend upon minimum semen parameters such as progressive motility > 30%, strict morphology > 4%, total motile count in the native sample (TMSC) >5 million and inseminating motile count (IMC) > 5 million. Couples with parameters lesser than these are usually advised IVF-ICSI. In developing countries, affordability for IVF is an important deterrent to its widespread utilisation.Aims:To evaluate pregnancy rates after the use of a pooled consecutive ejaculate in infertile men with semen parameters of < 5 million TMSC, and to compare with pregnancy rates achieved among couples with semen parameters > 5 million TMSC after processing of a single ejaculate.Settings and Design:Private infertility practice. Retrospective study from Oct 2012 to June 2019.Methods and Materials:All consecutive patients (n=1979) who underwent IUI in the given study period were included. Patients undergoing donor sperm insemination and low IMC (<1 mill) were excluded from the study. The study group (n=128) included patients in whom the total motile sperm count (TMSC) of the native sample was < 5 million. The control group (n=1851) included patients with normal semen parameters. All participants of the study group with TMSC < 5 million were asked to give a second ejaculate within an hour or two of producing the first. The pooled consecutive ejaculates were used for sample processing and insemination. The primary outcome measure was clinical pregnancy rate. The secondary outcome measures were semen quality of the second ejaculate, TMSC and IMC of both groups.Statistical Analysis:Quantitative parameters were compared using Independent sample t-test and Mann Whitney u test. Multivariate binary logistic regression analysis was performed to test the association between the explanatory variables and outcome variable. P value < 0.05 was considered statistically significant.Results:6.47% (128/1979) of men were required to give a consecutive ejaculate. The initial ejaculate had significantly higher volume (2ml vs 1 ml; P < 0.001); but lower concentration (8 million/ml vs 19 million/ml; P <0.001) and lower progressive motility (25% vs 35%; P <0.001) in comparison with the second. The final IMC of the pooled ejaculate was 9.01 million vs 21.6 million in the control group (P<0.001). The clinical pregnancy rate was comparable between the control group and the consecutive ejaculate group (15.4% vs 15.63%; P =0.94).Conclusion:Consecutive semen samples produced immediately after the first have significantly lower volume but higher sperm count and progressive motility. In couples with moderate male factor infertility with semen parameters inadequate for IUI, pooled consecutive ejaculates yield higher inseminating motile counts which enhance IUI success rates.

Different factors affecting the success of intrauterine insemination

Objective: The purpose of this study was to investigate the influence of various factors on the outcome of intrauterine insemination (IUI) as a trial for improving the quality of health care provided for women with infertility problems as well as infertility center outcomes. Methods: Cohort study conducted over two years between December 2016 and December 2018 in IVFICSI center. Two hundred forty-nine couples diagnosed with different infertility etiologies underwent 487 cycles of IUI were enrolled. Ultrasound follicular measurements were recorded around time of ovulation as well as different factors were col- lected and compared between pregnant and non-pregnant groups. Main outcome measures were clinical pregnancy rate and risk of OHSS ac- cording to the woman’s age, BMI, infertility type, different etiology of female infertility, the ovulation drug used and the quantity and size of ovarian follicles before hCG injection. Setting: Department of Obstetrics and Gynecology, Suez Canal Uni- versity Hospitals, Ismailia. Results:Pregnancy was achieved in 21.4% of cycles enrolled in the anal- ysis being significantly higher in women with mean follicular diameter of leading follicle of (19.8 +/- 1.97mm) in women with shorter infertility duration. The highest pregnancy rate was achieved in third IUI cycle. Conclusion: Leading follicle mean diameter of 19.8 mm was the op- timum diameter to trigger the ovulation and to have pregnancy. Early treatment of infertility is recommended as the success rate of IUI seems to get less with longer duration of infertility.

HERE COMES THE SUN: SERUM VITAMIN D LEVELS AND INTRAUTERINE INSEMINATION SUCCESS IN WOMEN OF ADVANCED MATERNAL AGE

Vitamin D is often thought to play an integral role in human reproduction. Previous research has shown vitamin D receptors to be located throughout the endometrium and on the granulosa cells of growing follicles, implicating its necessity in adequate reproductive function. As such, studies show that women deficient in vitamin D have decreased probability of live birth after IVF. Yet, more recent studies have found that the same is not true for women undergoing intrauterine insemination (IUI), as vitamin D levels did not seem to impact pregnancy rates. Thus, we sought to better understand the relationship between vitamin D and reproductive success among infertile women. The purpose of this study was to determine the relationship between serum vitamin D levels and IUI success rates in women of advanced maternal age. All patients over the age of 40 who underwent IUI between January 2017 - August 2019 were included. All patients received a basic fertility work up, including serum vitamin D and AMH levels, as well as ultrasound evaluations. Sufficient serum vitamin D levels were defined > 20 ng/mL. Thus, patients were divided into two groups: patients with vitamin D deficiency (0-19.99 ng/mL) and vitamin D sufficiency (>20 ng/mL) at baseline. Serum HCG levels were taken 12 days post-IUI. Positive pregnancy was defined as a blood HCG >5 (units). Clinical pregnancy rate and miscarriage rates were also noted. T-tests and chi square analysis were used to analyze the data using SPSS (SPSS Inc., Chicago, IL, USA). A total of 167 patients were analyzed. Baseline characteristics between the two groups, including age, BMI, and AMH were insignificant. The average baseline vitamin D level for deficient patients was 15.53 ng/mL while the average for sufficient patients was 35.83 ng/nL. There was a statistically significant difference in pregnancy rates between women over 40 with deficient and sufficient vitamin D levels (p<0.001). Of note, a negative correlation was found between vitamin D and AMH (p<0.05). Although previous research showed that vitamin D levels had no effect on IUI success in women under 40 years of age, here we demonstrated that vitamin D sufficiency in women over 40 years of age may play a role in IUI success. Further research is needed to analyze the costs and benefits of allotting time for women of advanced maternal age to replenish their vitamin D levels if they are pursuing IUI.

Intrauterine Insemination- Can we make it more successful?

The success rate of Intrauterine Insemination (IUI) to a great extent depends on the selection of the cohort of women undergoing the procedure. IUI is found to be beneficial in cases of unexplained infertility, unilateral tubal block or patients having early endometriosis with good tubo-ovarian relation. When ovulation stimulation with gonadotropins is undertaken success rate of IUI increases further. It is definitely helpful in younger patients but with advanced age the success rate declines. Usually the group of women more than 35years of age have been seen to be unfavourable with the procedure. [1] Overall success rate of IUI is not more than 20% even in best hands. In some highly selected cases where Post-coital Cervical Mucus and Intra-uterine Aspirate Test (PCT-IUA) proves poor sperm entry, IUI may be beneficial and pregnancy rate goes upto 40-45%. [2] In case of good sperm entry there is about 60% spontaneous conception and IUI is of limited value with only 2% success rate. [2] [3]