Role of intrauterine insemination in infertile couple seeking care at Acharya Vinobha Bhave rural tertiary care hospital

Sanjana Sunil Khemka, Deepti Shrivastava, C. Hariharan, Arpita Jaiswal

Abstract


Background: Fibroids Infertility affects between 60 million to 68 million people worldwide; generally one in ten couples experience primary or secondary infertility. The majority of those who suffer, live in the developing world. Universally, the prevalence rises significantly with a woman’s age. The WHO estimates the overall prevalence of infertility in India to be between 3.9 and 16.8 per cent. Objective: To assess the outcome of intrauterine insemination (IUI) amongst infertile couples seeking care at AVBRH. And to correlate the outcome of IUI with various parameters associated with infertility.

Methods: 50 patients undergoing 72 stimulated IUI cycles between September 2012 and august 2014. It was a prospective interventional study. Interventions: Ovarian stimulation with clomifene citrate & gonadotrophins was initiated and a single IUI was performed 36 h after triggering ovulation. Main outcome: Pregnancy rates by urine pregnancy test per couple. Pregnancy rates by urine pregnancy test per cycle. Secondary outcome: livebirth, on-going PR, abortion rate.

Results: The pregnancy rate per couple and per cycle were 22% and 15.27% respectively. Live birth were 8%, on-going pregnancy was 4%, abortions were 10%.  

Conclusions: On the basis of analysis of successful outcome of IUI it can be said that the patients with best prognosis are the one with age <30 years, lesser duration of infertility, good motile spermatozoa, preovulatory follicle, good endometrial thickness, & semen preparation are certainly the cornerstones for successful intrauterine insemination.


Keywords


Pregnancy rate, Intrauterine insemination, Cumulative pregnancy rate

Full Text:

PDF

References


Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker HW, Behre HM, et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update. 2010;16(3):231-45.

Vayena E, Rowe P. Peterson H. Assisted reproductive technology in developing countries: why should we care? Fertil Steril. 2002;781:13-5.

Vayena E, Rowe P, Griffin D, Van Look P, Turmen T. Forward, current practices and controversies in assisted reproduction. In: Vayena E, Rowe P, Griffin D, eds. Report of a Meeting on Medical, Ethical, and Social Aspects of Assisted Reproduction, 2001 17-21 Sept. Geneva, Switzerland: WHO; 2002: xv-xxi.

Cramer DW, Walker AM, Sciff. Statistical methods in evaluating the outcome of infertility therapy. Fertil Steril. 1979;32:80.

Agarwal SK, Buyalos RP. Clomiphene citrate with intrauterine insemination: is it effective therapy in women above the age of 35 years? Fertil Steril. 1996;65:759-63.

Bagis T, Haydardedeoglu B, Kilicdag EB, Cok T, Simsek E, Parlakgumus AH. Single versus double intrauterine insemination in multi-follicular ovarian hyperstimulation cycles: a randomized trial. Hum Reprod. 2010;25:1684-90.

Duran HE, Morshedi M, Kruger T, Oehninger S. Intrauterine insemination: a systematic review on determinants of success. Hum Reprod Update. 2002;8:373-84.

Nuojua-Huttunen S, Tomas C, Bloigu R, Tuomivaara L, Martikainen H. Intrauterine insemination treatment in subfertility: an analysis of factors affecting outcome. Hum Reprod. 1999;14:698-703.

Guzick DS, Carson SA, Coutifaris C, Overstreet JW, Factor-Litvak P, Steinkampf MP, et al. Efficacy of superovulation and intrauterine insemination in the treatment of infertility. N Engl J Med. 1999;340:177-83.

Shamila S, Sasikala SL. Primary report on the risk factors affecting female infertility in South Indian districts of Tamil Nadu and Kerala. Indian J Community Med. 2011;36(1):59-61.

Samal S, Dhadwe K, Gupta U, Gupta NK. Epidemiological study of male infertility. Indian Med Gazette. 2012 May;146(5):174-80.

Kang BM, Wu TC. Effect of age on intrauterine insemination with frozen donor sperm. Obstet Gynaecol. 1996;88:93-8.

Westerlaken LA, Naaktgeboren N, Helmerhorst FA. Evaluation of pregnancy rates after intrauterine insemination according to induction, age and sperm parameters. J Assist Reprod Genet. 1998;15:359-64.

Collins JA, Burrows EA, Willan AR. The prognosis for live birth among untreated infertile couples. Fertil Steril. 1995;64:22-8.

Scott RT, Opsahl MS, Leonardi MR, Neall GS, Illions EH, Navot D. Life table analysis of pregnancy rates in a general infertility population relative to ovarian reserve and patient age. Hum Reprod. 1995;10:1706-10.

Mohan S. Kamath, Priya Bhave, T. K. Aleyamma, Raju Nair, A. Chandy, Ann M. Mangalaraj, et al. Predictive factors for pregnancy after intrauterine insemination: a prospective study of factors affecting outcome; J Hum Reprod Sci. 2010 Sep-Dec;3(3):129-34.

Tomlinson M, Amissah-Arthur J, Thompson K, Kasraie J, Bentick B. Infertility: prognostic indicators for intrauterine insemination (IUI): statistical model for IUI success. Hum Reprod. 1996;11:1892-6.

Hughes E, Brown J, Collins J, Vanderkerchove P. Clomifene citrate for unexplained subfertility in women. Cochrane Database Syst Rev. 2000;(2):CD000057.

Nuojua-Huttunen S, Tomas C, Bloigu R, Tuomivaara L, Martikainen H. Intrauterine insemination treatment in subfertility: an analysis of factors affecting outcome. Hum Reprod. 1999;14:698-703.

Shahrzad Zadehmodarres, Belgheis Oladi, Shahrbanoo Saeedi, Fatemeh Jahed, Haleh Ashraf. Intrauterine insemination with husband semen: an evaluation of pregnancy rate and factors affecting outcome. J Assist Reprod Genet. 2009;26:7-11.

Behpour Yousefi, Azam Azargon. Predictive factors of intrauterine insemination success of women with infertility over 10 years. J Pak Med Assoc. 2011 Feb;61(2):165-8.

Lígia FP de Araújo, Edilberto de AraújoFilho, Cássio L. Fácio, Márcia CO. Bossoni, Ligiane A. Machado-Paula, José E. Corrente, et al. Efficacy of sperm motility after processing and incubation to predict pregnancy after intrauterine insemination in normospermic individuals. Reprod Biol Endocrinol. 2013;11:101.

Merviel P, Heraud MH, Grenier N, Lourdel E, Sanguinet P, Copin H. Predictive factors for pregnancy after intrauterine insemination (IUI): an analysis of 1038 cycles and a review of the literature. Fertil Steril. 2010;93(1):79.