Factors affecting success of intrauterine insemination: a 3 year prospective study
Keywords:IUI, Post wash sperm count, Endometrial thickness, PCO, Male factor
Background: Intrauterine insemination (IUI) is the therapeutic process of placing washed spermatozoa transcervically into the uterine cavity for the treatment of infertility. The aim of this study is to analyze the variables that contribute to the success of stimulated IUI cycles. A prospective study was done to identify the most important parameters with regard to IUI success that would provide important data for predicting the success of therapy and further help in planning sub fertility treatment for couples.
Methods: This prospective analytical study was done at KJK Fertility Research and Gynaec Centre, Thiruvananthapuram, Kerala over a period of 3 years from June 2012 to June 2015 in 3851 stimulated IUI cycles.
Results: The overall pregnancy rate was 15.2%. Among the predictive factors evaluated, the infertility diagnosis (PCO and male factor, p value <0.001), the post wash semen count (5-10 million, p value <0.001), type of IUI (double IUI over single IUI, p value <0.001) and the endometrial thickness on the day of trigger (9-10mm, χ2 =551.59 df =5 p<0.001) significantly influenced the pregnancy rate.Conclusions: IUI is a successful contemporary treatment for appropriately selected cases of PCO and male factor infertility, especially when female age is <35 years.
Keck C, Gerber-Schafer C, Wilhelm C, Vogelgesang D, Breckwoldt M. Intrauterine insemination for treatment of male infertility, International Journal of Andrology. 1997;20:55-64.
Duran HE, Morshedi M, Kruger T, Oehninger S. Intrauterine insemination: A systematic review on determinants of success. Hum Reprod Update. 2002;8:373-84.
Guzick DS, Carson SA, Coutifaris C, Overstreet JW, Factor-Litvak P, Steinkampf MP. Efficacy of superovulation and intrauterine insemination in the treatment of infertility. N Engl J Med. 1999;340:177-83.
Hughes EG. Stimulated intra-uterine insemination is not a natural choice for the treatment of unexplained subfertility: Effective treatment or ‘not a natural choice’? Hum Reprod. 2003;18:912-4.
Van Rumste M, Custers I, van der Veen F, van Wely M, Evers J, Mol B. The influence of the number of follicles on pregnancy rates in intrauterine insemination with ovarian stimulation: A meta-analysis. Hum Reprod Update. 2008;14:563-70.
Wainer R, Albert M, Dorion A, Bailly M, Bergere M, Lombroso R. Influence of the number of motile spermatozoa inseminated and of their morphology on the success of intrauterine insemination. Hum Reprod. 2004;19:2060-5.
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.
World Health Organization, Department of Reproductive Health and Research. WHO laboratory manual for the examination and processing of human semen. Switzerland: WHO Press. 2010.
Baird DT, Collins J, Egozcue J, Evers LH, Gianaroli L, Leridon H. Fertility and ageing. Hum Reprod Update. 2005;11:261-76.
Grondahl M, Andersen YC, Bogstad J, Nielsen F, Meinertz H, Borup R. Gene expression profiles of single human mature oocytes in relation to age. Hum Reprod. 2010;25:957-68.
Leridon H. Can assisted reproduction technology compensate for the natural decline in fertility with age? A model assessment. Hum Reprod. 2004;19:1548-53.
Dickey RP, Taylor SN, Lu PY, Sartor BM, Rye PH, Pyrzak R. Effect of diagnosis, age, sperm quality, and number of pre ovulatory follicles on the outcome of multiple cycles of clomiphene citrate-intrauterine insemination. Fertil Steril. 2002;78:1088-95.
Agrawal SK, Buyalon RP. Clomiphene citrate with intrauterine insemination. Is it effective therapy in women above the age of 35years? Fertil Steril. 1996;65:759-63.
Frederick J, Denker M, Rojas A, Horta I, Stone S, Asch R. Infertility: Is there a role for ovarian stimulation and intra-uterine insemination after age 40? Hum Reprod. 1994;9:2284-6.
Soria M, Pradillo G, García J, Ramón P, Castillo A, Jordana C. Pregnancy Predictors after Intrauterine Insemination: Analysis of 3012 Cycles in 1201 Couples. J Reprod Infertil. 2012;13(3):158-66.
Härkki P, Tiitinen A, Ylikorkala O. Endometriosis and assisted reproduction techniques. Ann N Y Acad Sci. 2010;1205:207-13.
Vlahos NF, Coker L, Lawler C, Zhao Y, Bankowski B, Wallach EE. Women with ovulatory dysfunction undergoing ovarian stimulation with clomiphene citrate for intrauterine insemination may benefit from administration of human chorionic gonadotropin. Fertil Steril. 2005;83(5):1510-6.
Dickey RP, Taylor SN, Lu PY, Sartor BM, Rye PH, Pyrzak R. Effect of diagnosis, age, sperm quality, and number of pre ovulatory follicles on the outcome of multiple cycles of clomiphene citrate intrauterine insemination. Fertil Steril. 2002;78(5):1088-95.
Reuter H, Cohen S, Fureg C, Baker S. sonographic appearance of the endometrium and ovaries during cycles stimulated with human menopausal gonadotropin. J Reprod Med. 1996;41:509-14.
Esmailzadeh S. Endometrial thickness and pregnancy outcome after IUI. Fertility Steril. 2007;88:432-7.
Dickey RP, Olar TT, Taylor SN, Curok DN, Matulich EM. Relationship of endometrial thickness and pattern to fecundity in ovulation induction cycles: ffect of cc alone and with HMG. Fertil Steril. 1993;59:756-60 .
Weissman A-Gotlieb L, Casper RF. The detrimental effect of increased endometrial thickness on implantation and pregnancy rates. Fertil Steril. 1999;71:147-9.
Sakhel K, Abozaid T, Schwark S, Ashraf M, Abuzeid M. Semen parameters as determinants of success in 1662 cycles of intrauterine insemination after controlled ovarian hyperstimulation. Fertil Steril. 2005;84(1):S248-9.
Wainer R, Albert M, Dorion A. Influence of the number of motile spermatozoa inseminated and of their morphology on the success of intrauterine insemination, Human Reprod. 2004;19,9:2060-5.
Miller DC, Hollenbeck BK, Smith GD. Processed total motile sperm count correlates with pregnancy outcome after intrauterine insemination, Urology. 2002;60(3):497-501.
Berg U, Brucker C, Berg FD. Effect of motile sperm count after swim-up on outcome of intrauterine insemination, Fertility and Steril. 1997;67,4:747-50.
Koyun Ok E, Doğan OE, Okyay RE, Gülekli B. The effect of post-wash total progressive motile sperm count and semen volume on pregnancy outcomes in intrauterine insemination cycles: a retrospective study.J Turk Ger Gynecol Assoc. 2013;14(3):142-5.
Cantineau AEP, Heineman MJ, Cohlen BJ. Single versus double intrauterine insemination (IUI) in stimulated cycles for sub fertile couples. Cochrane Database of Systematic Reviews. 2003;1:CD003854.
Silverberg KM, Johnson JV, Olive DL, Burns WN, Schenken RS. A prospective, randomized trial comparing two different intrauterine insemination regimens in controlled ovarian hyper stimulation cycles. Fertil Steril. 1992;57:357-61.
Ragni G, Maggioni P, Guermandi E, Testa A, Baroni E, Colombo M. Efficacy of double intrauterine insemination in controlled ovarian hyperstimulation cycles. Fertil Steril. 1999;72:619-22.
Wei Liu, Fei Gong, Keli Luo, Guangxiu Lu. Comparing the pregnancy rates of one versus two intrauterine inseminations (IUIs) in male factor and idiopathic infertility. J Assist Reprod Genet. 2006;23(2):75-9.
Gauci MM, Kruger TF, Coetzee K, Smith K, Van Der Merwe JP, Lombard CJ. Stepwise regression analysis to study male and female factors impacting on pregnancy rate in an intrauterine insemination programme. Andrologia. 2001;33(3):135-41.
Cantineau AEP, Cohlen BJ. Ovarian stimulation protocols (anti-oestrogens, gonadotrophins with and without GnRH agonists/antagonists) for intrauterine insemination (IUI) in women with subfertility, The Cochrane Database of Systematic Reviews. 2007;2:1-135.