Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

Pregnancy Predictors after Intrauterine Insemination: Analysis of 3012 Cycles in 1201 Couples

Authors
Macizo Soria 1
Gálvez Pradillo 1
Jorquera García 1
Peinado Ramón 1
Alvarez Castillo 1
Canteras Jordana 2
Parrilla Paricio 1
1 Department of Obstetrics and Gynecology, Human Reproduction Unit, Virgen de la Arrixaca University Hospital, Murcia, Spain
2 Department of Biostatistics, School of Medicine, University of Murcia, Murcia, Spain
Abstract
Background: Intrauterine insemination (IUI) is the first therapeutic step in assisted reproductive techniques and many factors, including male and female infertility and technique-dependent factors, have been reported to influence pregnancy rates after IUI. Methods: We carried out this retrospective study on 1201 couples undergoing 3012 intrauterine insemination cycles during 2002 to 2009. Pregnancy rate per cycle in terms of female infertility factors, male infertility factors, and technique-dependent factors were evaluated. The χ2, t-test, Kaplan-meier method, and multiple logistics regression model, were used for data analysis. The p < 0.05 was considered statistically significant. Results: The highest pregnancy rates were obtained in cases whose infertility duration was shorter (p < 0.05), Body Mass Index (BMI) was ≥25 (p < 0.05), FSH
Keywords
gonadotropin
Intra uterine insemination
Ovarian hyperstimulation
Pregnancy rate
Semen Analysis
Katzorke T, Kolodziej FB. [Significance of insemination in the era of IVF and ICSI]. Urologe A. 2010; 49(7):842-6. German.
Kamath MS, Bhave P, Aleyamma T, Nair R, Chandy A, Mangalaraj AM, et al. Predictive factors for pregnancy after intrauterine insemination: A prospective study of factors affecting outcome. J Hum Reprod Sci. 2010;3(3):129-34.
Souter I, Baltagi LM, Kuleta D, Meeker JD, Petrozza JC. Women, weight, and fertility: the effect of body mass index on the outcome of superovulation/ intrauterine insemination cycles. Fertil Steril. 2011; 95(3):1042-7.
Akanji Tijani H, Bhattacharya S. The role of intrauterine insemination in male infertility. Hum Fertil (Camb). 2010;13(4):226-32.
Abma JC, Chandra A, Mosher WD, Peterson LS, Piccinino LJ. Fertility, family planning, and women's health: new data from the 1995 National Survey of Family Growth. Vital Health Stat 23. 1997;(19):1-114.
World Health Organization. [Recent advances in medically assisted conception]. Geneva: WHO; 1992. 111 p. Report No.: 820:2-7. Spanish.
Gray RH. Epidemiology of infertility. Curr Opin Obstet Gynecol. 1990;2(2):154-8.
Templeton A, Fraser C, Thompson B. The epidemiology of infertility in Aberdeen. BMJ. 1990;301(67 44):148-52.
Vanrell JA. [Sterility, subfertility and infertility: definition, frequency and etiology]. In: Vanrell JA, Calaf J, editors. Human Fertility and sterility. Barcelona: Masson-Salvat; 1992. p. 1-8. Spanish.
Stephen EH, Chandra A. Updated projections of infertility in the United States: 1995-2025. Fertil Steril. 1998;70(1):30-4.
Matorras R. [Epidemiology of infertility, Updates of the Spanish Society of Fertility]. Spain: Spanish Fertility Society; 2000. p. 7-9. Spanish.
Collins JA, Burrows EA, Wilan AR. The prognosis for live birth among untreated infertile couples. Fertil Steril. 1995;64(1):22-8.
Snick HK, Snick TS, Evers JL, Collins JA. The spontaneous pregnancy prognosis in untreated subfertile couples: the Walcheren primary care study. Hum Reprod. 1997;12(7):1582-8.
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(3):698-703.
Brzechffa PR, Daneshmand S, Buyalos RP. Sequential clomiphene citrate and human menopausal gonadotrophin with intrauterine insemination: the effect of patient age on clinical outcome. Hum Reprod. 1998;13(8):2110-4.
Goverde AJ, McDonnell J, Vermeiden JP, Schats R, Rutten FF, Schoemaker J. Intrauterine insemination or in-vitro fertilisation in idiopathic subfertility and male subfertility: a randomised trial and cost-effectiveness analysis. Lancet. 2000;355 (9197):13-8.
Stone BA, Vargyas JM, Ringler GE, Stein AL, Marrs RP. Determinants of the outcome of intrauterine insemination: analysis of outcomes of 9963 consecutive cycles. Am J Obstet Gynecol. 1999; 180(6 Pt 1):1522-34.
Dodson WC, Kunselman AR, Legro RS. The effect of obesity on treatment outcomes for infertile ovulatory women undergoing superovulation and intrauterine insemination. Fertil Steril. 2005;84(Supple1):S72-73.
Hassan MA, Killick SR. Negative lifestyle is associated with a significant reduction in fecundity. Fertil Steril. 2004;81(2):384-92.
Clark AM, Thornley B, Tomlinson L, Galletley C, Norman RJ. Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Hum Reprod. 1998; 13(6):1502-5.
Pasquali R, Antenucci D, Casimirri F, Venturoli S, Paradisi R, Fabbri R, et al. Clinical and hormonal characteristics of obese amenorrheic hyperandrogenic women before and after weight loss. J Clin Endocrinol Metab. 1989;68(1):173-9.
Buyalos RP, Daneshmand S, Brzechffa PR. Basal estradiol and follicle-stimulating hormone predict fecundity in women of advanced reproductive age undergoing ovulation induction therapy. Fertil Steril. 1997;68(2):272-7.
Navot D, Bergh PA, Williams MA, Garrisi GJ, Guzman I, Sandler B, et al. Poor oocyte quality rather than implantation failure as a cause of agerelated decline in female fertility. Lancet. 1991;337 (8754):1375-7.
Ahmed Ebbiary NA, Lenton EA, Salt C, Ward A M, Cooke ID. The significance of elevated basal follicle stimulating hormone in regularly menstruating infertile women. Hum Reprod. 1994;9(2): 245-52.
Mullin CM, Trivax B, Baxter M, Virji N, Saketos M, San Roman G. Day 3 follicle stimulating hormone (FSH) and estradiol (E2): could these values be used as markers to predict pregnancy outcomes in women undergoing ovulation induction (OI) therapy with intrauterine insemination (IUI) cycles? Fertil Steril. 2005;84 Suppl1:S162.
Scott RT, Toner JP, Muasher SJ, Oehninger S, Robinson S, Rosenwaks Z. Follicle-stimulating hormone levels on cycle day 3 are predictive of in vitro fertilization outcome. Fertil Steril. 1989;51 (4):651-4.
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 P H, Pyrzak R. Effect of diagnosis, age, sperm quality, and number of preovulatory follicles on the outcome of multiple cycles of clomiphene citrateintrauterine insemination. Fertil Steril. 2002;78(5): 1088-95.
Toma SK, Stovall DW, Hammond MG. The effect of laparoscopic ablation or danocrine on pregnancy rates in patients with stage I or II endometriosis undergoing donor insemination. Obstet Gynecol. 1992;80(2):253-6.
Dorjpurev U, Kuwahara A, Yano Y, Taniguchi T, Yamamoto Y, Suto A, et al. Effect of semen characteristics on pregnancy rate following intrauterine insemination. J Med Invest. 2011;58(1-2):127-33.
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 Suppl 1:S248-9.
Hughes EG. The effectiveness of ovulation induction and intrauterine insemination in the treatment of persistent infertility: a meta-analysis. Hum Reprod. 1997;12(9):1865-72.
Aboulghar M, Mansour R, Serour G, Abdrazek A, Amin Y, Rhodes C. Controlled ovarian hyperstimulation and intrauterine insemination for treatment of unexplained infertility should be limited to a maximum of three trials. Fertil Steril. 2001;75 (1):88-91.
Khalil MR, Rasmussen PE, Erb K, Laursen SB, Rex S, Westergaard LG. Intrauterine insemination with donor semen. An evaluation of prognostic factors based on a review of 1131 cycles. Acta Obstet Gynecol Scand. 2001;80(4):342-8.
Dickey RP, Olar TT, Taylor SN, Curole DN, Rye PH. Relationship of follicle number and other factors to fecundability and multiple pregnancy in clomiphene citrate-induced intrauterine insemination cycles. Fertil Steril. 1992;57(3):613-9.
Plosker SM, Jacobson W, Amato P. Predicting and optimizing success in an intrauterine insemination programme. Hum Reprod. 1994;9(11):2014-21.
Ransom MX, Blotner MB, Bohrer M, Corsan G, Kemmann E. Does increasing frequency of intrauterine insemination improve pregnancy rates significantly during superovulation cycles? Fertil Steril. 1994;61(2):303-7.
Ragni G, Maggioni P, Guermandi E, Testa A, Baroni E, Colombo M, et al. Efficacy of double intrauterine insemination in controlled ovarian hyperstimulation cycles. Fertil Steril. 1999;72(4):619-22.
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(7):1684-90.
Cohlen BJ, Vandekerckhove P, te Velde ER, Habbema JD. Timed intercourse versus intrauterine insemination with or without ovarian hyperstimulation for subfertility in men. Cochrane Database Syst Rev. 2000;(2):CD000360.
Bry-Gauillard H, Coulondre S, Cédrin-Durnerin I, Hugues JN. [Benefits and risks of ovarian stimulition before intrauterine insemination]. Gynecol Obstet Fertil. 2000;28(11):820-31. French.
Cantineau AE, Cohlen BJ, Heineman MJ. Ovarian stimulation protocols (anti-oestrogens, gonadotrophins with and without GnRH agonists/antagonists) for intrauterine insemination (IUI) in women with subfertility. Cochrane Database Syst Rev. 2007;(2):CD005356.
Casadei L, Zamaro V, Calcagni M, Ticconi C, Dorrucci M, Piccione E. Homologous intrauterine insemination in controlled ovarian hyperstimulation cycles: a comparison among three different regimens. Eur J Obstet Gynecol Reprod Biol. 2006;129 (2):155-61.
Dankert T, Kremer JA, Cohlen BJ, Hamilton CJ, Pasker-de Jong PC, Straatman H, et al. A randomized clinical trial of clomiphene citrate versus low dose recombinant FSH for ovarian hyperstimulation in intrauterine insemination cycles for unexplained and male subfertility. Hum Reprod. 2007; 22(3):792-7.
Gerli S, Bini V, Di Renzo GC. Cost-effectiveness of recombinant follicle-stimulating hormone (FSH) versus human FSH in intrauterine insemination cycles: a statistical model-derived analysis. Gynecol Endocrinol. 2008;24(1):18-23.
Demirol A, Gurgan T. Comparison of different gonadotrophin preparations in intrauterine insemination cycles for the treatment of unexplained infertility: a prospective, randomized study. Hum Reprod. 2007;22(1):97-100.
Kocak M, Dilbaz B, Demir B, Taşci Y, Tarcan A, Dede S, et al. Lyophilised hMG versus rFSH in women with unexplained infertility undergoing a controlled ovarian stimulation with intrauterine insemination: a prospective, randomised study. Gynecol Endocrinol. 2010;26(6):429-34.
Sagnella F, Moro F, Lanzone A, Tropea A, Martinez D, Capalbo A, et al. A prospective random-ized noninferiority study comparing recombinant FSH and highly purified menotropin in intrauterine insemination cycles in couples with unexplained infertility and/or mild-moderate male factor. Fertil Steril. 2011;95(2):689-94.
Matorras R, Osuna C, Exposito A, Crisol L, Pijoan JI. Recombinant FSH versus highly purified FSH in intrauterine insemination: systematic review and metaanalysis. Fertil Steril. 2011;95(6):1937-42.
Balasch J, Fábregues F, Peñarrubia J, Creus M, Vidal R, Casamitjana R, et al. Follicular development and hormonal levels following highly purified or recombinant follicle-stimulating hormone administration in ovulatory women and WHO group II anovulatory infertile patients. J Assist Reprod Genet. 1998;15(9):552-9.
Matorras R, Recio V, Corcóstegui B, Rodríguez-Escudero FJ. Recombinant human FSH versus highly purified urinary FSH: a randomized study in intrauterine insemination with husbands' spermatozoa. Hum Reprod. 2000;15(6):1231-4.
Balasch J, Miró F, Burzaco I, Casamitjana R, Civico S, Ballescá JL, et al. The role of luteinizing hormone in human follicle development and oocyte fertility: evidence from in-vitro fertilization in a woman with long-standing hypogonadotrophic hypogonadism and using recombinant human follicle stimulating hormone. Hum Reprod. 1995; 10(7):1678-83.
De la Fuente A. [Evaluation of the effectiveness, safety and cost-effectiveness of highly purified human menopausal gonadotropin. Study of use Menopur ® in Intrauterine Artificial Insemination (IAC/IAD)]. Fertil Rev. 2007:24(6):363-7. Spanish.
Dickey RP, Taylor SN, Curole DN, Rye PH, Lu P Y, Pyrzak R. Relationship of clomiphene dose and patient weight to successful treatment. Hum Reprod. 1997;12(3):449-53.
Mannaerts B, Shoham Z, Schoot D, Bouchard P, Harlin J, Fauser B, et al. Single-dose pharmacokinetics and pharmacodynamics of recombinant human follicle-stimulating hormone (Org 32489*) in gonadotropin-deficient volunteers. Fertil Steril. 1993;59(1):108-14.
Chung MT, Chan TF, Loo TC, Tang HH, Lin LY, Tsai YC. Comparison of the effect of two different doses of recombinant gonadotropin for ovarian stimulation on the outcome of intrauterine insemination. Taiwan J Obstet Gynecol. 2011;50(1):58-61.
Journal of Reproduction & Infertility
Volume 13, Issue 3
Summer 2012
Pages 158-166