Determinants of the outcome of intrauterine insemination: Analysis of outcomes of 9963 consecutive cycles

To investigate a possible common environmental exposure that may partially explain the observed decrease in human semen quality, we correlated seminal plasma and blood cadmium levels with sperm concentration and sperm motility. We studied three separate human populations: group 1, infertility patients (Long Island, NY, USA); group 2, artificial insemination donors (AID) (Rochester, NY, USA); and group 3, general population volunteers (Rochester, NY, USA). Information about confounding factors was collected by questionnaire. Seminal plasma cadmium did not correlate with blood cadmium (Spearman correlation, n = 91, r = -0.092, P = 0.386, NS). Both blood and seminal plasma cadmium were significantly higher among infertility patients than the other subjects studied (for example, median seminal plasma cadmium was 0.282 μg/L in infertility patients versus 0.091 μg/L in AID and 0.092 μg/L in general population volunteers; Kruskal-Wallis test, P < 0.001). The percentage of motile sperm and sperm concentration correlated inversely with seminal plasma cadmium among the infertility patients (r = -0.201, P < 0.036 and r = -0.189, P < 0.05, respectively), but not in the other two groups. Age (among infertility patients) was the only positive confounder correlating with seminal plasma cadmium. To validate our human findings in an animal model, we chronically exposed adolescent male Wistar rats to low-moderate cadmium in drinking water. Though otherwise healthy, the rats exhibited decreases in epididymal sperm count and sperm motility associated with cadmium dose and time of exposure. Our human and rat study results are consistent with the hypothesis that environmental cadmium exposures may contribute significantly to reduced human male sperm concentration and sperm motility.

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“…This result is consistent with prior findings (114,115). Sperm concentration is also postulated to be contributory (115)(116)(117).…”

Section: Discussionsupporting

confidence: 94%

Cadmium Concentrations in Blood and Seminal Plasma: Correlations with Sperm Number and Motility in Three Male Populations (Infertility Patients, Artificial Insemination Donors, and Unselected Volunteers)

Benoff

Hauser

Marmar

et al. 2009

Mol Med

136

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“…ongoing pregnancy instead of delivery. In this age group delivery rates per cycles were reported in several papers [2,9,11,18,24] and varied from 1.4 % up to 9.8 % per cycle. In our study 63 IUI patients achieved a low crude cumulative delivery rate of 7.8 %.…”

Section: Discussionmentioning

confidence: 87%

Assisted reproduction counseling in women aged 40 and above: a cohort study

Brucker

Tournaye

Haentjens

et al. 2013

J Assist Reprod Genet

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Purpose Fertility treatment in women aged ≥40 year old remains difficult and controversial. All available studies in older women report results of one specific method of ART, i.e. IUI, IVF/ICSI or oocyte donation, and success rates are always published per attempt but never per patient. Randomized studies are not available because of the obvious heterogeneity in patient populations and treatment options.This prospective observational study aimed at analyzing the outcome in a consecutive cohort of patients above 40 undergoing various methods of ART. Methods A total number of 909 women older than 40 attended our fertility centre during a 3 years period. A flowchart showing the consecutive ART treatments with their respective outcome was constructed. Any delivery after 22 weeks gestation (or 500 g.) was taken as primary endpoint.Crude cumulative delivery rates (CDRs) and binomial exact 95 % confidence limits (95 % CLs) were calculated for each group of interest. Results ART treatment could be proposed to 737 patients (81 %) and eventually 585 patients (64 %) started ART treatment: 111 patients started IUI, 439 patients started IVF/ICSI and 35 patients started oocyte donation as a primary approach ART. Ten patients got pregnant spontaneously and delivered before starting any treatment. In the 909 patients consulting for infertility, 111 deliveries were achieved after ART, i.e. a crude CDR of 12.2 % (95 % CL 10.1 % to 14.5 %). Conclusion Only 10 % of patients aged 40 and above could achieve delivery of their genetically-own child, while 1 % conceived spontaneously. More than one third of patients consulting never started any treatment for different reasons, i.e. anticipated poor prognosis, financial restrictions, illness or spontaneous pregnancy.

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“…Resulting pregnancy rates are as high as 10.5% to 17.9% per cycle, as compared with baseline fecundity of 2% per cycle in this population [14]. The combination of controlled ovarian stimulation and IUI has gained acceptance among patients and physicians due to the fact that it is less expensive and less invasive than other forms of assisted reproductive technologies, such as in-vitro fertilization (IVF), while affording similar monthly fecundity rates in treatment of some etiologies [2].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Timing of Iui in Ovarian Stimulated Cycles

Wang

Chang

Chen

et al. 2006

Archives of Andrology

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& This study was conducted to compare pregnancy rates following two different timings of intrauterine insemination (IUI) in ovarian stimulated cycles. This retrospective study included 135 couples undergoing treatment for infertility. IUI was performed at either 24 hr or 36 hr after hCG injection. Pregnancy rates did not differ between the two groups or in subgroups receiving different methods of ovarian stimulation. Pregnancy rates were similar when IUI was performed at either 24 or 36 hr after hCG injection in ovarian stimulated cycles.

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Determinants of the outcome of intrauterine insemination: Analysis of outcomes of 9963 consecutive cycles

Cited by 118 publications

References 17 publications

Cadmium Concentrations in Blood and Seminal Plasma: Correlations with Sperm Number and Motility in Three Male Populations (Infertility Patients, Artificial Insemination Donors, and Unselected Volunteers)

Cadmium Concentrations in Blood and Seminal Plasma: Correlations with Sperm Number and Motility in Three Male Populations (Infertility Patients, Artificial Insemination Donors, and Unselected Volunteers)

Assisted reproduction counseling in women aged 40 and above: a cohort study

Comparison of Timing of Iui in Ovarian Stimulated Cycles

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