Homologous intrauterine insemination. An evaluation of prognostic factors based on a review of 2473 cycles

Abstract

IUI-H is a simple and inexpensive treatment giving acceptable pregnancy rates for up to four treatment cycles providing that at least 3 to 4 mature follicles have developed at the time of insemination, which implies that hormonal ovarian stimulation and induction of ovulation is used, that insemination occurs between cycle day 13 and 16 and that at least 5 million motile sperms are available for insemination. Our results indicate that in the presence of tubal pathology or less than 5 million motile sperms, the couples should be referred directly to IVF-treatment.

Stimulated intrauterine insemination (SIUI) and donor insemination (DI) as first line management for a selected subfertile population: the Manchester experience

“…All these studies were retrospective except one [21], which was a prospective observational study and included 1,624 couples who underwent 3,381 clomiphene citrate-stimulated IUI cycles using either husband or donor sperm. The results of our study as well as those of others [2,6,7] showed that most of the pregnancies occurred in the first four treatment cycles, although few patients received more than 4 cycles. Other authors found that SIUI has the highest pregnancy rate within the first two [20,21,23] or three [1,[3][4][5]8] treatment cycles.…”

“…Previous studies have evaluated some or all of the prognostic factors influencing the success rate of IUI including the age of the woman [2], the sperm count and quality [4,20,21] or combined factors including the cycle's number [1,3,5,7,10,22,23]. All these studies were retrospective except one [21], which was a prospective observational study and included 1,624 couples who underwent 3,381 clomiphene citrate-stimulated IUI cycles using either husband or donor sperm.…”

“…There is no consensus regarding the optimum number of SIUI cycles that can be offered to couples before they move on to in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Some authors advocate that after three to four cycles of IUI the pregnancy rates decline [1][2][3][4][5][6][7][8], while others have suggested that there are still acceptable pregnancy rates achievable after the sixth cycle [9,10]. Only two studies clearly identified their objective as determination of the optimal number of IUI [11] or SIUI [12] cycles for the subfertile couple before resorting to IVF with or without ICSI.…”

Factors Leading to Pregnancies in Stimulated Intrauterine Insemination Cycles and the Use of Consecutive Ejaculations Within a Small Clinic Environment

“…When it came to male factor consideration, attaining 5 million motile sperm threshold for IUI is recommended [21,28], while there is no consensus on a lower limit of semen quality at which one would advocate IUI [29];the systematic review confirms favourable correlation with IUI success in the range of 5-10 million [30].…”

How to Perform the Best Intrauterine Insemination? A Review

“…It must be remembered that Total Motile Sperm Count [TMSC] inseminated has been cited as the most predictive index of conception after IUI cycles [9][10][11]. A minimalTMSC of 1 million for insemination was initially reported to be a requirement for pregnancy after insemination [12], but the systematic review of the literature by Ombelet et al in 2014 indeed confirms that the native sperm TMSC which shows the best correlation with IUI success is in the range of 5-10 million [6,[13][14][15][16]. According to a previous study, sperm concentration above 10 million is not related to further improvement in conception rates [12], while other investigators have reported the best pregnancy rates when more than 10 million motile spermatozoa are inseminated [9,17].…”