Intrauterine insemination—No more Mr. N.I.C.E. guy?

Geisler, Minna; Ledwidge, Mark; Bermingham, Margaret; McAuliffe, Mary; McMenamin, M.; Waterstone, John

doi:10.1016/j.ejogrb.2017.01.016

Cited by 18 publications

(16 citation statements)

References 16 publications

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“…A recent RCT shows that after 3–4 years unexplained infertility randomised for three cycles of IUI (CC) or expectant management5 a three-fold improvement in outcome in LBR from 31% and 9% is seen. IUI LB/cycle probabilities ranged from 21.4% to 5.1% dependent on age, cycle number and previous parity, with a MGP of 5.4% 18. IUI was also effective on LBR (OR 1.95 (1.10 to 3.44) (95% CI)) when compared with intercourse or expectant management in a stimulated cycle 19.…”

Section: Discussionmentioning

confidence: 97%

Observational retrospective study of UK national success, risks and costs for 319,105 IVF/ICSI and 30,669 IUI treatment cycles

et al. 2020

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ObjectiveTo compare success rates, associated risks and cost-effectiveness between intrauterine insemination (IUI) and in vitro fertilisation (IVF).DesignRetrospective observational study.SettingThe UK from 2012 to 2016.ParticipantsData from Human Fertilisation and Embryology Authority’s freedom of information request for 2012–2016 for IVF/ICSI (intracytoplasmic sperm injection)and IUI as practiced in 319 105 IVF/ICSI and 30 669 IUI cycles. Direct-cost calculations for maternal and neonatal expenditure per live birth (LB) was constructed using the cost of multiple birth model, with inflation-adjusted Bank of England index-linked data. A second direct-cost analysis evaluating the incremental cost-effective ratio (ICER) was modelled using the 2016 national mean (baseline) IVF and IUI success rates.Outcome measuresLB, risks from IVF and IUI, and costs to gain 1 LB.ResultsThis largest comprehensive analysis integrating success, risks and costs at a national level shows IUI is safer and more cost-effective than IVF treatment.IVF LB/cycle success was significantly better than IUI at 26.96% versus 11.49% (p<0.001) but the IUI success is much closer to IVF at 2.35:1, than previously considered. IVF remains a significant source of multiple gestation pregnancy (MGP) compared with IUI (RR (Relative Risk): 1.45 (1.31 to 1.60), p<0.001) as was the rate of twins (RR: 1.58, p<0.001).In 2016, IVF maternal and neonatal cost was £115 082 017 compared with £2 940 196 for IUI and this MGP-related perinatal cost is absorbed by the National Health Services. At baseline tariffs and success rates IUI was £42 558 cheaper than IVF to deliver 1LB with enhanced benefits with small improvements in IUI. Reliable levels of IVF-related MGP, OHSS (ovarian hyperstimulation syndrome), fetal reductions and terminations are revealed.ConclusionIUI success rates are much closer to IVF than previously reported, more cost-effective in delivering 1 LB, and associated with lower risk of complications for maternal and neonatal complications. It is prudent to offer IUI before IVF nationally.

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Section: Discussionmentioning

confidence: 97%

Observational retrospective study of UK national success, risks and costs for 319,105 IVF/ICSI and 30,669 IUI treatment cycles

et al. 2020

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“…Finally, although the clinical pregnancy rate seen in our population was 7.59%, the subgroup of patients thought to have ideal conditions for intrauterine insemination (age ≤ 35 years, unexplained infertility, ovarian factor infertility or minimal endometriosis, and partners with sperm count ≥2.5×10 6 retrieved on the day of insemination) had a pregnancy rate of 12.74%. Geisler et al. (2017) recently aimed to find the factors that might support more individualized applications of IUI, and reported that IUI associated with controlled ovarian hyperstimulation, especially in younger patients, produced good live birth rates.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors in intrauterine insemination cycles

Sicchieri

Silva

Rosa‐e‐Silva

et al. 2018

JBRA Assisted Reproduction

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ObjectiveThis study aimed to evaluate the clinical pregnancy rate of intrauterine insemination cycles in relation to patient age, cause of infertility, ovulation induction method, number of mature follicles and sperm with progressive motility.MethodsThis retrospective observational study included 237 intrauterine insemination cycles performed from 2011 to 2015 at the Assisted Reproduction Service of the Hospital das Clínicas of the Ribeirão Preto Medical School, University of São Paulo. Student's t-test was used to compare quantitative variables and the chi-square test was used to compare qualitative variables.ResultsPatient age was inversely and significantly correlated with pregnancy rates (p=0.001) (Pregnant women = 32.56±5.64 years, non-pregnant women = 36.64±5.03 years). Cause of infertility, ovulation induction method, number of mature follicles and sperm with progressive motility were not associated with pregnancy rates. The overall clinical pregnancy rate was 7.59%. In the subgroup of patients (n=102 cycles) considered ideal for intrauterine insemination (age ≤35 years, unexplained infertility, ovarian factor infertility or minimal endometriosis, and a partner with sperm count ≥2.5×106 retrieved on the day of insemination) the pregnancy rate was 12.74%.ConclusionIn the studied group, female patient age was the only variable significantly correlated with intrauterine insemination success rates.

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“…It is important to point out that even in patients diagnosed with idiopathic infertility, fertility rates may decline due to lower oocyte quality, fertilization failure or embryo implantation abnormalities (Wolff et al ., 2013). Advanced maternal age is an established independent negative prognostic factor for live births and clinical pregnancy associated with lower chances of spontaneous or assisted pregnancy (Geisler et al ., 2017). In the present study, a clear relationship was observed between lower clinical pregnancy rates and advanced maternal age.…”

Section: Discussionmentioning

confidence: 99%

Intrauterine insemination as a primary viable option to infertile couples: evaluation of patients in a private center

Bonow

Donne

Rosa³

et al. 2019

JBRA Assisted Reproduction

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Objective:This study aimed to identify which parameters positively affect the clinical pregnancy rates of IUI cycles and find which couples should opt for IUI.Methods:This retrospective observational study included 261 patients submitted to 381 IUI cycles with fresh or cryopreserved partner semen (IU-H) from January 2012 to February 2017 in a private center in Curitiba-PR, Brazil.Results:Idiopathic infertility was the most frequent finding (35.9%). Patients younger than 40 years accounted for 87.9% of the IUI cycles (n=335) and 16.1% of the clinical pregnancies (n=54). The pregnancy rate was three times higher in patients with an endometrium thickness ≥8 mm compared to patients with endometrium thickness <8mm. Sperm motility >55% was linked to higher pregnancy rates (p=0.002). Concerning gonadotropins, 159 (48.4%) took rFSH, 127 (38.7%) hMG, and 42 (12.8%) uFSH, with pregnancy rates of 21.3%, 10.4% and 10.5%, respectively.Conclusion:Patients under 40 years of age with endometrium thickness ≥8 mm, sperm motility >55%, and on rFSH had significantly higher pregnancy rates (p<0.05).

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Intrauterine insemination—No more Mr. N.I.C.E. guy?

Cited by 18 publications

References 16 publications

Observational retrospective study of UK national success, risks and costs for 319,105 IVF/ICSI and 30,669 IUI treatment cycles

Observational retrospective study of UK national success, risks and costs for 319,105 IVF/ICSI and 30,669 IUI treatment cycles

Prognostic factors in intrauterine insemination cycles

Intrauterine insemination as a primary viable option to infertile couples: evaluation of patients in a private center

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