Intrauterine insemination treatment in subfertility: an analysis of factors affecting outcome

Nuojua-Huttunen, Sinikka; Tomás, Cǎndido; Bloigu, Risto; Tuomivaara, Leena; Martikainen, Hannu

doi:10.1093/humrep/14.3.698

Cited by 222 publications

(222 citation statements)

References 48 publications

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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: 88%

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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Section: Discussionmentioning

confidence: 88%

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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“…In the present study, we also observed that as the infertility duration became longer, the gestation rates also increased. However, in the literature, many studies have indicated that as the age (5,8,17) and infertility duration (7,17,18) increase, gestational rates decrease. Also, Ibérico et al (19) reported in a study published in 2004 that gestational rates in IUI decreased independently of the age through longer infertility durations.…”

Section: Discussionmentioning

confidence: 99%

“…For instance, there are many studies related to age (4), the ovarian reserve of females (5) and sperm parameters in males (6), and the duration and type of infertility (7), which are pre-cycle parameters. Furthermore, the effects of cyclic parameters, such as selected ovulation induction protocols and the characteristics of the obtained follicles, have been evaluated on IUI outcomes in different studies (8)(9)(10). Despite all these studies, there is still no consensus on parameters that can predict the chances of clinical pregnancy after IUI.…”

Section: Introductionmentioning

confidence: 99%

Factors affecting clinical pregnancy rates after IUI for the treatment of unexplained infertility and mild male subfertility

Atasever¹,

Kalem²,

Hatırnaz³

et al. 2016

J Turkish German Gynecol Assoc

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Objective:The aim of the present retrospective study was to evaluate intrauterine insemination (IUI) clinical experiences and to define the variables for predicting success. Material and Methods:The present study was an observational trial performed in a private IVF center on subfertile couples who had applied for treatment between 2002 and 2012, in which the data of 503 IUI cases were retrospectively reviewed. Couples who had been diagnosed with unexplained and mild male subfertility were included. The primary outcome measure was the clinical pregnancy rate in an attempt to form a predictive model for the odds of a clinical pregnancy. Recorded parameters were used to determine the prediction model. Results:Utilizing univariate logistic regression analysis, clinical pregnancy was positively associated with the duration of infertility (OR=1.09, p=0.089), secondary infertility (OR=1.77, p=0.050), and +4 sperm motility after preparation (OR=1.03, p=0.091). Following an adjustment analysis involving a multivariate logistic regression, clinical pregnancy was still found to positively associate with secondary infertility (OR=2.51, p=0.008). Conclusion:IUI success in secondary infertile couples who were in the unexplained infertility and mild male subfertility groups was higher than that in primary infertile couples, and the chances of pregnancy increased as sperm numbers with +4 motility increased. It is difficult to concomitantly evaluate all these parameters and to determine a predictive parameter in IUI independent from other factors. (J Turk Ger Gynecol Assoc 2016; 17: 134-8) Keywords: Intrauterine insemination, unexplained infertility, male subfertility Received: 1 April, 2016 Accepted: 25 July, 2016 Factors affecting clinical pregnancy rates after IUI for the treatment of unexplained infertility and mild male subfertility

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“…Intrauterine insemination is most frequently used (15). Although this is a low risk procedure, it is expensive, requiring sperm preparation in the laboratory and usually controlled ovarian stimulation and ultrasonography, generally restricting the treatment to specialized centers (16).…”

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confidence: 99%

In situ variation of cervical mucus pH during exposure to atmospheric air

Correa¹,

Mattos²,

Ferrari³

2001

Braz J Med Biol Res

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The objective of the present study was to determine if exposure of cervical mucus to air during specular examination could modify mucus pH. Detection of changes is justified because of their possible interference with sperm-mucus interaction, since an acidic pH is unfavorable to sperm penetration and is associated with infertility due to the cervical factor. Twenty women with good quality mucus were evaluated. pH measurements of ecto-and endocervical mucus were made in situ using a glass electrode after 0-, 5-and 10-min exposure to air. There was a progressive alkalinization of mucus pH. Mean values of ectocervical mucus pH were 6.91, 7.16 and 7.27, while mean values of endocervical mucus pH were 7.09, 7.34 and 7.46 at 0, 5 and 10 min, respectively. Significant differences were found between the mean values obtained at 0 and 5 min, and at 0 and 10 min (P<0.05), whereas the differences in mean values at 5 and 10 min were not significant at either site. We conclude that 5 to 10 min of exposure to atmospheric air affects cervical mucus pH in a significant way. Since tests used to evaluate sperm-mucus interaction generally have not considered this possibility, we suggest that they should be performed immediately after mucus collection in order to avoid misinterpretation of the results. Abnormalities of the cervix and its secretion are reported to be responsible for infertility in approximately 5 to 10% of women (1). Evaluation of sperm-cervical mucus interaction is important in infertility investigation. The traditional method for the evaluation of sperm-cervical mucus interaction in vivo is the postcoital test (PCT), but in vitro cervical mucus-sperm penetration tests are also used (2,3).Sometimes, negative or abnormal PCT are attributed to immunological problems in particular. Anyway, recent studies have shown that the incidence of immunological factors in these cases is low, and that 80% of them can be reversed by means of a bicarbonate douche (4). The improvement observed with mucus alkalinization suggests that the low mucus pH (5) causes the poor spermmucus interaction. In addition, it was reported that some cases of negative PCT (absence of progressive sperm) or absent PCT (absence of sperm) involving ovulatory mucus and normal sperm became normal during the performance of in vitro cervical mucussperm penetration tests (6,7). It was suspected that this alteration occurred due to the variation of mucus pH after exposure to air.Previous studies have reported pH variation of mucus exposed to air (8,9), but those

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Intrauterine insemination treatment in subfertility: an analysis of factors affecting outcome

Cited by 222 publications

References 48 publications

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

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

Factors affecting clinical pregnancy rates after IUI for the treatment of unexplained infertility and mild male subfertility

In situ variation of cervical mucus pH during exposure to atmospheric air

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