Therapeutic Intrauterine Insemination Improves with Gonadotropin Ovarian Stimulation

F, Irianni; Ramey, Jacques W.; Vaintraub, Marco Túlio; Oehninger, Sergio; Acosta, Anı́bal A.

doi:10.3109/01485019308988381

Cited by 13 publications

(6 citation statements)

References 38 publications

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“…mean age, mean BMI and mean number of cycles), but certainly we did not and cannot look at every possible confounding factor. Our overall PR was 16% per cycle, which is comparable with some past studies where PR of 14-20 % have been achieved (Chaffkin et al, 1991;Irianni et al, 1993). In our study, subjects who had natural cycle IUI (group A) had requested the procedure either to avoid gonadotrophin stimulation or because they had become pregnant in the past on natural cycle IUI when this was practised in the Unit.…”

Section: Discussionsupporting

confidence: 86%

“…IUI combined with gonadotrophin stimulation has been advocated as an effective treatment for some types of infertility when compared with no stimulation (Martinez et al, 1991b;Chaffkin et al, 1991;Irianni et al, 1993). Whether this improvement in fecundity rates after HMG stimulation was related to the obtained polyovulation only or might have been caused by the correction of subtle ovulatory disorders still remains unclear.…”

Section: Discussionmentioning

confidence: 99%

“…The main hypothesis postulated to explain the success of this treatment has been related to the timing of the presence of an increased concentration of motile spermatozoa in the proximity of the oocyte (Moghissi, 1986). Furthermore, a higher pregnancy rate (PR) is achieved when IUI is combined with the use of human menopausal gonadotrophin (HMG) to stimulate multiple follicle development (Martinez et al, 1991;Irianni et al, 1993). The efficiency of IUI with HMG injection may be more evident in the treatment of mild or even moderate male factor, cervical factor, endometriosis or unexplained infertility (Chaffkin et al, 1991;Hurst et al, 1992;Nulsen et al, 1993;Gregoriou et al, 1995), but the contributing factors to maximize IUI PR remain unresolved.…”

Section: Introductionmentioning

confidence: 99%

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Intrauterine insemination: effect of the temporal relationship between the luteinizing hormone surge, human chorionic gonadotrophin administration and insemination on pregnancy rates

Fuh¹,

Wang²,

Tai³

et al. 1997

Human Reproduction

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The optimal time period for intrauterine insemination (IUI) in relation to either luteinizing hormone (LH) surge or human chorionic gonadotrophin (HCG) administration leading to the best pregnancy rates has not been determined. In this study, 856 consecutive human menopausal gonadotrophin (HMG)-stimulated and 49 natural unstimulated IUI cycles carried out at a reproductive medicine unit affiliated with a tertiary centre were analysed in a retrospective fashion. There were three scenarios in the temporal relationship of the LH surge, HCG administration and artificial insemination. These were (group A) subjects who had an endogenous LH surge but were not given HCG; (group B) subjects who were given HCG after an observed LH surge, and (group C) subjects who were given HCG before the LH surge. The overall pregnancy rate (PR) was 16% per cycle. The PR was 9% in group A, 20% in group B and 14% in group C. The PR in group B was significantly better than group C (P = 0.04). In group B, the longer the time interval between the LH surge and HCG administration, the better the PR up to 20 h (P = 0.025); the timing of IUI based on the LH surge was not critical to the achievement of pregnancy within 3 days. In group C, PR improved with the increasing interval between HCG and IUI from <28 h up to 60 h. We conclude that a better PR is achieved if a spontaneous LH surge occurs before HCG administration, especially where the administration of HCG is delayed 8-20 h after an observed LH surge; the timing of IUI based on the LH surge is not critical to the achievement of pregnancy within 3 days.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intrauterine insemination: effect of the temporal relationship between the luteinizing hormone surge, human chorionic gonadotrophin administration and insemination on pregnancy rates

Fuh¹,

Wang²,

Tai³

et al. 1997

Human Reproduction

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“…Of the nine publications that used the strict criteria for sperm morphology (Kruger et al. , 1986, 1988), six stated a positive predictive value for sperm morphology (Irianni et al. , 1993; Toner et al.…”

Section: Discussionmentioning

confidence: 99%

Prediction of pregnancy by intrauterine insemination using CASA estimates and strict criteria in patients with male factor infertility

et al. 2004

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This study was performed to predict pregnancy by intrauterine insemination (IUI) using computer-aided sperm analysis (CASA) estimates and strict criteria in patients with male factor infertility. IUI was performed in 682 cycles on 160 male factor infertile patients. Semen examinations were carried out by CASA and strict criteria before and after sperm preparation using continuous-step density gradient centrifugation. Receiver operating characteristics (ROC) curves were constructed for assessment of the effectiveness of each individual parameter in predicting pregnancy by IUI. A clinically acceptable threshold was calculated when sensitivity plus specificity were maximum. The average cycle of IUI performed was 4.3 +/- 2.4. Pregnancy rate per cycle and per patient were 7.2% (49/682) and 28.1% (45/160), respectively. Using ROC curve, it was shown that normal sperm morphology assessed by the strict criteria before sperm separation and five parameters after sperm separation including rapid, progressive motility, average path velocity (VAP), curvilinear velocity (VCL), and straight line velocity (VSL) were able to predict pregnancy by IUI. Correlation between sperm parameters and pregnancy outcome was examined by the logistic regression model. In a multivariate analysis normal morphology before sperm separation >or=15.5% [odds ratio (OR) = 2.2, p = 0.02], rapid after sperm separation >or=25.5% [OR = 3.9, p = 0.029], and VCL after sperm separation >or=102.65 microm/sec [OR = 3.2, p = 0.002] were the parameters of predictive value for pregnancy outcome. Adjustment of the model for female age, female infertility factors, and the methods of ovulation induction did not change this finding, and the final model still had the same covariates. Pregnancy rates per cycle according to the number (0, 1, 2 and 3) of variables satisfied with the three parameters were 0% (0/110), 1.6% (3/183), 9.7% (21/217) and 15.1% (23/151), respectively. Three semen parameters including normal morphology before sperm separation, rapid and VCL after sperm separation were identified as predictors of pregnancy by IUI. These variables would be helpful when counselling patients before they make the decision to proceed with in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI)-ET.

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“…The proportion of normal morphology has been considered as the best predictor of fertility [28][29][30] . According to conventional techniques for the evaluation, cutoff values of 31 and 39% were discovered by the ROC curve [31] or comparing the time to pregnancy between each level of sperm morphology [27] . On the other hand, a cutoff point as low as 10% was suggested at the same time [8,11,28] .…”

Section: Discussionmentioning

confidence: 99%

Reference Values of Semen Parameters for Healthy Chinese Men

Gao

Gao²,

Walker³

et al. 2008

Urol Int

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Aims: To establish reference values of semen parameters in a residential, geographic, and age representative sample of healthy Chinese men. Methods: From a national study of 1,191 healthy Chinese men, semen samples were analyzed from 105 subjects whose wives or partners were pregnant within the 12 months prior to the date when the semen sample was taken. Results: The means, fifth percentiles, and percentages lower than the WHO criteria for semen parameters were, respectively: 75.8 × 10⁶/ml, 17.8 × 10⁶/ml, and 6.7% for sperm concentration; 206.9 × 10⁶/ejection, 26.3 × 10⁶/ejection, and 6.7% for total sperm count; 18.9, 3.0, and 79.1% for rapid progressive motility; 49.1, 25.3, and 52.4% for sperm progressive motility; 73.8, 49.3, and 45.7% for sperm viability, and 49.5, 25.2, and 9.5% for normal morphology. Conclusion: The values of semen parameters for Chinese men are lower than the WHO criteria, especially for rapid progressive motility, progressive motility, and sperm viability, and a different standard for Chinese may be needed.

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Therapeutic Intrauterine Insemination Improves with Gonadotropin Ovarian Stimulation

Cited by 13 publications

References 38 publications

Intrauterine insemination: effect of the temporal relationship between the luteinizing hormone surge, human chorionic gonadotrophin administration and insemination on pregnancy rates

Intrauterine insemination: effect of the temporal relationship between the luteinizing hormone surge, human chorionic gonadotrophin administration and insemination on pregnancy rates

Prediction of pregnancy by intrauterine insemination using CASA estimates and strict criteria in patients with male factor infertility

Reference Values of Semen Parameters for Healthy Chinese Men

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