Effect of Clinical and Semen Characteristics on Efficacy of Ovulatory Stimulation in Patients Undergoing Intrauterine Insemination

Purpose: We measured the effect of ovulatory stimulation(OS) upon intrauterine insemination (IUI) success rates,particularly among patients with risk factors for IUI failure. Methods: Retrospective review of medical and laboratoryresults from 512 patients who underwent 1576 cycles ofIUI with partner's sperm over a 3 year period. Data werecollected on 3 risk factors for IUI failure (advanced femaleage >37.7 years, prior corrective pelvic surgery, and poorpost-wash sperm motility), and on method of OS (none,clomiphene citrate, or gonadotropin). Results: Patients who underwent OS had significantly higherpregnancy rates (7.6;pc) than those who did not (4.7%, p =0.02). However, when patients were stratified by their riskfactors, OS made a significant difference only for patientswithout risk factors. These patients had a 15.5% per cyclepregnancy rate with OS, compared to 7.9% in unstimulatedIUI cycles (p = 0.04). Conclusions: Ovulatory stimulation doubles IUI pregnancyrates among young patients without a prior pelvic surgeryand with good post-wash semen quality. The benefit of OSfor patients with risk factors for IUI failure is unclear. Thesepatients should be counseled that their chances for successwith IUI are limited, with or without OS.     

精液处理后活动精子总数对宫腔内人工授精妊娠率的影响

目的:探讨精液处理后活动精子总数(PTMS)对宫腔内人工授精(IUI)妊娠成功率的影响。方法:回顾性分析372例不孕患者共816个IUI周期的临床资料。按照PTMS数量将IUI周期分成4个区间组:PTMS<3×106(A组),3×106-5×106(B组),5×106-10×106(C组),>10×106(D组),分别比较各组间的IUI周期妊娠率。结果:816个IUI周期共获得110例妊娠,总周期妊娠率为13.5%。不同PTMS分组的周期妊娠率分别为3.8%,4.2%,14.8%和14.3%。其中A组、B组的周期妊娠率均显著低于C组和D组(P<0.05)。结论:PTMS是男性生育力评估及助孕方式选择的重要参考依据。当PTMS超过5×106时,可首选IUI治疗。     

Sperm Motility Is a Major Determinant of Pregnancy Outcome Following Intrauterine Insemination

Purpose: Our purpose was to assess whether one or more sperm parameters have predictive value for the outcome of intrauterine insemination treatment. Methods: Infertile couples whose normoovulatory and normomechanical female partners underwent superovulation and intrauterine insemination were investigated. The semen profile of the male partner was discounted. In 160 couples, 544 cycles were obtained, resulting in 59 ongoing pregnancies (10.84%/cycle, 36.87%/patient). Results: The only parameter found to be significantly correlated with a positive outcome was the degree of sperm motility following preparation for intrauterine insemination. Close to half (47.5%) of the couples with a very good or an excellent degree of sperm motility conceived, whereas only 8.3% of those patients who had poor or fair sperm motility conceived. None of the semen characteristics, such as volume, count, percentage motility, or percentage normal morphology, were found to correlate with cycle outcome. Although there was a progressive increase in the pregnancy rate with an increase in the total number of motile sperm inseminated, it did not reach significance. Seventy percent of the pregnancies were achieved within a maximum of three treatment cycles. The spermatogram is not accurate enough as a prognostic factor for treatment outcome. Conclusions: The degree of sperm motility, after appropriate preparation for intrauterine insemination, is the only parameter to be correlated with treatment outcome. For couples with a normal female partner, we suggest a maximum of three treatment cycles of induction of ovulation and intrauterine insemination, whenever good progressive motile sperm is obtained after suitable preparation. For cases with poor sperm progression, we suggest appropriate couple counseling and that an alternative assisted reproduction procedure be taken into consideration.     

Effects of Cryopreserved Semen Quality and Timed Intrauterine Insemination on Pregnancy Rate and Gender of Offspring in a Donor Insemination Program

Purpose: Our purpose was to study the relationship among cryopreserved donor semen quality, pregnancy rates, and preconception sex selection after intrauterine insemination. Methods: We reviewed the records of the 203 women in our donor insemination program from 1987 to 1994 who became pregnant after more than one insemination cycle and had no female-factor infertility. They were categorized according to the number of cycles required for pregnancy. Semen samples from 54 donors were analyzed before freezing and after thawing. Specimens resulting in pregnancy were compared to specimens from the same donor that did not. Semen characteristics were compared to gender of the child. Results: Two hundred fifty two-women became pregnant of the 422 who were enrolled. The pregnancy rate per cycle was 13%. Semen quality was not related to pregnancy outcome or offspring gender. However, more male children (101 vs 83) were born. Conclusions: Semen characteristics in good-quality cryopreserved donor semen do not affect pregnancy rate or offspring gender.     

The Effect of Patient and Semen Characteristics on Live Birth Rates Following Intrauterine Insemination: A Retrospective Study

Purpose: To identify characteristics of female patients andof semen that were associated with live birth followingintra-uterine insemination (IUI). Methods: Retrospective review of medical and laboratoryresults from 533 women who underwent IUI with partner'ssperm from 1993 through 1995. Results: Among 1728 cycles, 116 (6.7%) resulted in livedeliveries. Among the 38 patient and semen variablesanalyzed, only 3 were associated with successful IUI outcome:female age <37.7 years at the time of treatment (P = 0.02);the absence of any corrective pelvic surgery (P < 0.001);and postwash sperm motility (P = 0.006). Couples withnone of these three risk factors achieved per-cycle pregnancyrates of 12.4%. Women with two risk factors (age and pelvicsurgery) achieved per-cycle pregnancy rates of 4.6% whensperm had good postwash motility. No pregnancies wereachieved when low postwash motility was combined withany other risk factor. Conclusions: Advanced female age, poor postwash spermmotility, and a history of corrective pelvic surgery aresignificant risk factors for poor IUI success rates. Poor postwashsperm motility in combination with either of these other tworisk factors resulted in no successful pregnancies.     

Sperm Preparation for Intra-uterine Insemination

Controlled ovarian hyperstimulation and sperm injection or intra-uterine insemination (COH/SI) have become important forms of treatment for unexplained and male factor infertility. An extensive literature on sperm preparation has developed (more than 2,000 papers), and the recent withdrawal of indications for human use of Percoll makes it necessary to re-examine the methods available which have been proven effective. In this paper, we have reviewed methods of sperm preparation and their applicability to intra-uterine insemination.     

Evaluation of Pregnancy Rates After Intrauterine Insemination According to Indication, Age, and Sperm Parameters

Purpose: Our purpose was to evaluate intrauterine insemination results obtained in our clinic and identify prognostic factors for the chance of pregnancy. Methods: A retrospective study of data from 1989 to 1996 was undertaken. Only first attempts were included in this study, except for the part on the cumulative pregnancy rates. Couples with either one-sided tubapathology, hormonal dysfunction, idiopathic infertility, or andrological indication were selected. All women were stimulated with clomiphene citrate. Five hundred sixty-six couples who underwent 1763 cycles were included in the study. Results: The overall pregnancy rate for first pregnancies was 6.9% per cycle and 21.4% per patient. For first intrauterine insemination attempts this was 8.8% per cycle/patient, varying between 5.0% for andrological indication and 10.6% for tubapathology, 10.0% for idiopatic indication, and 10.3% for hormonal indication. These differences were not significant. Age did not have a significant effect either, although there were no pregnancies observed in women 40 years or older. The number of inseminated spermatozoa significantly affected the pregnancy rate: <2 million, 4.6%; 2 to <10 million, 3.9%; and 10 million, 11.3%. Conclusions: Unless semen characteristics are insufficient, intrauterine insemination is a useful treatment for infertile couples.     

Relationship of Total Motile Sperm Count and Percentage Motile Sperm to Successful Pregnancy Rates Following Intrauterine Insemination

Purpose:This study sought (i) to investigate the relationship between postwash total motile sperm count and postwash percentage motile sperm in predicting successful intrauterine insemination and (ii) to determine the minimal postwash total motile sperm count required to achieve pregnancy with intrauterine insemination.Methods:Five hundred four women, who underwent 1636 intrauterine insemination cycles with their partner's sperm for infertility treatment from 1993 through 1995, were included in this retrospective study. All patient charts were reviewed for age, infertility etiology, ovarian stimulation regimens, semen characteristics, and treatment outcome. To determine the relationship between total motile sperm count and intrauterine insemination outcome, patients were grouped as (1) less than 0.5 million, (2) 0.5 to 1 million, (3) 1 to 5 million, (4) greater than 5 million, and (5) greater than 20 million.Results:Similar live birth rates (per cycle) were seen among the postwash total motile sperm count groups: group 1, 3.5%; group 2, 2.4%; group 3, 7.0%; group 4, 6.9%; and group 5, 7.0% (P = 0.37). However, regardless of the postwash total motile sperm count, the postwash motility predicted intrauterine insemination success at a cutoff value of 40%.Conclusions:The percentage of postwash sperm motility, and not the postwash total motile sperm count, can predict successful intrauterine insemination outcome. Such information can be useful in counseling patients regarding their chance of success with intrauterine insemination and in determining when alternate methods of assisted reproduction may be a better approach.     

影响宫腔内人工授精临床妊娠率的相关因素分析

目的:探讨影响宫腔内人工授精(IUI)临床妊娠率的各种相关因素。方法:回顾性分析本生殖中心实施IUI治疗的2011个周期。对女方年龄、不孕年限、授精时机及次数、方案、输卵管因素与妊娠结局的关系进行分析。结果:夫精人工授精(AIH)-IUI治疗1508个周期,临床妊娠率11.74%。供精人工授精(AID)-IUI治疗503个周期,临床妊娠率27.83%。二者比较有显著差异(P<0.05)。随着女性年龄增长,不孕年限延长,IUI的妊娠率逐渐降低。单次排卵前、单次排卵后和双次授精妊娠率无统计学差异;AIH诱导排卵的妊娠率高于自然周期。原发或继发不孕、单侧或双侧输卵管通畅间,妊娠率无统计学差异。结论:IUI中女方年龄、不孕年限、精子数量和用药方案是影响妊娠的重要因素。     

来曲唑等4种促排卵药物用于宫腔内人工授精的疗效比较

目的:比较来曲唑等4种促排卵药物用于宫腔内人工授精的疗效。方法:回顾分析南方医院生殖医学中心2006年1月至2010年6月采用自然周期(NC)和来曲唑(LE)、氯米芬(CC)、尿促性素(HMG)、尿促卵泡素(u-FSH)4种促排卵药物用于夫精宫腔内人工受精(IUI),共565个周期的临床资料进行比较分析。结果:5组临床妊娠率分别为4.1%、13.4%、8.7%、16.1%、13.8%,促排卵各组妊娠率均高于自然周期组(P均<0.05)。各促排卵组之间,妊娠率差异无统计学意义(P>0.05)。LE组优势卵泡数、排卵数及绒促性素(HCG)日子宫内膜厚度与NC组比较差异均无统计学意义(P>0.05)。结论:促排卵治疗增加IUI妊娠率。LE促排卵作用温和,妊娠率与低剂量HMG和u-FSH方案相当,用于IUI促排卵安全有效。     

Does Seasonality Alter Intrauterine Insemination Outcomes: A 5-Year Study

PURPOSE: To determine if seasonal changes alter pregnancy rate in intrauterine insemination (IUI) patients. METHODS: One-thousand and eighty semen analyses prepared for IUI were evaluated in this retrospective cohort study of 496 patients. RESULTS: Volume, pH, sperm concentration, and pregnancy rates were not altered by season. However, the percent motility, the total motile spermatozoa in the ejaculate, the straight-line velocity (VSL) of spermatozoa, as well as the morphology of sperm were altered by season. In a subset of these patients that were defined as normal, only the VSL and the morphology of the spermatozoa were altered by seasonal changes. CONCLUSIONS: Seasonality alters sperm motility parameters as well as morphology, but these changes are not significant enough to alter pregnancy rates.     

显微穿刺时机对卵胞浆内单精子注射结局的影响

目的:探讨寻找实施卵胞浆内单精子注射(intracytoplasmic sperm injection,ICSI)最佳显微穿刺时机。方法:单纯因男方因素不孕接受ICSI治疗的146例患者的167个周期,在注射hCG后36～38h取卵。在注射hCG后37～40h行ICSI为A组,共576个卵,在注射hCG后41～48h行ICSI为B组,共449个卵。观察和比较受精率、卵裂率、优质胚胎形成率及胚胎种植率。结果:A组ICSI卵的受精率和卵裂率分别为79.51%和97.38%,与B组的受精率(80.85%)和卵裂率(97.52%)比较无显著性差异(P>0.05)。优质胚胎率在A组达76.91%,高于B组(70.06%),差异有显著性(P<0.05)。A组和B组的胚胎种植率分别为18.91%和19.11%,无显著性差异(P>0.05)。结论:注射hCG后37～48h期间行ICSI,穿刺时间不影响受精率和卵裂率。在注射hCG后37～40h行ICSI可提高优质胚胎率,但对胚胎种植率无明显影响。     

Success in Pregnancy Through Intrauterine Insemination at First Cycle in 300 Infertile Couples: An Analysis

Objective

The aim of this article was to determine digital levels of the association of factors of pregnancy success after the first cycle of intrauterine insemination (IUI) with 300 infertile couples.

Methods

The IUI procedure was followed at 36 h after triggering the ovulation, if at least one follicle measured >15 mm. Endometrium thickness (ET) and serum luteinizing hormone (LH) levels were measured at day 10 for each patient. The post-wash total motile fraction (TMF) of semen of the partner of each patient was also evaluated. The principal component analysis (PCA) was done with the data to quantify the associations of related factors.

Results

The clinical pregnancy rate of first cycle IUI attempts was 17.3 %, observed in females, aged 20–39 years and men with TMF >5 million spermatozoa. The ovarian stimulation enabled the development of follicles measuring >16 mm, with LH levels <10 mIU/L and ET >5 mm for success. The PCA revealed that with the female-age parameter, three factors, NF, ET, and LH were related in the component 1; similarly, NF, LH, and RFS were related in component 2; age, NF, ET, LH, LFS, and TMF were related in component 3; and NF, ET, LH, RFS, and LFS in component 4 were related, i.e., the best correlation.

Conclusions

Associated principal determinative factors, LH, female-age, NF and LFS values were highly significant, but the factors, ET, RFS and TMF were statistically insignificant for success through IUI in pregnancy.     

Comparison of the role of cervical and intrauterine insemination techniques on the incidence of multiple pregnancy after Artificial Insemination with Donor Sperm

Purpose: Our purpose was to investigate the role of the insemination technique used in an artificial insemination program with donor sperm (AID) in multiple pregnancy rates. Methods: We carried out a retrospective nonrandom analysis of 300 pregnancies corresponding to 300 cycles in women from our Artificial Insemination Donor Sperm Program. All cycles were stimulated with gonadotropins. Single and multiple pregnancy cycles and intracervical and intrauterine pregnant cycles were compared. Results: Intracervical insemination was performed in 173 cycles (58%), and intrauterine insemination in 127 (42%). Two hundred twenty-three pregnancies were single (74%), and 77 multiple (26%). In multiple pregnancy cycles, initial dose and mean total daily dose of gonadotropins, plasma estradiol levels, and number of follicles≥14 mm were significantly higher compared to those in single pregnancy cycles. Multiple pregnancy rate was significantly higher among pregnancies after intrauterine insemination (32%) than after intracervical insemination (21%). Conclusions: The intrauterine technique of insemination in AID-stimulated cycles with gonadotropins is related to multiple pregnancy risk.     

The Antral Follicle Count Predicts the Outcome of Pregnancy in a Controlled Ovarian Hyperstimulation/Intrauterine Insemination Program

Purpose: Our purpose was to test whether age-related changes in antral follicle counts can predict the pregnancy outcome in the early follicular phase of a controlled ovarian hyperstimulation/intrauterine insemination (COH/IUI) program. Methods: A selected group of 107 women (36 healthy women requesting child sex preselection, 52 women with unexplained infertility, and 19 with minimal endometriosis) who underwent controlled ovarian hyperstimulation with clomiphene citrate (CC) plus human menopausal gonadotrophin (hMG) and subsequent intrauterine insemination were enrolled in the study. Transvaginal ultrasonography (7.0 MHz) was used to determine the total number of antral follicles (2–8 mm) in the right and left ovaries. The association among the antral follicle count, age, dominant follicle, and estradiol (E ₂ ) level on the day of human chorionic gonadotropin (hCG) was analyzed. The association of the pregnancy rate and OHSS with the antral follicle count, dominant follicle count, and age was also examined. Results: The total antral follicle number decreased with age (P<0.0001). Dominant follicle number increased with total antral follicle number in women who received CCplus hMG/ IUI (P<0.0001). The pregnant group had a higher number of antral follicle and dominant follicles in comparison with the nonpregnant group (P<0.01 and P<0.02, respectively). The E ₂ level on the day of hCG injection increased positively with the total number of antral follicles (P<0.0001) and the total number of dominant follicles (P<0.0001). In women aged younger than 35 years, the pregnancy rate and dominant follicle number rose as the number of antral follicles increased (P<0.03 and P<0.0001, respectively). The pregnancy rate was low (2/39) in women aged older than 35 years regardless of the number of antral follicles (P<0.05) and the extent of hMG administration (P<0.02). Women aged older than 35 also produced fewer dominant follicles (P<0.001). No pregnancy was achieved in a patient with an antral follicle number of less than five (17 cases). Conclusions: Age-related changes in antral follicle count significantly predicted the dominant follicle count and the pregnancy outcome. In women with antral follicle counts of less than five or who are older than 35 years, the application of COH/IUI may not be indicated.     

原发不孕患者行短时受精和half-ICSI结果的比较

目的:探讨女性原发不孕患者行短时受精和half-ICSI 2种受精方式对受精率和胚胎发育潜能的影响。方法:回顾性分析175个周期女性原发不孕患者体外助孕资料,分为短时受精和/或联合早期补救ICSI周期组(A组,114个周期,其中A1组103个短时IVF受精周期,A2组11个早期补救ICSI周期)及half-ICSI周期组(B组,61个周期),分析比较各组IVF/ICSI-ET结局。结果:B组较A组不孕年限长,获卵数多,正常受精率低,差异有统计学意义(P<0.05)。但异常受精率、优质胚胎率和临床妊娠率差异无统计学意义(P>0.05)。A1组正常受精率明显低于A2组(P<0.05),异常受精率、优质胚胎率和临床妊娠率组间差异无统计学意义(P>0.05)。不同病因对A、B组患者的妊娠结局无显著影响。结论:短时受精和/或联合早期补救ICSI对原发不孕患者是一种较为合理而安全的受精方式。     

Determining the Fertility Benefit of Controlled Ovarian Hyperstimulation With Intrauterine Insemination After Operative Laparoscopy in Patients With Endometriosis

Study ObjectiveTo determine the fertility benefit of controlled ovarian hyperstimulation (COH) and intrauterine insemination (IUI) in surgically treated endometriosis.DesignRetrospective cohort study (Canadian Task Force classification II-2).SettingCleveland Clinic Foundation, tertiary care center.PatientsNinety-six women of reproductive age who underwent operative laparoscopy to treat endometriosis-related infertility (endometriosis stage I/II n = 67; stage III/IV n = 29) from 2001 to 2011 at the Cleveland Clinic Foundation.InterventionsCOH via letrozole, clomiphene, or gonadotropins, with or without IUI.Measurements and Main ResultsKaplan-Meier estimations of cumulative pregnancy rates were compared by stage between COH/IUI and spontaneous cycles. Patients with stage I/II endometriosis attempted spontaneous pregnancy for 669 months and 216 COH + IUI cycles, and patients with stage III/IV endometriosis attempted spontaneous pregnancy for 379 months and 74 COH + IUI cycles. Crude pregnancy rates were 45.7% in stage I/II and 40.5% in stage III/IV. Twelve-month cumulative pregnancy rates in stage I/II were 45% for spontaneous attempts and 42% for COH + IUI, and in stage III/IV were 20% for spontaneous attempts and 10% for COH + IUI (not significant). Cumulative pregnancy rates for COH/IUI in stage I/II were significantly higher than in stage III/IV. Monthly fecundity rates were 3.81% for stage I/II spontaneous, 4.59% for COH/IUI, 3.05% for stage III/IV spontaneous, and 1.68% for COH/IUI (not significant).ConclusionsCOH + IUI did not improve pregnancy rates in any stage of endometriosis. In stage III/IV we recommend postoperative in vitro fertilization.     

Success of intrauterine insemination in women aged 40-42 years

OBJECTIVE: To determine how advancing female age decreases successful outcomes of intrauterine insemination (IUI) alone or combined with ovarian stimulation. DESIGN: Retrospective review. SETTING: Academic fertility center. PATIENT(S): Infertile men and women. INTERVENTION(S): Intrauterine insemination alone or combined with ovarian stimulation. MAIN OUTCOME MEASURE(S): Pregnancy rates, miscarriage rates, and live birth rates per insemination cycle according to female age. RESULT(S): The 1,117 cycles of IUI resulted in 217 pregnancies, for an overall pregnancy rate for all female ages of 19.4% and a live birth rate of 12.9% per cycle inseminated. The overall live birth rate per insemination declined with advancing maternal age. CONCLUSION(S): Advancing female age decreases successful outcomes with IUI. The live birth rate with IUI for women 40-42 years old (n = 82) was 9.8% per insemination and may demonstrate that IUI is an appropriate treatment for this age group of women.