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。     

超排卵对宫腔内人工授精周期妊娠率的影响

目的分析超排卵对人工授精结局的影响，探讨超排卵对不同人群治疗的有效性。方法回顾性分析我院生殖科2000年3月-2007年12月期间女方有自发排卵的739个人工授精周期，比较不孕原因、女方年龄、有无子宫内膜异位症等因素下超排卵与自然周期妊娠率。结果739个人工授精周期中，超排卵周期233个，自然周期506个，妊娠率分别为21．6％和13．5％（P〈0.05），不孕因素中，宫颈因素为378个，男性因素为100个，盆腔输卵管因素44个，子宫内膜异位症85个，不明原因132个，其中宫颈因素和不明原因不孕周期超排卵周期妊娠率明显高于自然周期（22．40％，14．62％；27．03％，12．63％ P〈0.05）；男性因素、输卵管因素、子宫内膜异位症、女方年龄大于37岁周期，超排卵与自然周期妊娠率差异无显著性（P〉0.05）。超排卵周期中，氯米芬与促性腺素周期临床妊娠率无显著差异（P〉0.05）。结论因宫颈因素、不明原因不孕行人工授精夫妇超排卵周期妊娠率高，而男性因素、子宫内膜异位症、盆腔输卵管因素或年龄大于37岁妇女进行人工授精时慎重选择排卵诱导。     

Study of the Relationship between the Mixed Agglutination Reaction Test and Outcome of in vitro Fertilization-Embryo Transfer

目的:探讨混合抗球蛋白反应试验(MAR)与常规体外受精-胚胎移植(IVF-ET)治疗的关系.方法:回顾性分析562例第1次行IVF治疗不孕患者的临床资料,按照MAR检测结果将IVF周期分成4个区间组:＜10％,10％～30％,30％～50％,＞50％,分析各组间受精率、胚胎发育及临床妊娠情况.结果:540个IVF移植周期中共获得279例妊娠,周期妊娠率为51.7％.MAR＞50％组的受精率显著低于其余各组(P＜0.05),而各组间女方年龄、不孕年限、受精失败率、精子密度、精子活动率、正常形态精子百分率、优质胚胎率、胚胎种植率、临床妊娠率及流产率比较则均无统计学差异(P＞0.05).结论:MAR检测结果在预测IVF受精结局中有一定的价值,但与IVF治疗的临床妊娠结局无关.     

影响男性不育官腔内人工授精妊娠率的因素分析

目的探讨影响男性不育患者行宫腔内人工授精（IUI）临床妊娠的相关因素。方法回顾性分析337对不孕夫妇因男性因素行IUI共667周期的资料,分析男女双方年龄、不孕年限、女方体重指数（BMI）、促排卵方案以及处理后前向运动精子总数（PTMS）对临床妊娠率的影响。结果女方年龄≥35岁者临床妊娠率为12．6％,显著低于年龄〈30岁者;男方年龄≥35岁者临床妊娠率为15．9%,显著低于年龄〈35岁者;克罗米芬联合促性腺激素周期临床妊娠率为25．5％,显著高于自然周期;PTMS〈5×10^6临床妊娠率为8．3％,显著低于PTMS≥10×10^6（P〈0．05）。结论男性不育患者行IUI治疗过程中需要充分考虑男女双方年龄对治疗结局的影响,适时选择促排卵方案,以提高临床妊娠率;当PTMS〈5×10^6,IUI妊娠率显著下降,建议行IVF-ET／ICSI—ET治疗以改善妊娠结局。     

3178周期宫腔内夫精人工授精临床结局及其影响因素分析

目的:评估宫腔内夫精人工授精(IUI)的临床结局及其影响因素。方法:回顾性分析行IUI治疗的1 646对夫妇共3 178个周期的临床资料,分析临床妊娠率及其与女方年龄、不孕类型、不孕病因、是否促排卵治疗、IUI时机、IUI周期次数的关系。结果:IUI临床妊娠率为12.4%(394/3 178);对临床妊娠率有统计学意义的影响因素是女方年龄、不孕病因、是否促排卵治疗;而不孕类型、IUI时机、IUI周期次数不影响临床妊娠率。结论:女方年龄、不孕病因、是否促排卵治疗均可影响妊娠率,治疗时应综合考虑多种因素的影响。     

促排卵对不同病因宫腔内人工授精的结局分析

目的:探讨促排卵对不同病因不孕患者人工授精的影响。方法:回顾性分析因男性因素、输卵管盆腔因素、子宫内膜异位症(EMS)和不明原因进行人工授精患者的资料,根据患者进行自然周期或促排卵周期分组,比较不同周期组的临床妊娠率和活产率。采用多元回归分析模型校正患者年龄、不孕年限、不同因素构成比、基础FSH、LH、E_2、子宫内膜厚度、类型、宫腔内人工授精(IUI)日卵泡直径及男性前向运动精子总数。评估在男性因素、输卵管盆腔因素、EMS和不明原因中促排卵周期与临床妊娠率的关系。结果:①促排卵组患者平均年龄、不孕年限以及不孕因素构成比(男性因素、输卵管盆腔因素、EMS和不明原因)与自然周期比较,无统计学差异(P0.05),而临床妊娠率和活产率均高于自然周期,但无统计学差异(P=0.08);②通过多元因素回归分析校正了年龄、基础内分泌水平、不孕因素、内膜厚度和类型及前向运动精子总数等混杂因素后,促排卵周期相对于自然周期依然有显著优势(OR=1.607;95%CI=1.115~2.316);③在不同因素不孕患者中,促排卵周期可提高输卵管盆腔因素患者的活产率(OR=4.56;95%CI=1.53~13.53)。结论:促排卵周期可提高输卵管盆腔因素患者宫腔内人工授精的临床妊娠和活产率。     

体外受精-胚胎移植后早期妊娠丢失的相关风险因素分析

目的：分析体外受精-胚胎移植（IVF-ET）后早期自然妊娠丢失及其相关因素。方法：收集2001年5月—2007年12月在中山大学孙逸仙纪念医院生殖中心行IVF-ET治疗获得妊娠的患者547例,根据其妊娠12周时情况分为妊娠丢失组和妊娠持续组,回顾性比较分析2组患者中女方的一般情况、不孕病因;男方的精液检查情况、精子来源和助孕过程。结果：本中心新鲜IVF/胞浆内单精子注射（ICSI）-ET周期的早期妊娠丢失率为26.87%,临床流产率为16.45%。547例患者中女方年龄≥37岁患者的早期妊娠丢失率为46.7%,显著高于≤30岁的患者（27.2%）及30～37岁的患者（21.7%,均P＜0.05）;单孕囊组妊娠丢失率为35.0%,显著高于多孕囊组的10.9%（P＜0.001）。多因素Logistic回归分析显示辅助生殖治疗后早期妊娠丢失相关风险因素依次为：多囊卵巢综合征（PCOS）排卵障碍（OR=7.025,95%CI为2.426～20.341）、女方年龄（OR=1.080,95%CI为1.006～1.160）、孕囊数（OR=0.042,95%CI为0.022～0.081）、人绒毛膜促性腺激素（hCG）注射日子宫内膜厚度（OR=0.904,95%CI为0.808～1.012）。结论：新鲜IVF/ICSI-ET周期的早期妊娠丢失率与自然妊娠流产率相似,早期妊娠丢失与PCOS患者的排卵障碍、女方年龄、着床孕囊数相关,高危患者在进行辅助生殖治疗前应积极治疗,尽早采取安胎措施减少妊娠丢失。     

麒麟丸联合芬吗通对薄型子宫内膜厚度、血流和妊娠率的影响

目的:观察麒麟丸联合芬吗通对薄型子宫内膜厚度及类型、血流和妊娠率的临床疗效。方法:前瞻性研究76例薄型子宫内膜不孕患者,随机分为对照组和研究组各38例,对照组经阴道给予芬吗通,研究组在对照组的基础上联合口服麒麟丸进行治疗。比较对照组和研究组治疗3个周期后子宫内膜厚度、类型、血流、血雌激素(E2)浓度情况和治疗半年后的自然妊娠率。结果:对照组和研究组治疗3个周期后的子宫内膜厚度、类型、血流、E2浓度情况均有明显改善(P0.05),且研究组子宫内膜厚度和血流优于对照组,差异均有统计学意义(P0.05);治疗半年后自然妊娠率研究组显著高于对照组(52.6%vs 28.9%),差异有统计学意义(P0.05);研究组和对照组中妊娠患者子宫内膜厚度、类型、血流分别与本组中未妊娠患者比较,差异均有统计学意义(P0.05)。结论:麒麟丸联合芬吗通治疗因子宫内膜薄而致的不孕,可有效改善子宫内膜厚度及血流,提高治疗半年后的自然妊娠率。     

供精人工授精结局分析及临床应用价值

目的:探讨供精人工授精(AID)成功的影响因素及临床应用价值。方法:回顾性分析在本中心实施AID的2 467对不孕夫妇共5 470个周期的临床资料,分析影响AID临床妊娠率的相关因素及妊娠结局。结果:①年龄35岁和≥35岁的临床妊娠率分别为21.49%和12.27%,差异有统计学意义(P0.05);②不孕年限≤5年和5年者比较,妊娠率有统计学差异(22.09%vs 16.45%,P0.05);③自然周期和控制性促排卵周期的临床妊娠率分别为21.92%和17.46%,差异有统计学意义(P0.05);④不同授精方式宫颈内授精(ICI)、宫腔内授精(IUI)及ICI/IUI组的临床妊娠率分别为20.61%、16.52%和18.56%,差异无统计学意义(P0.05);⑤每周期授精次数对AID的妊娠率有显著影响,1次和2次授精的成功率分别为10.64%和21.26%(P0.05);⑥注入前向运动精子总数40~60×106和60×106的妊娠率有统计学差异(19.32%vs26.07%,P0.05);⑦第1、第2、第3、第4周期的累计妊娠率分别为20.02%、33.40%、41.06%、43.70%,随着授精次数的增加,累计妊娠率显著升高(P0.05);⑧1 110例妊娠者中33例(11.98%)流产,13例(1.17%)发生宫外孕,多胎率为3.15%,出生缺陷发生率为0.67%。结论:①在AID治疗中女方年龄、不孕年限、治疗方案、授精次数及注入前向运动精子总数均是影响成功妊娠的相关因素;②AID技术安全有效,患者至少应进行3~4个周期的AID治疗,未成功者应及时求助于试管婴儿等其他辅助生殖技术。     

康妇炎胶囊在治疗输卵管通而不畅性不孕中的临床应用

目的 探讨康妇炎胶囊在治疗输卵管通而不畅性不孕中的临床应用效果。方法 2012年1月至2014年1月在天津医科大学第二医院根据子宫输卵管造影结果选择轻度输卵管通而不畅患者143例（治疗组89例和对照组54例）和重度输卵管通而不畅患者120例（治疗组77例和对照组43例）。轻度输卵管通而不畅治疗组采用输卵管通液术联合康妇炎胶囊口服,对照组仅行输卵管通液术。重度输卵管通而不畅治疗组采用宫腹腔镜再通手术联合康妇炎胶囊口服,对照组仅行宫腹腔镜再通手术。记录患者12个月内妊娠的情况并计算宫内妊娠率和异位妊娠率等指标。结果 轻度输卵管通而不畅治疗组宫内妊娠率显著高于对照组（70.8%对51.9%）,差异有统计学意义（P＜0.05）;输卵管妊娠率显著低于对照组（1.1%对7.4%）,差异有统计学意义（P＜0.05）;生化妊娠率两组比较（4.5%对7.4%）,差异无统计学意义（P＞0.05）。重度输卵管通而不畅患者治疗组宫内妊娠率显著高于对照组（37.7%对20.9%）,差异有统计学意义（P＜0.05）;输卵管妊娠率显著低于对照组（5.2%对16.3%）,差异有统计学意义（P＜0.05）;生化妊娠率两组比较（6.5%对9.3%）,差异无统计学意义（P＞0.05）。12个月后轻度输卵管通而不畅治疗组未妊娠患者的输卵管通而不畅率（26.2%对50%）和阻塞率（4.8%对22.2%）均低于对照组,差异有统计学意义（均P＜0.05）;重度输卵管通而不畅治疗组未妊娠患者的输卵管通而不畅率（32.1%对52.2%）和阻塞率（7.7%对21.7%）均低于对照组,差异有统计学意义（均P＜0.05）。结论 康妇炎胶囊在辅助治疗输卵管通而不畅性不孕中具有良好的疗效,可以提高输卵管通而不畅性不孕患者的宫内妊娠率和再通率,同时降低输卵管妊娠率。     

Gamete intra-fallopian transfer or intrauterine insemination after controlled ovarian hyperstimulation for treatment of infertility due to endometriosis.

We compared the effectiveness of gamete intra-Fallopian transfer (GIFT) and intrauterine insemination (IUI) after controlled ovarian hyperstimulation (COH) in the treatment of infertility due to endometriosis. This was a retrospective study carried out at a tertiary teaching medical center. A total of 127 consecutive patients with endometriosis were treated with GIFT or IUI after COH between June 1990 and December 1998. Patients were divided into two groups. Group 1 (n = 97) included patients with stages 1 and 2 endometriosis, and group 2 (n = 30) included patients with stages 3 and 4 endometriosis. Laparoscopic conservative surgery for endometriosis was performed prior to IUI for patients in both group 1 and group 2. In group 1, 55 patients underwent 95 cycles of IUI after COH and 42 patients underwent 57 cycles of GIFT. In group 2, 14 patients underwent 16 cycles of IUI after COH, while 16 patients underwent 22 cycles of GIFT. The stimulation protocol for both GIFT and IUI was mid-luteal pituitary down-regulation with a gonadotropin releasing hormone agonist (GnRH-a) followed by gonadotropins. In group 1, the pregnancy rates (GIFT = 50.9%, IUI = 29.4%) and the delivery rates (GIFT = 28.1%, IUI = 14.7%) per cycle were significantly higher in GIFT compared to IUI (p = 0.009 and p = 0.05, respectively). There was no significant differences in the pregnancy rate (GIFT 69%, IUI 50.9%, respectively) or the delivery rate (GIFT 38.1%, IUI 25.5%) per patient. In group 2, there was no significant difference in the pregnancy rate (GIFT 54.5%, IUI 31.3%) or the delivery rate (GIFT 40.9%, IUI 12.5%) per cycle, but the difference in the pregnancy rate (GIFT 75%, IUI 35.7%) and the delivery rate (GIFT 56.3%, IUI 14.3%) per patient was significantly higher in GIFT compared to IUI (p = 0.04 and p = 0.02, respectively). We conclude that, when the same stimulation protocol is used in the early stages of endometriosis, a few cycles of IUI can achieve similar results to GIFT, and therefore should be used first. In advanced stages of endometriosis GIFT appears to be more effective.     

Comparison of the effectiveness of single intrauterine insemination (IUI) versus double IUI per cycle in infertile patients

OBJECTIVE: To compare a single periovulatory intrauterine insemination (IUI) with a regimen based on double IUI, performed during preovulatory and periovulatory periods, in patients undergoing controlled ovarian hyperstimulation (COH). DESIGN: Prospective, randomized study. SETTING: Infertility and endocrinology units of a medical university. PATIENT(S): One hundred ten patients with male factor, cervical factor, and unexplained infertility who were undergoing 486 cycles of COH with IUI. INTERVENTION(S): The patients were randomly divided into two groups. One group underwent single IUI in the first cycle and double IUI in the second cycle; this alternating pattern was continued up to six cycles unless pregnancy occurred. For patients in the second group, double IUI was performed in the first cycle and single IUI in the second cycle; this pattern was repeated as in the first group. MAIN OUTCOME MEASURE(S): Relationship of single and double IUI to rates of clinical pregnancy and abortion. RESULT(S): Forty-two women became pregnant, with an overall pregnancy rate per cycle of 8.6% and pregnancy rate per couple of 38.2%. Pregnancy rate per cycle was 7.9% in single IUI cycles and was 9.4% in double IUI cycles; these findings were not statistically significant. CONCLUSION(S): Among patients undergoing COH-IUI, results of single and double IUI do not statistically differ.     

Intrauterine insemination after ovarian stimulation as a treatment for subfertility because of subnormal semen: a prospective randomized controlled trial.

OBJECTIVE: To determine whether intrauterine insemination (IUI) after ovarian stimulation with human menopausal gonadotropin (hMG) gives a better pregnancy rate (PR) than natural intercourse in couples with subfertility because of subnormal semen. DESIGN: Prospective randomized controlled trial. SETTING: University based subfertility clinic. PATIENTS: Couples with subnormal semen as the only identifiable cause of subfertility. INTERVENTIONS: In control cycles, the couples had natural intercourse. In IUI cycles, IUI was performed after ovarian stimulation with hMG and human chorionic gonadotropin. MAIN OUTCOME MEASURE: The clinical PRs and complications of IUI cycles and control cycles were compared. RESULTS: There were six clinical pregnancies in the 42 IUI cycles, whereas there was no clinical pregnancy in the 42 control cycles. The clinical PR in IUI cycles (14.3% per cycle) was significantly higher than that in control cycles (0%). Six patients (14.3%) developed moderate degree of ovarian hyperstimulation syndrome in IUI cycles. CONCLUSION: Intrauterine insemination after ovarian stimulation with hMG is useful in treatment of subfertile couples with subnormal semen.     

Gonadotropin-releasing hormone agonist improves the efficiency of controlled ovarian hyperstimulation/intrauterine insemination

OBJECTIVE: Leuprolide acetate (LA) has improved the efficiency of human menopausal gonadotropins (hMG) in in vitro fertilization cycles. We hypothesized that the combination of LA/hMG/intrauterine insemination (IUI) would be more efficacious than hMG/IUI cycles. DESIGN: During an 18-month period, all patients completing either a hMG/IUI cycle (group I) or a LA/hMG/IUI cycle (group II) had the characteristics and outcomes of their stimulation cycles assessed. The groups were not prospectively randomized. SETTING: Referral center at a tertiary care hospital. PATIENTS: One hundred twenty three patients in group I completed 219 cycles, and 64 patients in group II completed 102 cycles. Twenty-eight of the patients who failed to conceive with hMG/IUI were advanced to group II. MAIN OUTCOME MEASURES: Pregnancy/IUI is compared between the two groups. RESULTS: Group II demonstrated significantly greater clinical pregnancy/IUI than group I (26.5% and 16.0%, respectively, P less than 0.05), as well as a higher live birth/IUI (21.6% and 12.8%, respectively, P less than 0.05). No difference was present in the rate of fetal wastage or multiple births. CONCLUSIONS: In our patients with recalcitrant infertility, the addition of a gonadotropin-releasing hormone agonist to hMG/IUI improved the pregnancy rate, without increasing the rate of multiple births or fetal wastage.     

Treatment of infertile women with unilateral tubal occlusion by intrauterine insemination and ovarian stimulation

ObjectiveThe aim of this study was to evaluate the value of intrauterine insemination (IUI) combined with ovarian stimulation in women with unilateral tubal occlusion detected on hysterosalpingography (HSG).Materials and MethodsA total of 703 patients undergoing IUI and controlled ovarian hyperstimulation were enrolled in this study. The study group consisted of 133 patients treated for unilateral tubal occlusion diagnosed by HSG during 2005–2011. The control group consisted of 570 patients with unexplained infertility treated during the same period. In all cases of the retrospective study, menstrual cycles were regular, basal serum follicle-stimulating hormone levels and sperm parameters were normal.ResultsThere were no significant differences in pregnancy rate per cycle between the study (17.3%) and control groups (18.9%). The pregnancy rate was higher in patients with proximal tubal occlusion (21.7%) compared with mid-distal tubal occlusion (12.5%) or unexplained infertility (18.9%), but the difference was not statistically significant.ConclusionsInfertile patients with only unilateral proximal tubal occlusion detected on HSG can be treated initially by IUI combined with ovarian stimulation. The cycle outcomes in patients with proximal tubal occlusion are similar to patients with unexplained infertility. However, the stimulated IUI might not be a good choice for patients with unilateral mid-distal tubal occlusion because of a lower success rate, although further evidence is needed.     

Luteal phase support with progesterone in intrauterine insemination: a prospective randomized study

Objective: To determine the effect of vaginal progesterone as luteal support on pregnancy outcomes in infertile patients who undergo ovulation induction with gonadotropins and intrauterine insemination (IUI). Design: Prospective randomized trial. Setting: Tertiary referral center. Patient(s): About 398 patients with primary infertility were treated during 893 ovarian stimulation and IUI cycles from February 2010 to September 2012. Methods: All patients underwent ovarian stimulation with gonadotropins combined with IUI. Patients in the supported group received vaginal micronized progesterone capsules 200?mg once daily from the day after insemination until next menstruation or continuing for up to 8 weeks of pregnancy. Women allocated in the control group did not receive luteal phase support. Main outcome measure(s): Livebirth rate, clinical pregnancy rate and early miscarriage rate per cycle. Result(s): Of the 893 cycles, a total of 111 clinical pregnancies occurred. There were no significant differences between supported with progesterone and unsupported cycle in terms of livebirth rate (10.2% versus 8.3%, respectively, with a p value?=?0.874) and clinical pregnancy rate (13.8% compared with 11.0% in unsupported cycle with a p value?=?0.248). An early miscarriage rate of 3.6% was observed in the supported cycles and 2.7% in the unsupported cycles, with no significant differences between the groups (p value?=?0.874). Conclusion(s): In infertile patients treated with mildly ovarian stimulation with recombinant gonadotropins and IUI, luteal phase support with vaginal progesterone is not associated with higher livebirth rate or clinical pregnancy rate compared with patients who did not receive any luteal phase support.     

针灸联合宫内人工授精(IUI)治疗多囊卵巢综合征所致不孕——65例疗效观察

目的:观察针灸与药物促排卵配合宫腔内人工授精(IUI)治疗多囊卵巢综合征(PCOS)所致不孕的临床疗效。方法:125例PCOS患者随机分为2组:治疗组65例,在药物促排卵基础上于IUI术前、后加针灸治疗;对照组60例,在IUI术前单以药物促排卵治疗。结果:治疗组的周期排卵率为83.9%,妊娠率为36.9%,黄素化未破裂卵泡(LUF)发生率为4.1%,周期取消率为6.3%;对照组周期排卵率为69.9%,妊娠率为20%,LUF发生率为23.1%,周期取消率为21.4%,组间比较均有显著差异(P<0.05或P<0.01)。结论:针灸配合IUI治疗PCOS可有效提高临床妊娠率,降低了LUF及卵巢过度刺激综合征(OHSS)等并发症的发生率。     

Pregnancy after endometrial scratching in infertile couples undergoing ovulation induction and intrauterine insemination cycles—a randomized controlled trial

Purpose

To study the effect of endometrial scratching in infertile couples undergoing ovulation induction and intrauterine insemination (IUI) cycles.

Methods

A prospective randomized controlled trial was conducted in the Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India. One hundred forty-four women with primary/secondary infertility were recruited. Couples were either unexplained or male factor infertility. Subjects were randomized into intervention (scratching) and control group. All patients received ovulation induction with clomiphene citrate (day 2–6) 50 mg/day +75 IU HMG on days 6 and 7. In addition, endometrial scratching was done on day 8 of ovulation induction cycle in intervention group. All couples were planned for three cycles of ovulation induction and IUI over 6 months. After each failed cycle, couple was advised to try for natural conception for one cycle. Those who conceived were excluded from further analysis. Primary outcome was clinical pregnancy rate. Secondary outcome measures included conception rate, ongoing pregnancy, abortion and ectopic rate.

Results

Baseline characteristics were comparable in both groups. Clinical pregnancy rate was significantly higher in intervention group (31.9%; 23/72) as compared to control group (16.7%; 12/72) (p value 0.030). On per cycle analysis, first IUI cycle had significantly high pregnancy rate (18.1%; 13/72) as compared to control group (5.6%; 4/72). Three patients in intervention group and one in control group conceived in wash out cycle. Ongoing pregnancy rate was significantly higher in scratching group (30.0%; 21/70) as compared to control group (15.7%; 11/70) (p value0.044).

Conclusions

Endometrial scratching can be used as a low cost-effective tool to improve clinical pregnancy and ongoing pregnancy rate in IUI cycles. Further large number studies are required to document its role in improving live birth rate.

Trial registration number

CTRI/2015/12/006419

     

Good efficiency of intrauterine insemination programme for serodiscordant couples with HIV-1 infected male partner: A retrospective comparative study

Objective

Assisted reproduction techniques can minimize the risk of HIV female contamination when the male partner is HIV-infected. The aim of this study was to investigate the efficiency of sperm washing and intrauterine insemination (IUI) in these couples.

Study design

Retrospective comparative study. Eighty-four HIV-1 serodicordant couples underwent 294 IUI. The control group was composed of 90 couples (320 IUI cycles) with donor sperm. Spermatozoa from HIV-1 infected male partner were prepared and tested for HIV-1 according to sperm washing method. Spermatozoa from HIV-1 and donor male were frozen before IUI. IUI were performed after ovarian stimulation. Main outcomes measures were pregnancy rate per cycle and baby take-home rate per couples.

Results

Although the pregnancy rate and baby take-home rate were higher in IUI with sperm washing than in IUI using donor sperm (18.0 versus 14.7 and 52.4 versus 41.1, respectively), the differences were not statistically significant. In serodiscordant couples, blood estradiol levels under ovarian stimulation and total motile sperm inseminated were a determining factor in achieving pregnancy. No female HIV-1 contamination occurred.

Conclusion

This study demonstrates that sperm washing and IUI are highly effective in enabling serodiscordant couples with an HIV-1 infected male partner to have a child.     

The relationship of sperm parameters to cycle fecundity in superovulated women undergoing intrauterine insemination

Semen parameters of raw and prepared (post-swim-up) specimens from 451 cycles of intrauterine insemination (IUI) were analyzed in relation to cycle fecundity in 232 patients undergoing ovarian stimulation with sequential clomiphene citrate/menotropin therapy. Pregnancy occurred in 42 cycles, resulting in an overall pregnancy rate of 17.7%, and a cycle fecundity of 9.3%. Cycle fecundity was positively correlated with the parameters of post-swim-up log sperm density (r = 0.994), and with log total motile sperm inseminated (r = 0.964; inseminates were limited to a maximum of 20 million total motile sperm). Post-swim-up motility did not correlate (r = 0.308) with cycle fecundity; however, most specimens had a motility of greater than 40% post-swim-up. Only one pregnancy occurred when less than 1 million motile sperm were inseminated (38 cycles), which resulted in a cycle fecundity of 2.6% for these cycles. This may represent the threshold of effectiveness for IUI in this setting. Highest cycle fecundity was obtained with an inseminate containing approximately 10 million or more motile sperm. Parameters of raw samples correlated less well with cycle fecundity than did prepared specimens. Analysis of post-swim-up semen parameters can provide useful prognostic information for women undergoing IUI with ovarian stimulation; this information is helpful in counseling patients regarding their chances of success with this therapy.