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.