A Study of Predictive Factors Affecting Outcome of Intrauterine Tuboperitoneal Insemination (original) (raw)
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International Journal of Research in Medical Sciences, 2017
Background: Infertility management has become more substantial and relevant with an increase in the number of infertile patients as well as advances in the science of reproduction. The objective of our study was to assess the role of intrauterine tuboperitoneal insemination (IUTPI) and intrauterine insemination (IUI) in the treatment of infertile patients.Methods: 236 infertile patients, 118 in each group attending the infertility clinic, after applying both inclusion and exclusion criteria were enrolled in the present study. Patients in each study group were given clomiphene citrate for ovarian stimulation followed by injection hCG for triggering ovulation. Insemination with washed husband’s sperm was performed about 36-40 hours after hCG administration, using 10ml of inseminate in IUTPI and 0.5ml inseminate in IUI. The patient was then called after 2 weeks for urine pregnancy test (UPT) which, if positive was considered as clinical pregnancy.Results: Out of the total 236 cases, 4...
Factors predicting the outcome of intrauterine insemination
The Medical Journal of Basrah University, 2012
Background: Intrauterine insemination (IUI) is a frequently indicated therapeutic modality in infertility and considered to be of low to moderate complexity before the application of more sophisticated assisted reproductive technologies (ART). It is simple and inexpensive treatment in which processed and concentrated motile sperm are placed directly into uterine cavity. IUI is used together with various controlled ovarian hyperstimulation (COH) protocols for many indications such as male infertility, ovulatory disorders, endometriosis and unexplained infertility. Aim of study: Is to identify the important prognostic variables contributing to the successful outcome. Patients and methods: A prospective study was carried out at Assisted Conception Unit of Basra Medical College, A total of 203 cycles were analyzed to identify prognostic factors regarding treatment outcome. The variables selected for analysis were female age, duration and etiology of infertility, sperm parameters, number of preovulatory follicles, and number of previous treatment cycles and the method of COH. Results: The overall pregnancy rate per cycle was 9.3% (19/203). Of 19 pregnancies, 68.4% resulted in live birth, 26.3% in spontaneous abortion, and 5.3% were ectopic pregnancy. The multiple pregnancy rate was 15.8 % (3 twin pregnancies). Three significant variables for successful outcome were total motile sperm count (>10x10 6), the method of ovarian stimulation (use of r-FSH alone being superior to Clomiphen Citrate (CC) with r-FSH and CC alone), and multifollicular response. There was a tendency to a higher pregnancy rate in women <40 years and shorter duration of infertility (< 5 years) but this did not reach a statistical significance. Significant difference was not observed among different etiologies, although lowest pregnancy rate was found in unexplained infertility group. Conclusion: IUI may be an option for a selected group of couples prior to considering more sophisticated and expensive assisted reproductive techniques. High total motile sperm count (>10x10 6), controlled ovarian hyperstimulation (COH) with r-FSH and multifollicular response are valuable predictors for pregnancy in COH-IUI cycle.
Evaluation of Role of Intrauterine Insemination in Infertility in a Tertiary Care Hospital
The last few decades have witnessed a tremendous progress in the treatment of infertility. Intrauterine insemination (IUI) is such a technique in which the washed sperm is introduced in the uterine cavity in proper time IUI may be done using husband’s semen (IUI-H) or donor’s semen (IUI-D). The rationale of IUI is to overcome vaginal acidic pH, cervical mucus hostility and to deposit adequate number of highly motile and morphologically normal sperms near the fundal region of the uterus around the expected time of ovulation. This very study was targeted to evaluate the success rate of IUI using husband’s semen (IUI-H) in terms of clinical pregnancies in infertile couples and to establish its role in the management of infertility. AIMS AND OBJECTIVES: To evaluate the pregnancy rate per cycle of IUI and also the associated prognostic factors and adverse effects, if any. MATERIALS AND METHODS : In a prospective observational longitudinal study carried out over one year (from 1st June, 2011 to 31st May, 2012) in the Department of Obstetrics and Gynaecology, Eden Hospital, Medical College, Kolkata., total 53 couples fulfilling the inclusion criteria and exempted from the exclusion criteria were included. We included infertile couples with women in the age of 20-40 years, having anatomic defects of vagina or cervix, sexual dysfunction, minimum to mild endometriosis (AFS score ≤15), and chronic anovulatory menstrual cycles; male partners with anatomic defects of penis like hypospadius, semen volume in excess or deficit, sexual dysfunction, mild & moderate oligozoospermia, mild asthenozoospermia and mild teratozoospermia; and couples with unexplained infertility. Excluded were the women with bilateral tubal blockage, pelvic tuberculosis and severe pelvic endometriosis; male partners with azoospermia, severe oligoasthenoteratozoospermia, retrograde ejaculation and anejaculation and erectile dysfunction. After obtaining “Institutional Ethical Committee” clearance, and informed consent from each of them, history taking, baseline investigations including serology and basic infertility work up (semen analysis, ultrasonography, tubal patency test, hormonal evaluation) were done in each case. After ovulation induction serial folliculometry, single IUI, per cycle, was performed using husband’s washed sperms 36 hour after hCG triggering. Maximum 6 cycles of IUI were performed in each couple. The outcome was noted in terms of clinical pregnancy. Thus total 143 IUI cycles were performed in 53 couples in the study. RESULTS: Out of total 143 IUI cycles conducted in 53 infertile couples, 14 cycles were successful in terms of confirmed pregnancy. The cycle fecundability, i.e., the pregnancy rate per cycle of IUI was 9.79%. The pregnancy rate per couple was 26.42%. Out of these 14 pregnancies, one woman (7.14%) had spontaneous abortion in 10th week of gestation. Total 8 pregnancies were reported to have ended in live birth, of which 5 was term delivery. At the time of end of this study, 5 women were continuing pregnancies. Thus live birth rate per cycle of IUI, i.e., cycle fecundity was at least 5.59%. The success of IUI depended on the number of cycles performed on a couple (maximum after 3rd cycle and no pregnancy reported after 6th cycle), the age of both of the partners (particularly the woman), duration and type of infertility, initial seminal parameters,drugs used in COH, IMSC (inseminating motile sperm count), number and size of developing follicle sand endometrial thickness. Complications of IUI were mostly mild, commonest being pain. Mild OHSS occurred in 22.30% cycles and multiple pregnancy in only one cycle. However, medical and obstetric complications (diabetes, hypertension, ante-partum haemorrhage, preterm labour, IUGR) were not uncommon in pregnancies after IUI. But, no congenital anomaly was reported till the end of this study. DISCUSSION: IUI should be considered as cost-effective therapy for infertile couples in suitable cases. Our study supported the findings of different authors regarding cycle fecundability, fecundity, determinants of successful IUI and prognostic factors. There is little rationale to continue IUI beyond 6 cycles. Most of the complications were few and IUI does not increase the chance of congenital anomaly of the offspring. CONCLUSION: IUI should be considered as effective treatment option for many unfortunate infertile couples who attend Govt. hospitals and cannot afford costly treatments like IVF. Proper case selection is important before this mode of therapy and needs proper pre-treatment evaluation of the couples. KEYWORDS: Intrauterine insemination, unexplained infertility, male subfertility, ovarian hyperstimulation syndrome.
Human Reproduction, 1996
We report on 332 infertile couples who underwent 1115 cycles of intrauterine insemination (IUI) with washed husband's semen. The indication for IUI was an abnormal post-coital test due to either a male or cervical infertility factor. The mean number of IUI cycles per patient was 3.4, the overall pregnancy rate 18.7%, and the pregnancy rate per cycle 5.6%. The cumulative pregnancy rate calculated by life table analysis showed that 16.0% of pregnancies occurred in the first three treatment cycles, while the cumulative pregnancy rate was 26.9% by the sixth cycle. The outcome of the therapy was adversely affected if the woman's age was >39 years and/or total motile sperm count per insemination was <1X1O*. No pregnancy occurred in women older than 44 years or in cases with a total motile sperm count before semen preparation of <1X1O*.
Obstetrics and gynecology international, 2009
Objective. There is an asymmetric allocation of technology and other resources for infertility services. Intrauterine insemination (IUI) is a process of placing washed spermatozoa transcervically into the uterine cavity for treatment of infertility. This is a review of literature for the potential use of IUI as a basic infertility treatment in technology-limited settings. Study design. Review of articles on treatment of infertility using IUI. Results. Aspects regarding the use of IUI are reviewed, including ovarian stimulation, semen parameters associated with good outcomes, methods of sperm preparation, timing of IUI, and number of inseminations. Implications of the finding in light of the needs of low-technology medical settings are summarized. Conclusion. The reviewed evidence suggests that IUI is less expensive, less invasive, and comparably effective for selected patients as a first-line treatment for couples with unexplained or male factor infertility. Those couples may be off...
Predictive factors of intrauterine insemination success of women with infertility over 10 years
Journal of the Pakistan Medical Association
The relationship between maternal age, duration of infertility, pre-ovulatory follicles, endometrial thickness and motile sperms with intra uterine insemination (IUI) success in women with infertility over 10 years was surveyed. We performed a descriptive - cross sectional study among couples (n=26) with a history of infertility for more than 10 years who were treated with IUI. The data was collected between 2000 and 2007 in the fertility ward of Amiralmomenin Hospital of Semnan University of Medical Sciences. Patients underwent a basic fertility workup and the ovarian hyperstimulation was done with clomiphene citrate (CC) and human chorionic gonadotrophin (hMG) alone or in combination. A volume of 0.3-0.4 ml suspension of processed spermatozoa (after swim-up procedure) was introduced into the uterine cavity 36h after human chorionic gonadotrophin (hCG) administration. The comparison between variables was performed by chi-square and student's test on SPSS (Version 10.0). The tot...
2014
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. Keywords Intrauterine insemination Á Endometrium thickness Á Luteinizing hormone Á Number of follicles Á Fallopian tube Á Total motile fraction of semen
Intrauterine insemination: a systematic review on determinants of success
Human Reproduction Update, 2002
Intrauterine insemination (IUI) is a frequently indicated therapeutic modality in infertility. Here, a systematic review of the literature was performed to examine the current status of clinical and laboratory methodologies used in IUI and the impact of female and male factors on pregnancy success. Emphasis was centred in questioning the following: (i) the value of IUI against timed intercourse; (ii) IUI application with or without controlled ovarian hyperstimulation; (iii) timing and frequency of IUI; and (iv) impact of various parameters (male/female) on the prediction of pregnancy outcome. The odds of multiple pregnancy occurrence and its risk factors, as well as the costeffectiveness of IUI treatment compared with more complex assisted reproductive technologies are discussed. A computerized literature search was performed including Medline and the Cochrane library, as well as a crossover search from retrieved papers. It is concluded that although IUI is a successful contemporary treatment for appropriately selected cases of female and/or male infertility, further research is needed through well-designed studies to improve the methodologies currently utilized. Importantly, the clinical management of the infertile couple should be performed in an expedited manner taking into consideration the age of the woman, the presence of multifactorial infertility and cost-effectiveness of the available treatment alternatives.
Evaluation of ten years of intrauterine insemination results at a tertiary center
Clinical and Experimental Obstetrics & Gynecology, 2016
To report on ten years of intrauterine insemination (IUI) practice at Haseki Training and Research Hospital to determine retrospectively, the impact of IUI on the management of subfertile couples. Materials and Methods: This study was a retrospective analsis of all IUI cycles completed from
Journal of assisted reproduction and genetics, 1998
Our purpose was to evaluate intrauterine insemination results obtained in our clinic and identify prognostic factors for the chance of pregnancy. 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. 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...