Semen collection at clinic resulted in a higher success rate than collection at home in hMG treated (44% vs. 18%) but not in Clomid-treated women (9% vs. 9%). Intervals of collection to sperm wash, sperm wash to IUI, and collection to IUI were shorter in pregnant than in nonpregnant hMG-treated women (27 vs. 41 minutes, 42 vs. 85 minutes, and 99 vs. 156 minutes, respectively) but not in Clomid-treated women (28 vs. 38 minutes, 51 vs. 63 minutes, and 109 vs. 131 minutes, respectively; difference not statistically significant). Semen processed within 30 minutes after collection resulted in a higher success rate than that processed 31-60 minutes after collection in hMG-treated (48% vs. 18%) but not in Clomid-treated women (10% vs. 8%). Intrauterine insemination performed within 90 minutes of collection resulted in a higher success rate than IUI performed at 91-120 minutes or >120 minutes after collection in hMG-treated (99% vs. 22% and 7%, respectively) but not in Clomid-treated women (11%, 4%, and 10%, respectively). CONCLUSION(S): For i.u.i. with hMG but not Clomid, semen collection at the clinic is more effective than, and should be chosen over, collection at home. Delaying semen processing and/or delaying IUI compromises the pregnancy outcome in hMG-IUI cycles.
http://www.ncbi.nlm.nih.gov/pubmed/15589871
Four hundred seventeen women underwent 929 cycles for a median of 4 IUI attempts per couple. The median ejaculatory abstinence interval was 4 days (range 0-30) with an overall pregnancy rate (success rate) of 12% per cycle. Abstinence correlated positively with inseminate sperm count but negatively with motility. Variations in inseminate parameters did not correlate with success rates. However, abstinence intervals significantly affected success rates. The highest success rate was observed with an abstinence interval of 3 days or less (14%) and the lowest success rate seen with an abstinence interval of 10 days or more (3%). CONCLUSION(S): An abstinence interval of 3 days or less was associated with higher success rates following IUI. Prolonged abstinence decreases success rates, independent of other sperm parameters, perhaps as a result of sperm senescence and functional damage not readily identified by standard semen analysis.
http://www.ncbi.nlm.nih.gov/pubmed/16169402
An ejaculatory abstinence period of <or=2 days before IUI produced the highest pregnancy rates (success rates) per cycle compared with longer intervals of ejaculatory abstinence. This higher conception rate occurred despite a lower total number of motile spermatozoa inseminated.
http://www.ncbi.nlm.nih.gov/pubmed/19732887
BACKGROUND: In natural cycles, women conceive when intercourse takes place during a six-day period ending on the day of ovulation. The current practice in intrauterine insemination (IUI) cycles is to perform the IUI 24-36 hours after the hCG administration, when the ovulation is already imminent. In this study hCG was administered after the IUI, which more closely resembles the fertilisation process in natural cycles. RESULTS: The analysis included 228 cycles with hCG administered before and 104 cycles hCG administered after the IUI. The pregnancy rates (success rates) were 10.9% and 19.6%, respectively. Independent factors affecting the cycle outcome were sperm count (odds ratio 2.65), number of follicles > 16 mm at IUI (odds ratio 2.01) and the time of hCG administration (2.21).CONCLUSION: Improved pregnancy rate was observed with administration of hCG after IUI.
http://www.ncbi.nlm.nih.gov/pubmed/20178630
To determine the optimal time for administration of human chorionic gonadotropin (hCG) in clomiphene citrate (Clomid) induced intrauterine insemination cycles. METHODS: A retrospective analysis of 171 consecutive cycles was performed. An increase in luteinizing hormone level >100% over the mean of the preceding two days was defined as luteinizing hormone surge. Human chorionic gonadotropin was given in preparation for intrauterine insemination based on the follicle size and estradiol level prior to surge in 85 cycles (Group A), with the spontaneous surge in 64 cycles (Group B) and not given in 22 cycles (Group C) due to high luteinizing hormone levels. RESULTS: The overall success rate per cycle was 18.1% (31/171), 15.2% (prior to LH surge), 20.3% (with LH surge) and 22.7% (not given), (difference not statistically significant). CONCLUSION: Although there may be physiological reasons to propose that timing the human chorionic gonadotropin to the luteinizing hormone surge will improve the success rate, they were not demonstrated.
http://www.ncbi.nlm.nih.gov/pubmed/16021859
The live birth rate after intrauterine insemination was significantly higher after stimulation with gonadotrophins (13%) than after clomiphene cirate (Clomid) (8%) if only 1 follicle 14 mm or larger was present. If 2 or more follicles were present, there was no statistically significant difference between both stimulation methods. CONCLUSION: Treatment of intrauterine insemination with gonadotrophin is effective with an acceptable (multiple) live birth rate when 1 or 2 follicles 14 mm or larger are present.
http://www.ncbi.nlm.nih.gov/pubmed/18060945
OBJECTIVE: To evaluate the effectiveness of offering double intrauterine insemination (IUI) to clients in our fertility program. STUDY DESIGN:Single IUIs were performed at 36 hours following hCG or the day following LH surge; double IUIs were performed 18 and 36 hours following hCG or the day of and day following LH surge. RESULTS: One hundred ten clinical pregnancies occurred for 508 couples in 999 single IUI cycles (success rate per cycle, 11.0%); 45 clinical pregnancies for 174 couples occurred in 277 double IUI cycles (success rate per double cycle, 16.2%). Differences for success rates were noted regarding diagnostic categories between single and double IUI groups (ovulation dysfunction, 12.9% vs 19.5%, and male factor, 7.9% vs. 17.5%) and ovulation protocols (Clomid-gonadotropins-hCG, 13.0% vs. 21.3%, and Lupron-gonadotropins-hCG, 4.2% vs. 25.0%). CONCLUSION: Double IUI is superior to single IUI overall, especially when comparing gonadotropin-containing ovarian stimulation protocols or within the ovulatory dysfunction and male factor diagnostic categories.
http://www.ncbi.nlm.nih.gov/pubmed/18441725
PROBLEM: Evaluate effects of endometriosis and serum antiendometrial antibodies on fecundity (success rates) in intrauterine insemination (IUI) cycles. RESULTS: Success rate was 11.5%. Double IUI improved success rates with significance achieved in certain study groups. Two study groups receiving double IUI had significantly increased success rates: endometriosis negative/serum antiendometrial antibodies positive (odds ratio: 5.1) and endometriosis positive/serum antiendometrial antibodies positive (odds ratio: 4.1). CONCLUSION: Double IUI improves susccess rate in serum antiendometrial antibodies positive patients.
http://www.ncbi.nlm.nih.gov/pubmed/21244562
OBJECTIVE: To investigate the role of ultrasound guidance in intrauterine insemination (IUI). RESULTS: In the ultrasound-guided IUI and blinded IUI groups, the pregnancy rates were 23.4 and 13.9%, respectively. The difference between the groups was statistically significant, thereby indicating that ultrasound guidance improves success rates. In the ultrasound-guided IUI group, 9.7% of the cases were difficult, while in the blinded IUI group, 26.2% were difficult and the difference between the groups was also statistically significant. Conclusion: Ultrasound guidance in IUI improves success rates and reduces the frequency of difficult IUI.
http://www.ncbi.nlm.nih.gov/pubmed/23235295
OBJECTIVE: To evaluate the effect of vaginal progesterone as luteal phase support on success rates in controlled ovarian stimulation and intrauterine insemination cycles in couples with unexplained or mild male factor infertility. RESULTS: In total, 148 cycles with luteal phase support and 142 cycles without luteal phase support were performed. The clinical pregnancy rates per cycle were higher for cycles with luteal phase support than for the unsupported cycles (24.3% vs. 14.1% respectively). CONCLUSION: The use of vaginal suppositories as luteal phase support significantly improved success rates in controlled ovarian stimulation and intrauterine insemination in patients with unexplained or mild male factor infertility.
http://www.ncbi.nlm.nih.gov/pubmed/22940119
OBJECTIVE: To determine the impact of luteal phase support on success rates in ovarian stimulation and intrauterine insemination (IUI) cycles with gonadotropins in couples with unexplained infertility. PATIENT(S): 214 couples with unexplained infertility who were treated during 427 ovarian stimulation and IUI cycles with recombinant FSH. INTERVENTION(S): Patients underwent ovarian stimulation with recombinant FSH combined with IUI. Patients randomized into the study group received luteal phase support in the form of vaginal progesterone gel (Crinone 8% gel). Patients randomized into the control group received no luteal phase support. RESULT(S): Demographic data were found to be homogeneous between the study and control groups. Clinical pregnancy rates per cycle and per patient were significantly higher in the study group (21.1% and 39.4%, respectively) compared with the control group (12.7% and 23.8%, respectively). Live birth rate per cycle and per patient was also significantly higher in patients with luteal support (17.4% and 35.8%, respectively) compared with control subjects (9.3% and 18.1%, respectively). CONCLUSION(S): Luteal phase support with vaginal progesterone gel significantly affects the success of ovarian stimulation and IUI cycles in patients with unexplained infertility.
http://www.ncbi.nlm.nih.gov/pubmed/18692788
OBJECTIVES: To determine the impact of luteal phase support with vaginal progesterone on pregnancy outcomes in infertile couples undergoing intrauterine insemination when recombinant follicle-stimulating hormone was used for ovulation induction. RESULTS: The clinical pregnancy rate (success rate) per patient was higher for supported than unsupported cycles (54.92% vs. 35.21%, respectively), but the per-cycle difference was not significant (29.54% vs. 19.84%, not statistically significant). Twenty-five pregnancies in supported cycles and seven pregnancies in unsupported cycles resulted in live births. When these rates were compared per cycle and per patient, significant differences were detected between the cycle types (18.9% per cycle and 35.2% per patient vs. 5.5% per cycle and 9.8% per patient). CONCLUSION: Luteal phase support with vaginal progesterone improved the success of intrauterine insemination cycles when recombinant FSH was used for ovulation induction.
http://www.ncbi.nlm.nih.gov/pubmed/21514032
BACKGROUND: Investigated the efficacy of GnRH antagonists in cycles with mild ovarian hyperstimulation followed by IUI in subfertile women. METHODS: Couples diagnosed with unexplained, male factor subfertility or associated with the presence of minimal or mild endometriosis received either a GnRH antagonists or a placebo. All women were treated with recombinant FSH in a low-dose step-up regimen starting on Day 2-4 of the cycle. A GnRH antagonist was added when one or more follicles of 14 mm diameter or more were visualized. When at least one follicle reached a size of ≥18 mm, ovulation was induced by hCG injection. A single IUI was performed 38-40 h later. Couples were offered a maximum of three consecutive cycles. RESULTS: Live birth rates were not significantly different between the group treated with GnRH antagonist (8.4%) and the placebo group (12%). CONCLUSIONS: Adding a GnRH antagonist in cycles with mild ovarian hyperstimulation in an IUI program does not increase live birth rates.
http://www.ncbi.nlm.nih.gov/pubmed/21339196
OBJECTIVE: To analyze the effectiveness of pre-washing the intrauterine insemination catheters on IUI outcome. PATIENTS AND METHODS: Infertile couples involved in a IUI program were included in the study. Every other week for two years, IUI catheters were washed with culture medium prior to intrauterine sperm insemination. RESULT(S): Only the first IUI for each couple were analyzed. Washing the catheter, prior to use, resulted in a 49.7% increase in clinical pregnancy rate (22.0% vs 14.7%). This result is observed with fresh sperm (15.7% vs 11.1%) and frozen-thawed sperm as well (31.1% vs 19.8%). The early pregnancy termination rate was similar in all groups. DISCUSSION AND CONCLUSION: Pre-washing the catheter before IUI should be recommended in Good Laboratory Practice Guidelines as it is already the case for embryo transfer catheters. This raises the problem of washing all single-use devices, in contact with gametes or embryos during IVF.
http://www.ncbi.nlm.nih.gov/pubmed/22503402
AIM: The aim of the present study was to evaluate the efficacy of passive uterine straightening during intrauterine insemination (IUI). MATERIAL AND METHODS: Participants were 460 women with unexplained infertility. Interventions were IUI by passive straightening of the uterus by means of bladder filling, or IUI performed with an empty bladder. RESULTS: The pregnancy rate (success rate) was higher in the full bladder group than in the empty bladder (control) group (13.5% vs 7.4%). The risk of undergoing difficult IUI was higher in the empty bladder group than the full bladder group (10.0% vs 37.8%). The clinical pregnancy rate was also higher in the group of patients who had easy IUI than in the group of patients who had difficult IUI (12.7% vs 5.5%). CONCLUSION: Passive straightening of the uterus makes the procedure less difficult and improves the success rate.
http://www.ncbi.nlm.nih.gov/pubmed/22070446
METHODS: The study included a total 1146 first-stimulated cycles in infertile couples due to male factor, anovulation or unexplained infertility. Cycles were stimulated by clomiphine citrate (Clomid) or sequential Clomid-hMG or hMG and monitored by transvaginal ultrasound. When the leading follicle reached ≥ 18 mm mean diameter, 10000 IU hCG was given to trigger ovulation and IUI was timed for 36 ± 2 h later. Semen was processed and ovulation was checked at the time of IUI. Post-ovulatory cases received single IUI, while pre-ovulatory cases were sequentially randomized to receive either single or double IUI. RESULTS: Overall clinical pregnancy rate (success rate) in the whole cohort was 10.1%. When ovulation was present before IUI, success rate was 11.7% compared with 6.7% when ovulation was absent [odds ratio: 1.85]. When this odds ratio was computed according to infertility etiology, it was 1.26 (not statistically significant) for male factor infertility and 2.24 for non-male factor infertility. Comparing the success rate for double versus single IUI in pre-ovulatory cases, the odds ratio for all cycles was 1.9 (not significant), but according to etiology, it was 4.667 (approaching significance) in male factor and 1.2 (not significant) for non-male factors. CONCLUSIONS: Single IUI timed post-ovulation gives a better success rate when compared with single pre-ovulation IUI for non-male infertility, whereas for male factors, pre-ovulation, double IUI gives a better success rate when compared with single IUI.
http://www.ncbi.nlm.nih.gov/pubmed/21177312
253 couples with unexplained subfertility and an intermediate prognosis of a 30-40% probability of a spontaneous ongoing pregnancy within 12 months were randomly assigned either intrauterine insemination with controlled ovarian hyperstimulation for 6 months or expectant management for 6 months. FINDINGS: In the intervention group, 33% of the women conceived and 23% pregnancies were ongoing. In the expectant management group, 32% of the women conceived and 27% of the pregnancies were ongoing (difference not statistically significant). There was one twin pregnancy in each study group, and one woman in the intervention group conceived triplets. INTERPRETATION: A large beneficial effect of intrauterine insemination with controlled ovarian hyperstimulation in couples with unexplained subfertility and an intermediate prognosis can be excluded. Expectant management for 6 months is therefore justified in these couples.
http://www.ncbi.nlm.nih.gov/pubmed/16844491?dopt=Abstract
In vitro fertilization (IVF) with single embryo transfer has been proposed as a means of reducing multiple pregnancies associated with infertility treatment. All existing cost-effectiveness studies of IVF-SET have compared it with IVF with multiple embryo transfer but not with intrauterine insemination with gonadotropin stimulation (stimulated IUI). METHODS: Cost estimates were based on average costs of associated procedures in Canada. RESULTS: In our analysis, IVF-double embryo transfer proved to be the most cost-effective strategy at $35,144/live birth, followed by stimulated IUI at $66,960/live birth, and IVF-single embryo transfer at $109,358/live birth. The results were sensitive both to the cost of IVF cycles and to the probability of live birth. CONCLUSION: This economic analysis showed that IVF double embryo transfer was the most cost-effective strategy of the options, and IVF single embryo transfer was the least cost-effective.
http://www.ncbi.nlm.nih.gov/pubmed/18505665
In unexplained and mild male factor subfertility, both intrauterine insemination (IUI) and in-vitro fertilisation (IVF) are indicated as first line treatments. Because the success rate of IUI is low, many couples failing IUI subsequently require IVF treatment. METHODS: Mathematical modelling was used to estimate comparative clinical and cost effectiveness of either primary offer of one full IVF cycle (including frozen cycles when applicable) or "IUI + IVF" (defined as primary IUI followed by IVF for IUI failures) to a hypothetical cohort of subfertile couples who are eligible for both treatment strategies. RESULTS: Cost-effectiveness ratios for IVF, "unstimulated-IUI (U-IUI) + IVF", and "stimulated IUI (S-IUI) + IVF" were 12,600 pounds sterling, 13,100 pound sterling and 15,100 pound sterling per live birth-producing pregnancy respectively. For a hypothetical cohort of 100 couples with unexplained or mild male factor subfertility, compared with primary offer of IVF, 6 cycles of "U-IUI + IVF" or of "S-IUI + IVF" would cost an additional 174,200 pounds sterling and 438,000 pounds sterling, representing an opportunity cost of 54 and 136 additional IVF cycles and 14 to 35 live birth-producing pregnancies respectively. CONCLUSION: For couples with unexplained and mild male factor subfertility, primary offer of a full IVF cycle is less costly and more cost-effective than providing IUI (of any modality) followed by IVF.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1543624/
BACKGROUND: A recently published randomized controlled trial considered the effectiveness of Clomid and IUI in patients with unexplained infertility and found that neither treatment offered a superior live birth rate when compared with expectant management. METHODS: Five hundred and eighty women were randomized to either expectant management, Clomid or IUI for 6 months. RESULTS: Live birth rates in the three randomized groups were: Expectant management = 17%, Clomid = 13% and IUI = 22%. The average costs per treatment cycle were £0 for Expectant management, £83 (£17) for Clomid and £98 (£31) for IUI. CONCLUSIONS: Despite being more expensive, existing treatments such as empirical Clomid and unstimulated IUI do not offer superior live birth rates compared with expectant management of unexplained infertility.
http://www.ncbi.nlm.nih.gov/pubmed/21127355
OBJECTIVE: To report our center's success rates by intravaginal insemination (IVI) or intrauterine insemination (IUI) in 82 couples with male partners with spinal cord injuries. INTERVENTION(S): Intravaginal insemination and IUI. RESULT(S): Overall, 31 of the 82 couples (37.8% success rate) achieved 39 pregnancies. Intravaginal insemination, performed mostly at home by selected couples, was undertaken in 45 couples, 17 of whom (37.8% success rate) achieved 20 pregnancies. Intrauterine insemination was performed in 57 couples, 14 of whom (24.6% success rate) achieved 19 pregnancies, with a cycle success rate of 7.9%.
http://www.ncbi.nlm.nih.gov/pubmed/21621768
Forty-eight patients with male or idiopathic infertility were stimulated with human menopausal gonadotropin. Intrauterine insemination (IUI) or natural intercourse were performed after either hCG-induced or spontaneous, urinary LH surge-monitored ovulation. A total of 148 cycles were analyzed. In 40 cycles treated with hCG-induced ovulation and IUI, 7.5% patients conceived, whereas 37 women accomplished natural intercourse after hCG-induced ovulation and 5.5% became pregnant. When inseminated after a spontaneous LH surge, 8.8% of 34 patients achieved a pregnancy; no conception occurred in 37 spontaneously ovulatory cycles combined with timed intercourse. Success rates did not substantially differ between the treatment modalities or between mono-ovulatory and polyovulatory cycles. The cycle characteristics between spontaneous ovulatory and hCG-induced cycles significantly did differ.
http://www.ncbi.nlm.nih.gov/pubmed/1899393
OBJECTIVE: To compare the success rates achieved by intrauterine insemination or timed intercourse in gonadotrophin stimulated cycles in couples whose only detectable abnormality was poor sperm quality. RESULTS: Five pregnancies (3.9%) were achieved after 128 cycles with timed intercourse and 15 pregnancies (11.5%) after 130 cycles with intrauterine insemination. The difference was found to be statistically significant. CONCLUSION: We suggest that intrauterine insemination during hMG stimulated cycles improves the success rates of couples whose only detectable abnormality is poor sperm quality.
http://www.ncbi.nlm.nih.gov/pubmed/8820005
BACKGROUND: Although intra-uterine insemination (IUI) is widely used, its effectiveness remains a matter of debate. OBJECTIVES: To determine for male subfertility whether intrauterine insemination (IUI) improves the probability of conception compared with timed intercourse and whether the addition of controlled ovarian hyperstimulation influences the results. MAIN RESULTS: In natural cycles intrauterine insemination (IUI) significantly improved the probability of conception compared with timed intercourse (combined odds ratio 2.43). In cycles with controlled ovarian hyperstimulation IUI significantly improved the probability of conception also compared with timed intercourse (combined odds ratio 2.14). Despite clinical heterogeneity, these results are based on strong evidence. Intrauterine insemination in cycles with controlled ovarian hyperstimulation improved the probability of conception compared with IUI in natural cycles but significance was not reached (combined odds ratio: 1.79). Comparing IUI in controlled ovarian hyperstimulation-cycles with timed intercourse in natural cycles the first treatment modality significantly improved the probability of conception (combined odds ratio: 6.23). REVIEWER'S CONCLUSIONS: IUI offers couples with male subfertility benefit over timed intercourse, both in natural cycles and in cycles with controlled ovarian hyperstimulation.
http://www.ncbi.nlm.nih.gov/pubmed/10796711
OBJECTIVES: To determine whether for couples with unexplained subfertility IUI improves the live birth rate compared with timed intercourse, both with and without ovarian hyperstimulation. MAIN RESULTS: In the six trials where IUI was compared with timed intercourse, both in stimulated cycles, there was evidence of an increased chance of pregnancy (odds ratio 1.68). A significant increase in success rate was also found for women where IUI with ovarian hyperstimulation was compared with IUI in a natural cycle (odds ratio 2.33). However, the trials provided insufficient data to investigate the impact of IUI with or without ovarian hyperstimulation on several important outcomes including live birth, multiple pregnancies, miscarriage and risk of ovarian hyperstimulation. There was no evidence of a difference in success rate for IUI with ovarian hyperstimulation compared with timed intercourse in a natural cycle (one trial, 51 women: odds ratio 4.05, not statistically significant). AUTHORS' CONCLUSIONS: There is evidence that IUI with ovarian hyperstimulation increases the live birth rate compared to IUI alone. The likelihood of pregnancy was also increased for treatment with IUI compared to timed intercourse both in stimulated cycles.
http://www.ncbi.nlm.nih.gov/pubmed/17054143
The mean cycle success rate associated with hMG/IUI therapy was significantly higher than either hMG or IUI therapy alone for all patients (hMG/IUI = 19.6%, hMG = 6.3%, IUI = 3.4%). The improvement in cycle success rates with hMG/IUI therapy was also observed when the couples were separated by infertility diagnostic groups: male factor (hMG/IUI = 15.3%, hMG = 4.4%, IUI = 3.0%), cervical factor (hMG/IUI = 26.3%, hMG = 7.9%, IUI = 5.1%), endometriosis (hMG/IUI = 12.85%, hMG = 6.6%), and unexplained infertility (hMG/IUI = 32.6%, hMG = 5.5%, IUI = 0%). Moreover, in patients who had failed to conceive with hMG or IUI alone, the cycle fecundity rate when they were switched to hMG/IUI therapy equaled that of patients who received combined therapy from the onset. We conclude that cycle fecundity rates and cumulative success rates are significantly greater using a combination of hMG and IUI compared with either modality alone in the treatment of male factor, cervical factor, endometriosis, or unexplained infertility.
OBJECTIVES: To determine whether, for couples with unexplained subfertility, IUI improves the live birth rate compared with timed intercourse, both with and without ovarian hyperstimulation. MAIN RESULTS: One trial compared IUI in a natural cycle with expectant management and showed no evidence of increased live births (odds ratio 1.60, but not statistically significant). In the six trials where IUI was compared with timed intercourse, both in stimulated cycles, there was evidence of an increased chance of pregnancy after IUI (odds ratio 1.68). A significant increase in live birth rate was found for women where IUI with ovarian hyperstimulation was compared with IUI in a natural cycle (odds ratio 2.07). However the trials provided insufficient data to investigate the impact of IUI with or without ovarian hyperstimulation on several important outcomes including live births, multiple pregnancies, miscarriage and risk of ovarian hyperstimulation. There was no evidence of a difference in success rate for IUI with ovarian hyperstimulation compared with timed intercourse in a natural cycle (two trials, total 304 women: data not pooled). The final comparison of IUI in natural cycle to timed intercourse with ovarian hyperstimulation showed a marginal, significant increase in live births for IUI (odds ratio 1.95). AUTHORS' CONCLUSIONS: There is evidence that IUI with ovarian hyperstimulation increases the live birth rate compared to IUI alone. The likelihood of pregnancy was also increased for treatment with IUI compared to timed intercourse in stimulated cycles. One adequately powered multicentre trial showed no evidence of effect of IUI in natural cycles compared with expectant management.
http://www.ncbi.nlm.nih.gov/pubmed/22972053
BACKGROUND: Controlled ovarian hyperstimulation with clomiphene citrate (Clomid) combined with intrauterine insemination (IUI) is often used as treatment for ovulatory infertility which includes unexplained, male, cervical, endometriosis, and tubal infertility. AIMS: To review the effectiveness of Clomid and IUI in ovulatory infertility. RESULTS: Six published randomized controlled trials were included in the overall review. Meta-analysis demonstrated a higher cycle success rate with Clomid and IUI compared to timed intercourse in the natural cycle (odds ratio = 4.6). Treatment with gonadotrophins and IUI results in a higher success rate compared to Clomid and IUI (odds ratio = 2.9). CONCLUSIONS: Clomiphene citrate combined with IUI is more effective than timed intercourse in the natural cycle at achieving pregnancy in couples with ovulatory infertility. However, treatment with gonadotrophins and IUI is superior to Clomid and IUI.
http://www.ncbi.nlm.nih.gov/pubmed/15089830
BACKGROUND: Intra-uterine insemination (IUI) is one of the most frequently used fertility treatments for couples with male subfertility. Its use, especially when combined with ovarian hyperstimulation has been subject of discussion. Although the treatment itself is less invasive and expensive than others, its efficacy has not been proven. OBJECTIVES: The aim of this review was to determine whether for couples with male subfertility, IUI improves the live birth rates or ongoing pregnancy rates compared with timed intercourse, with or without ovarian hyperstimulation. MAIN RESULTS: For the comparison IUI versus timed intercourse, both in natural cycles, no evidence of difference between the probabilities of pregnancy rates per woman after IUI compared with timed intercourse was found (odds ratio 5.3, but not statistically significant). No statistically significant of difference between success rates per couple for IUI + ovarian hyperstimulation versus IUI could be found (odds ratio 1.47, but not statistically significant). For the comparison IUI versus timed intercourse both in stimulated cycles there was no evidence of statistically significant difference in success rates per couple either (odds ratio 1.67, but not statistically significant).
http://www.ncbi.nlm.nih.gov/pubmed/17943739
To evaluate the influence of female age and cause of infertility on the outcome of controlled ovarian hyperstimulation and intrauterine insemination (IUI), we studied 2717 controlled ovarian hyperstimulation cycles in 1035 subfertile couples. The cumulative clinical pregnancy rates were 39% and 58% after three and six controlled ovarian hyperstimulation cycles, respectively. The cumulative success rate significantly decreased with maternal age and differed by cause of infertility. The cumulative success rate continued to increase with an increase in controlled ovarian hyperstimulation cycle number up to the third, or forth cycle, in patients with mechanical and combined infertility, respectively, and in up to the second cycle in patients aged 40 years or more. These findings provide treatment guidelines for clinicians in determining the likelihood of treatment success and the point at which to proceed to the next treatment strategy.
http://www.ncbi.nlm.nih.gov/pubmed/20540664
OBJECTIVE: To assess the effects of semen characteristics on the success of intrauterine insemination (IUI). INTERVENTION: IUI cycles were preceded with ovarian stimulation. RESULT: A total of 82 clinical pregnancies were obtained (7.0% success rate per cycle, 28.9% per case). At the end of the sixth cycle, 73 clinical pregnancies had been achieved (89.0%). The success rate per cycle for patients ≤ 35 years age was 18%, which is significantly higher than that of patients >35 years of age. Pregnancies occurred up to the fifth cycle. The success rate per cycle was significantly higher in cases of sperm movement rates more than 30% (success rate 9.3%) and total motile sperm counts more than 10 million. CONCLUSION: In male sub-fertility cases of sperm parameters as motility rates ≥ 30% and motile sperm concentration ≥ 10 million, IUI could be a useful option for infertility treatment.
http://www.ncbi.nlm.nih.gov/pubmed/21372497
Couples 24-41 years old with primary and secondary infertility were included. Patients carried out a protocol of ovarian stimulation and follicular follow up. RESULTS: 668 cycles were analyzed in 391 couples. The success rate per cycle and couple was of 13.0 and 21.7% respectively. The three variables with statistical significance were: the infertility duration, sperm motility and the cycle number in which IUI was performed. No statistical significance was found in age of participant, type of infertility, length of infertility, aetiology, postcapacitation sperm density, number of follicles, or endometrial thickness. CONCLUSIONS:The greatest success in IUI will be achieved with infertility of 4 years or less, with sperm motility of 77.6% and in the first two cycles of treatment.
http://www.ncbi.nlm.nih.gov/pubmed/17539317
OBJECTIVE: To evaluate the pregnancy rate in natural cycle, in ovarian stimulation by clomifene citrate (Clomid), combination Clomid with gonadotropins and gonadotropins alone. RESULTS: The total success rate in IUI with husband sperm cycles was 8.6% (6.3% in natural cycles, 12.5% in cycles with Clomid, 16.4% in cycles Clomid with gonadotropins and 11.2 % in cycles with gonadotropins alone). The total success rate in IUI with donor sperm cycles was 20.2% (19.3% in natural cycles, 22.7% in cycles with Clomid, 38.5 % in cycles Clomid with gonadotropins and 13% in cycles with gonadotropins alone). Statistical difference we didn't reach. CONCLUSIONS: Ovulation induction increases success rate compared with natural cycle.
http://www.ncbi.nlm.nih.gov/pubmed/18236896
OBJECTIVE: To compare the result of IUI in infertile couples with different protocols of induction ovulation. METHODS: Infertile couples with different diagnosis (unexplained, male factor, endometriosis, tubal disease, ovulatory dysfunction and multifactorial infertility) were subjected to different protocol of induction ovulation: 50-100 mg clomid in day 2-6; 50 mg clomid in day 2-6 + 2 amp HMG (human menopausal gonadotropins) in day 5, 7, 9, 11; and 2 amp HMG per day. Natural ovulatory cycle + IUI was used for sperm stored patients. IUI was performed 36-40 hours after HCG injection. RESULTS: Thirty one pregnancies (7% per cycle, 15% per patient) occurred. One pregnancy occurred (pregnancy per cycle was 2% and per patient was 12%) in 8 patients undergoing 37 cycles of IUI with natural ovulation. The result with clomid in patients undergoing IUI was 2 pregnancies (4% per cycle, 7% per patient). In patients receiving IUI with clomid+HMG, 21 pregnancies occurred (7% per cycle, 16% per patient). In patients receiving IUI with HMG, 8 pregnancies occurred (9% per cycle, 23% per patient). CONCLUSION: The method chosen for ovulation induction had a critical bearing on the success of IUI. The result of IUI will be better by using induction ovulation compared to natural ovulatory cycle. In our program the combined use of HMG+IUI yielded a higher rate of success compared with CC+IUI, CC+HMG+IUI and natural ovulatory cycle+IUI.
http://www.ncbi.nlm.nih.gov/pubmed/15552282
OBJECTIVE: To determine whether hMG offers an advantage over clomiphene citrate (Clomid) in achieving pregnancy after IUI with husband's sperm. RESULT(S): The cycle fecundity rate was 14.44% for cycles with Clomid and 7.14% with hMG. The difference was not statistically significant. CONCLUSION(S): These data suggest that Clomid is an effective alternative to hMG in the population examined.
http://www.ncbi.nlm.nih.gov/pubmed/10632419
The cumulative probability of pregnancy after intrauterine insemination with no ovulation induction is 21.0% after six cycles with a monthly success rate of 3.4%. With Clomid the success rate is 32.7% with a monthly success rate of 6.1%, and with human menopausal gonadotropin the success rate is 60.7% with a monthly success rate of 13.0%. The human menopausal gonadotropin group had a significantly higher pregnancy rate and monthly success rate as compared with the other two groups. There were no differences between the no-stimulation and the Clomid groups. CONCLUSIONS: Human menopausal gonadotropin stimulation results in a significantly higher pregnancy rate and monthly success rate after intrauterine insemination as compared with no stimulation or Clomid use.
http://www.ncbi.nlm.nih.gov/pubmed/1615967
We investigated data from an earlier prospective trial with regard to the specific question of whether the application of mild hyperstimulation in IUI cycles could be an alternative strategy for obtaining acceptable pregnancy rates while preventing a high multiple pregnancy rate, compared with natural cycles for IUI. METHODS: Pregnancy outcome of 310 natural and 334 mildly hyperstimulated cycles for IUI in 171 couples with unexplained or mild male factor subfertility. RESULTS: Success rates were similar: 35 and 39.8% per couple in the natural and mildly hyperstimulated cycles respectively (no statistically significant difference). Multiple pregnancies, all twin pregnancies, were conceived significantly more frequently in the mild hyperstimulation group (27% of the pregnancies) than in the natural cycle group (4% of the pregnancies). All multiple pregnancies in the hyperstimulation group were conceived in multifollicular cycles. CONCLUSION: The application of a mild hyperstimulation protocol as an alternative to a standard hyperstimulation protocol for IUI does not result in higher success rates than IUI in the natural cycle, while at the same time multiple pregnancies cannot be avoided. Therefore, there is no place for the use of gonadotrophins in IUI treatment.
http://www.ncbi.nlm.nih.gov/pubmed/16037113
BACKGROUND: The influence of multifollicular growth on pregnancy rates in subfertile couples undergoing intrauterine insemination (IUI) with controlled ovarian hyperstimulation remained unclear. RESULTS: We included 14 studies reporting on 11,599 cycles. The absolute pregnancy rate was 8.4% for monofollicular and 15% for multifollicular growth. The pooled odds ratio for pregnancy after two follicles as compared with monofollicular growth was 1.6, whereas for three and four follicles, this was 2.0 and 2.0, respectively. Compared with monofollicular growth, success rates increased by 5, 8 and 8% when stimulating two, three and four follicles. The pooled odds ratio for multiple pregnancies after two follicles was 1.7 (not statistically significant), whereas for three and four follicles this was 2.8 and 2.3, respectively. The risk of multiple pregnancies after two, three and four follicles increased by 6, 14 and 10%. The absolute rate of multiple pregnancies was 0.3% after monofollicular and 2.8% after multifollicular growth.
http://www.ncbi.nlm.nih.gov/pubmed/18687698
The objective of the study was to analyze the pregnancy rate in intra-uterine insemination (IUI) in relation to pre-ovulatory follicular number, size and day of insemination. Couples with unexplained infertility and male factor infertility underwent IUI with or without ovarian stimulation. The mean number of IUI cycles per patient was 4.1, the overall success rate was 27.3% per patient, and the success rate per cycle was 6.9%. The success rate was 4.4% when one follicle was produced, whereas with more than two follicles, the rate increased to 21.2%. Hormonal stimulation using clomiphene citrate (Clomid) and/or human menopausal gonadotrophin/follicle stimulating hormone yielded a significant higher success rate compared to IUI in natural cycles (10.3% versus 3.3%). Although not statistically significant, the success rate decreased with advancing age of woman. The results suggest that IUI is a useful method of assisted conception in unexplained infertility and higher success rates can be achieved with good patient selection and ovarian stimulation.
http://www.ncbi.nlm.nih.gov/pubmed/19810378
PURPOSE: The purpose of the present study is to compare intrauterine insemination (IUI) success rates utilizing an extended semen transport time. This allowed clients to conveniently collect IUI specimens in the comfort and privacy of their home. A single IUI per treatment cycle was performed. BASIC PROCEDURES: In each IUI cycle the couples processed the specimen by adding sperm washing medium at room temperature to the specimen 30 min following collection and allowed it to incubate for two hours prior to IUI during transport. MAIN FINDINGS: Overall, success rates per cycle was 11.8% and per couple was 22.3%; respectively by diagnosis was: unexplained 22.6%, 38.8%; male factor 18.8%, 42.9%; ovulatory dysfunction 12.4, 22.6%; endometriosis 5.3%, 11.1%; tubal factor 7.6%,13.3%; and combined factors 9.7%, 20.0%. Unexplained vs endometriosis, tubal factor, and ovulatory dysfunction was statistically different. Male factor vs endometriosis was significantly different. Ovulatory dysfunction vs endometriosis was significantly different. Pregnancies by ovulation protocol: LH surge 4.5%,10.5%; Clomid-hCG 9.4%,14.9%; Clomid-gonadotropins-hCG 13.7%, 23.7%; gonadotrophins-hCG 17.5%, 45.3%; Lupron-gonadotropins-hCG 3.5%, 6.7%. CONCLUSIONS: We conclude that IUI is effective when utilizing an extended transport time allowing most couples to collect the specimen at home and is most effective when utilizing Gn-hCG therapy. Based on our analysis, endometriosis, tubal factor and combined diagnostic categories should proceed earlier to higher level assisted reproductive technologies.
http://www.ncbi.nlm.nih.gov/pubmed/17987885
Three hundred and seventeen women who underwent 507 consecutive controlled ovarian hyperstimulation /IUI cycles were recruited. The main outcome measure was pregnancy rate according to age, infertility diagnosis, duration of infertility, semen parameters, and the number of treatment cycles. The overall pregnancy rates were 16.9% per cycle and 25.9% per couple. Pregnancy rates decreased with advancing maternal age. Pregnancy rate was also significantly lower in patient with postwash total motile sperm count < or = 20 million/ml compared to those with postwash total motile sperm count >20 million/ml. The cumulative pregnancy rates varied greatly by diagnosis from 16% for patients with male factor infertility to 60% for patients with ovulatory disorder. Pregnancies among patients with male infertility, tubal factors infertility and endometriosis were achieved during the first three cycles. There is a clear age-related decline in success rates associated with controlled ovarian hyperstimulation /IUI treatment. Women of > 40 years old, couple with postwash TMSC < or = 20 million/ml, severe endometriosis and tubal factors have a particularly poor prognosis.
http://www.ncbi.nlm.nih.gov/pubmed/18551930
OBJECTIVE: To determine whether age, diagnosis, and cycle number influence cycle fecundity associated with gonadotropin-induced controlled ovarian hyperstimulation/IUI. RESULT(S): Success rates decreased with increasing patient age. The cumulative success rates varied greatly by diagnosis from 13% for patients with male factor infertility to 84% for patients with ovulatory factor infertility. Average cycle fecundity was considerably less varied by diagnosis. All pregnancies among patients with male factor infertility and tubal factor infertility were achieved during the first two cycles.
http://www.ncbi.nlm.nih.gov/pubmed/10519623
We determined the intrauterine insemination (IUI) pregnancy outcome in the same group of patients when applying different methods of ovulation induction. A group of patients with unexplained and male factor infertility consented to have the following treatment protocol: IUI to be performed in three natural ovulatory cycles in all patients, then in three clomiphene citrate stimulated cycles in the remaining non-pregnant patients, and then three cycles with controlled ovarian hyperstimulation in the remaining group. Of the total 147 patients 130, 138 and 123 underwent 273 natural, 278 Clomid and 266 controlled ovarian hyperstimulation IUI cycles, respectively. Unexplained infertility cases had a significantly higher success rate (58.7%) when compared to that of male factor cases (22.8%). IUI still has a place in the treatment of infertility due to selective causes.
http://www.ncbi.nlm.nih.gov/pubmed/9987574
OBJECTIVE: To identify the predictors of pregnancy rate (success rate) among women undergoing intrauterine insemination (IUI) cycles. STUDY DESIGN: Two hundred thirty-two women undergoing 255 IUI cycles were evaluated. RESULTS: The overall success rate was 9.4%. The success rate was 7.9% in the primary infertility group, whereas the rate was 21.4% in the secondary infertility group. The success rate was 3.1% for 1 preovulatory follicle, 9.3% for 2 follicles, 16.9% for 3 and 23.1% for 4. The success rate increased in accordance with the total motile sperm count before sperm preparation; however, the success rate was significantly higher in sperm morphology of >4% (according to Kruger criteria) than in the < or = 4% group (6.7% vs. 22.2%). The number of preovulatory follicles and the percentage of normal sperm morphology in processed sperm had the maximum power to predict the success rate following IUI.
http://www.ncbi.nlm.nih.gov/pubmed/18472648
The objective of this cross-sectional study was to identify the prognostic factors that influence the outcome of ovarian stimulation with intrauterine insemination (IUI) cycles using gonadotrophins in couples with unexplained and mild male-factor subfertility. Of 838 cycles in 456 women, 139 resulted in pregnancy (16.6% per cycle). Multivariate logistic regression analysis demonstrated that duration of infertility, type of infertility, aetiology of infertility, number of treatment cycles and number of dominant follicles before human chorionic gonadotrophin (HCG) were significant independent factors to predict clinical pregnancy. The duration of infertility, number of treatment cycles and number of dominant follicles before HCG were significant independent factors to predict live birth. In conclusion, for subfertile couples having shorter duration of subfertility, multifollicular response to gonadotrophins and in their first treatment cycle are more likely to succeed a live birth with IUI treatment using recombinant gonadotrophins.
http://www.ncbi.nlm.nih.gov/pubmed/18681993
PURPOSE: The aim was to determine success rate following intrauterine insemination (IUI) and its associated factors. METHODS: A retrospective analysis of 350 IUI cycles with ovarian stimulation by clomiphene citrate (Clomid) and/or gonadotropins was performed. RESULTS: The overall success rate was 22% (77/350). Of the 77 pregnancies, 88.3% resulted in live birth, 7.8% in spontaneous abortion, 2.6% in blighted ovum and 1.3% were ectopic. Logistic regression analysis revealed three predictive variables as regards pregnancy: number of the treatment cycle, duration of infertility, and age. Success rate did not have any independent relation to sperm count, type of infertility, number and size of follicle and side of ovulatory ovary. CONCLUSION: Our results indicate that Clomid and/or gonadotropins IUI is a convenient and useful treatment option in women with younger age ( <30 years) and fewer treatment cycles and fewer infertility duration (4 years).
http://www.ncbi.nlm.nih.gov/pubmed/19030984
Controlled ovarian stimulation with intrauterine insemination (IUI) is a common treatment in couples with unexplained infertility. Induction of multifollicular growth is considered to improve pregnancy outcome, but it contains an increased risk of multiple pregnancies and ovarian hyperstimulation syndrome. In this study the impact of the number of follicles (>14 mm) on the ongoing pregnancy rate and multiple pregnancy rate was evaluated in the first four treatment cycles. RESULTS: Three hundred couples were included. No significant difference was found in ongoing pregnancy rate between women with one, two, three or four follicles respectively, but in women with two or more follicles 12/73 (16%) pregnancies were multiples. Ongoing pregnancy rate was highest in the first treatment cycle and declined significantly with increasing cycle order, while multiple pregnancy rate did not change. CONCLUSIONS: In controlled ovarian stimulation IUI for unexplained non-conception, induction of more than one follicle did not improve the ongoing pregnancy rate, but increased the risk of multiple pregnancies.
http://www.ncbi.nlm.nih.gov/pubmed/16253970
High-order multiple pregnancy (three or more) was related to number of follicles of diameter > or = 10 mm, age, and treatment cycle. For age <32 years, HOMP was 6% for three to six follicles and 20% for seven or more follicles. For ages 32 to 37 years, HOMP was 5% for three to six follicles and 12% for seven or more follicles. In the first COH-IUI cycle, HOMP was 8% for three to six follicles and 15% for seven or more follicles. In the second cycle, HOMP did not occur unless there were more than six follicles. No HOMP occurred after the second cycle. Pregnancy rate did not increase significantly when there were more than four follicles. Continuing COH-IUI past the third cycle resulted in additional pregnancies in patients with one to eight follicles.
http://www.ncbi.nlm.nih.gov/pubmed/15749497
The overall pregnancy rate was 15%. Mean endometrial thickness on the day of hCG administration was significantly greater in cycles where pregnancy was achieved (10.1 vs. 7.7). In the multivariate analysis, the strongest predictor of IUI success was the number of IUI cycles. The woman's age was negatively associated with pregnancy outcome, while endometrial thickness and the total motile sperm count were positively associated with pregnancy outcome. CONCLUSION(S): The results of the present study suggest that clinicians providing IUI for infertile couples must pay close attention to endometrial development as well as to follicle growth and sperm motility.
http://www.ncbi.nlm.nih.gov/pubmed/17434500
We retrospectively analyzed 6,360 artificial insemination cycles of husband's semen through intrauterine insemination (IUI) or artificial insemination with donor semen through IUI in patients with infertility. The relationship between processed total motile sperm count and pregnancy outcome was determined. The study was divided into 6 groups according to processed total motile sperm count. Group 1: ≤ 2.0 million, Group 2: 2.1-4.0 million, Group 3: 4.1-6.0 million, Group 4: 6.1-8.0 million, Group 5: 8.1-10.0 million, and Group 6: >10.0 million. The total clinical pregnancy rate of husband's semen IUI was 10.81 % and donor semen IUI was 27.52 %. Among the 6 groups, the clinical pregnancy rate was the lowest in <2.0 million. With the increased processed total motile sperm count, the clinical pregnancy rate of IUI was improved. However, a statistical difference between groups was only observed for Group 1. When processed total motile sperm is ≤ 2 million the clinical pregnancy rate of IUI is significantly decreased. In this case in vitro fertilization (IVF) should be adopted.
http://www.ncbi.nlm.nih.gov/pubmed/21864206
PURPOSE: The aim was to determine pregnancy rate and its associated factors in Intrauterine Insemination (IUI) at IIUM Fertility Centre. METHODS: A retrospective analysis of 504 IUI cycles was conducted on all available records of infertile couples who had undergone IUI treatment at IIUM Fertility Centre between 2004 until 2008. RESULTS: The overall clinical pregnancy rate was 14.5%. Among 73 pregnancies, 44 cases were live births (60%), 23 cases were miscarriages (32%) and 6 were ectopic pregnancies (8%). Analysis from logistic regression revealed two predictive variables which influence the pregnancy; female age and male sperm count. Pregnancy wasn't related to the etiology of infertility, duration and type of infertility, cycle number of IUI, ovarian stimulation protocol and the number of dominant follicle. CONCLUSION: IUI remain as a convenient and useful treatment option in women of younger age (< 30 years) and male with higher sperm count (> or =100 million per ml).
http://www.ncbi.nlm.nih.gov/pubmed/22111439
BACKGROUND: The aim of this study was to determine the prognostic value of normal sperm morphology using MSOME with regard to clinical pregnancy after intrauterine insemination (IUI). METHODS: Each subject received 75 IU of recombinant FSH every second day from the third day of the cycle. When one or two follicles measuring at least 17 mm were observed, recombinant hCG was administered, and IUI was performed 12-14 h and 36-40 h after hCG treatment. RESULTS: Pregnancy occurred in 34 IUI cycles (clinical pregnancy rate per cycle: 21.8%, per patient: 30.6%). Based on the MSOME criteria, a significantly higher percentage of normal spermatozoa was found in the group of men in which the IUI cycles resulted in pregnancy (2.6%) compared to the group that did not achieve pregnancy (1.2%).
http://www.ncbi.nlm.nih.gov/pubmed/21861903
The aim of the presented study is to determine the effect of different sperm parameters on the pregnancy rate of intrauterine insemination (IUI) cycles in women with favorable fertility characteristics treated for infertility. Inclusion criteria for women were age <35 years, antral follicle count >5, FSH <15 IU/ml, and at least one patent tube documented by HSG or laparoscopy. Clinical pregnancy rates were achieved as 15.8% per cycle, and 18.8% per couple. Woman's age, partner's age, total number of motile sperm and motility, significantly influenced pregnancy rate. Partner's age significantly affected the pregnancy rate per cycle in women aged <30 years and total number of motile sperm >10 million. Pregnancy rate was the highest in IUI cycles when woman was <25 years old, total number of motile sperm was >10 million, and morphology was >4%.
http://www.ncbi.nlm.nih.gov/pubmed/21627427
OBJECTIVE: To determine the predictive factors for pregnancy after controlled ovarian hyperstimulation / intrauterine insemination (IUI). INTERVENTIONS: Ovarian stimulation with gonadotrophins was initiated and a single IUI was performed 36 h after triggering ovulation. MEASURES: Predictive factors evaluated were female age, duration of infertility, indication for IUI, number of preovulatory follicles, luteinizing hormone level on day of trigger and postwash total motile fraction. RESULTS: The overall clinical pregnancy rate and live birth rate were 8.75% and 5.83%, respectively. Among the predictive factors evaluated, the duration of infertility (5.36 vs. 6.71 years) and the postwash total motile fraction (10 vs 20 million) significantly influenced the clinical pregnancy rate. CONCLUSION: Our results indicate that controlled ovarian hyperstimulation / IUI is not an effective option in couples with infertility due to a male factor. Prolonged duration of infertility is also associated with decreased success, and should be considered when planning treatment.