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Radaelli MRM, Mingetti-Câmara VC, Nalano R, Ceschin NI, Cerialle PMA, Almodin CG. Timed intercourse in association with controlled ovarian hyperstimulation as the first-line treatment of couples with unexplained subfertility. JBRA Assist Reprod 2022; 26:612-619. [PMID: 35621275 PMCID: PMC9635603 DOI: 10.5935/1518-0557.20220001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To report on the pregnancy outcomes of timed intercourse (TI) with controlled ovarian hyperstimulation (COH) as the first-line treatment of unexplained subfertility, and provide some evidence on the factors involved. METHODS The records of couples treated between January 2016 and March 2019 were retrospectively analyzed. Couples were selected for TI based on standard infertility evaluation. Semen analysis by swim-up was conducted and the total motile sperm count (TMSC) obtained. The main outcome measured was the clinical pregnancy rates. Data were analyzed with t test, Pearson's Chi-squared test, and the Wald test for logistic regression with p≤0.05. RESULTS The records of 275 couples (449 cycles) were included in the analysis. Patients underwent TI up to six attempts. Patient- and cycle-based pregnancy rates were 18.55% and 13.14%, respectively. Eight patients got pregnant twice, resulting in a cumulative pregnancy rate of 21.4%. Women that did not get pregnant demonstrated a statistically higher mean age value than women who did (p=0.0186). Logistic regression indicated that for every year added to the woman's age, the chances of pregnancy reduced by 6.45%, and for cycles with TMSC ≥ 5 million, the chances of pregnancy were 1.91 times higher when compared to TMSC < 5 million. CONCLUSIONS TI with COH should be considered as the first-line treatment for selected couples with unexplained subfertility before more traumatic and costly IVF treatments were considered. The findings can assist doctors to conduct a more educated counselling concerning the chances patients have to get pregnant with TI.
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Affiliation(s)
- Moacir Rafael Martins Radaelli
- Materbaby Reprodução Humana e Genética,
Maringá, Brazil , Departamento de Urologia, Faculdade de Medicina Ingá,
UNINGÁ, Maringá, Brazil ,Corresponding author: Moacir Rafael Martins Radaelli,
Materbaby Reprodução Humana e Genética.
Departamento de Urologia, Faculdade de Medicina Ingá,
UNINGÁ. Maringá, PR, Brazil. E-mail:
| | | | - Raul Nalano
- Clínica de Reprodução Humana FERTICLIN,
São Paulo, Brazil
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Zarinara A, Kamali K, Akhondi MM. Estimation Methods for Infertility Treatment Success: Comparison of Four Methods. J Family Reprod Health 2021; 15:179-185. [PMID: 34721609 PMCID: PMC8536827 DOI: 10.18502/jfrh.v15i3.7136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To analyze and compare four methods for estimating the chance of treatment success in infertile couples. Materials and methods: In a retrospective cohort study, information on demographic and clinical features, including age, body mass index (BMI), duration of infertility, semen analysis, previous history of treatment and clinical examination of infertile couples were analyzed. Treatment success (childbearing) was calculated with four methods as live birth ratio, conditional probability and survival analysis (life table and Kaplan-Meyer method) and results are compared. Results: The fertility ratio for the first treatment cycle was 29.72% which decreased to 23.13% by total treatment cycles. The success rate was 75.4%. With conditional probability calculation at the end of the five treatment cycles. With the life table method in a five-year period, the probability for live birth was 78% and by Kaplan-Meyer method 73.1% and the median of treatment time was 562 days. Conclusion: Calculation of infertility treatment success rate by only simple live birth ratio of childbearing couples is associated with underestimation. Using the conditional probability method reduces that underestimation, but it is not considered the censored cases in the treatments. It seems life table (as a proxy of survival analysis) presents the closest estimation to clinical facts with considering the repetition of the treatment cycle and the duration of treatment.
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Affiliation(s)
- Alireza Zarinara
- Reproductive Biotechnology Research Centre, Avicenna Research Institute, Tehran, Iran
| | - Koorosh Kamali
- Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
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Stein A, Altman E, Rotlevi M, Deutsch A, Ben-Haroush A, Wertheimer A, Eizenhamer Y, Schohat T, Shufaro Y. Does the time interval from the end of sperm processing to intrauterine insemination (lab-to-uterus time) affect treatment outcome? Andrology 2021; 9:1859-1863. [PMID: 34245222 DOI: 10.1111/andr.13079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/17/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Intra-uterine insemination is an essential component in the treatment of infertility. Success rates are dependent on clinical factors of the female partner, sperm quality, and preparation technique. The effect of the time interval between the end of sperm preparation in the lab, and its injection into the uterine cavity (lab-to-uterus time) is yet to be determined. AIM To investigate the association between the lab-to-uterus time and the pregnancy rate. MATERIALS AND METHODS Partner and donor spermatozoa intra-uterine insemination cycles were included. Preparation for intra-uterine insemination of partners' fresh ejaculate or donor thawed spermatozoa was identical. The time interval from the completion of this stage to the actual intra-uterine injection was recorded. The lab-to-uterus intervals were divided into groups A (0-29 min), B (30-59 min), C (60-89 min), and D (90-180 min). Pregnancy was defined as two adequate consecutive doubling levels of hCG and the pregnancy rates were compared between the groups. RESULTS A total of 267 female patients (138 partner spermatozoa, 129 donors) who had 470 intra-uterine insemination cycles (218 partner spermatozoa, 252 donors) were included. No significant differences in pregnancy rates per treatment cycle were found between the four lab-to-uterus interval groups: A (n = 96 cycles; 16.7%), B (n = 217; 19.4%), C (n = 121; 16.5%), and D (n = 36; 36.1%). No difference was found in the pregnancy rates between partner and donor spermatozoa. In the case of fresh partner spermatozoa, the pregnancy rates for groups were as follows: A (n = 40 cycles, 20%); B (n = 94; 14.9%), C (n = 70; 17.1%), and D (n = 14; 35.7%) (NS). In the case of thawed donor spermatozoa, the pregnancy rates (per cycle) for groups were as follows: A (n = 56; 14.3%), B (n = 123; 22.8%), C (n = 51; 15.7%), and D (n = 22; 36.4)% (NS). CONCLUSIONS The intra-uterine insemination outcome was not affected by the lab-to-uterus time interval. Extended waiting up to 3 h for insemination did not have any detrimental effect on pregnancy rates, regardless if partner or donor spermatozoa was used.
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Affiliation(s)
- Anat Stein
- Andrology and Sperm Bank Service, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Eran Altman
- Andrology and Sperm Bank Service, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mali Rotlevi
- Andrology and Sperm Bank Service, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Avigail Deutsch
- Andrology and Sperm Bank Service, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Avi Ben-Haroush
- Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avital Wertheimer
- Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Eizenhamer
- Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Tzippy Schohat
- Research Authority, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Yoel Shufaro
- Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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4
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Onofre J, Geenen L, Cox A, Van Der Auwera I, Willendrup F, Andersen E, Campo R, Dhont N, Ombelet W. Simplified sperm testing devices: a possible tool to overcome lack of accessibility and inconsistency in male factor infertility diagnosis. An opportunity for low- and middle- income countries. Facts Views Vis Obgyn 2021; 13:79-93. [PMID: 33889864 PMCID: PMC8051200 DOI: 10.52054/fvvo.13.1.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Manual semen assessment (MSA) is a key component in a male’s fertility assessment. Clinicians rely on it to make diagnostic and treatment decisions. When performed manually, this routine laboratory test is prone to variability due to human intervention which can lead to misdiagnosis and consequently over- or under- treatment. For standardisation, continuous training, quality control (QC) programs and pricy Computer-Assisted Sperm Analysis (CASA) systems have been proposed, yet, without resolving intra- and inter-laboratory variability. In response, promising simplified sperm testing devices, able to provide cost-effective point-of-care male infertility diagnosis are prospected as a plausible solution to resolve variability and increase access to sperm testing. Materials and methods A throughout literature research for semen testing, sperm analysis, smart-phone assisted semen analysis, ‘at-home’ semen testing, male infertility, infertility in developing countries, infertility in low- and middle-income countries (LMIC) and quantitative sperm analysis was performed. A total of 14 articles, specific to ‘at-home’ simplified sperm assessment, were included to treat the core subject. Results Continuous training and consistent QC, are sine qua none conditions to achieve accurate and comparable MSA. Compliance does not rule-out variability, nevertheless. Emerging simplified sperm assessment devices are an actual alternative to resolve the lack of standardisation and accessibility to sperm analysis. YO ® , SEEM ® , and ExSeed ® are commercially available, user-friendly smartphone-based devices which can accurately measure volume, sperm concentration (millions/ml) and total motile sperm count. More broadly, by cost-effectiveness, availability, accuracy and convenient application, these devices could effectively select patients for first-line artificial reproduction treatments such as intrauterine insemination. Conclusions Accuracy and cost-effectiveness make smart-phone based sperm testing devices a practical and realistic solution to overcome variability in MSA. Importantly, these tools represent an actual opportunity to standardise and improve male subfertility diagnosis and treatment, especially in LMIC. However, before clinical application is possible, guidelines, further testing with special attention on accuracy in washed sperm, availability, cost-benefit and reliability are required.
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Affiliation(s)
- J Onofre
- Genk Institute for Fertility Technology, Genk, Belgium.,Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | - L Geenen
- University of Hasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - A Cox
- Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | - I Van Der Auwera
- Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | | | | | - R Campo
- Genk Institute for Fertility Technology, Genk, Belgium.,Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | - N Dhont
- Genk Institute for Fertility Technology, Genk, Belgium.,Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | - W Ombelet
- Genk Institute for Fertility Technology, Genk, Belgium.,Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
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Depuydt C, Donders G, Verstraete L, Beert J, Salembier G, Bosmans E, Dhont N, Kerkhofs C, Ombelet W. Negative Impact of Elevated DNA Fragmentation and Human Papillomavirus (HPV) Presence in Sperm on the Outcome of Intra-Uterine Insemination (IUI). J Clin Med 2021; 10:jcm10040717. [PMID: 33670283 PMCID: PMC7917808 DOI: 10.3390/jcm10040717] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 01/04/2023] Open
Abstract
We wanted to determine the sperm DNA fragmentation index (DFI) cutoff for clinical pregnancies in women receiving intra-uterine insemination (IUI) with this sperm and to assess the contribution of Human Papillomavirus (HPV) infection on sperm DNA damage and its impact on clinical pregnancies. Prospective non-interventional multi-center study with 161 infertile couples going through 209 cycles of IUI in hospital fertility centers in Flanders, Belgium. Measurement of DFI and HPV DNA with type specific quantitative PCRs (HPV 6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66 and 68) in sperm before its use in IUI. Clinical pregnancy (CP) rate was used as the outcome to analyze the impact on fertility outcome and to calculated the clinical cutoff value for DFI. A DFI criterion value of 26% was obtained by receiver operating characteristic (ROC) curve analysis. Couples with a male DFI > 26% had significantly less CPs than couples with DFI below 26% (OR 0.0326; 95% CI 0.0019 to 0.5400; p = 0.017). In sperm, HPV prevalence was 14.8%/IUI cycle. Sperm samples containing HPV had a significantly higher DFI compared to HPV negative sperm samples (29.8% vs. 20.9%; p = 0.011). When HPV-virions were present in sperm, no clinical pregnancies were observed. More than 1 in 5 of samples with normal semen parameters (17/78; 21.8%) had an elevated DFI or was HPV positive. Sperm DFI is a robust predictor of clinical pregnancies in women receiving IUI with this sperm. When DFI exceeds 26%, clinical pregnancies are less likely and in vitro fertilization techniques should be considered.
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Affiliation(s)
- Christophe Depuydt
- Department of Hormonology and Reproductive Health, AML, Sonic Healthcare, 2020 Antwerp, Belgium; (C.D.); (L.V.); (J.B.); (E.B.)
- Intermediate Structure for Human Body Material, AML, Sonic Healthcare, 2020 Antwerp, Belgium
| | - Gilbert Donders
- Femicare, Clinical Research for Women, 3300 Tienen, Belgium
- University Hospital Antwerpen, 2650 Antwerp, Belgium
- Department of Obstetrics and Gynecology, Regional Hospital Heilig Hart, 3300 Tienen, Belgium
- Correspondence: or ; Tel.: +32-16-808102
| | - Ludo Verstraete
- Department of Hormonology and Reproductive Health, AML, Sonic Healthcare, 2020 Antwerp, Belgium; (C.D.); (L.V.); (J.B.); (E.B.)
- Intermediate Structure for Human Body Material, AML, Sonic Healthcare, 2020 Antwerp, Belgium
| | - Johan Beert
- Department of Hormonology and Reproductive Health, AML, Sonic Healthcare, 2020 Antwerp, Belgium; (C.D.); (L.V.); (J.B.); (E.B.)
- Intermediate Structure for Human Body Material, AML, Sonic Healthcare, 2020 Antwerp, Belgium
- Department of Clinical and Molecular Pathology, AML, Sonic Healthcare, 2020 Antwerp, Belgium;
| | - Geert Salembier
- Department of Clinical and Molecular Pathology, AML, Sonic Healthcare, 2020 Antwerp, Belgium;
| | - Eugene Bosmans
- Department of Hormonology and Reproductive Health, AML, Sonic Healthcare, 2020 Antwerp, Belgium; (C.D.); (L.V.); (J.B.); (E.B.)
- Intermediate Structure for Human Body Material, AML, Sonic Healthcare, 2020 Antwerp, Belgium
| | - Nathalie Dhont
- Genk Institute for Fertility Technology, ZOL Hospitals, 3600 Genk, Belgium; (N.D.); (C.K.); (W.O.)
| | - Carmen Kerkhofs
- Genk Institute for Fertility Technology, ZOL Hospitals, 3600 Genk, Belgium; (N.D.); (C.K.); (W.O.)
| | - Willem Ombelet
- Genk Institute for Fertility Technology, ZOL Hospitals, 3600 Genk, Belgium; (N.D.); (C.K.); (W.O.)
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
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Punjabi U, Van Mulders H, Van de Velde L, Goovaerts I, Peeters K, Cassauwers W, Lyubetska T, Clasen K, Janssens P, Zemtsova O, Roelant E, De Neubourg D. Time intervals between semen production, initiation of analysis, and IUI significantly influence clinical pregnancies and live births. J Assist Reprod Genet 2021; 38:421-428. [PMID: 33403503 PMCID: PMC7884513 DOI: 10.1007/s10815-020-02020-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/23/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Does IDEF mapping help monitor the technical process of IUI and explore the potential improvements which might contribute to increased pregnancy and live birth rates? METHOD Retrospective analysis of 1729 homologous IUI cycles of couples attending a fertility clinic in a university hospital setting. Standardized conventional semen parameters were analyzed and the semen samples prepared via discontinuous density gradient centrifugation. RESULTS There was no significant association between sperm concentration, motility and morphology (analysis phase), and pregnancy outcome. Only female and male ages were significantly associated with the pregnancy outcome. There was a significant difference in the odds on clinical pregnancies and live births when analysis was ≤ 21 min initiated, and < 107 min between sample production and IUI, adjusted for male and female age. CONCLUSIONS Adjusting for the couple's age, we could show that time intervals between semen production and analysis and IUI when kept low significantly influenced clinical pregnancies and live births.
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Affiliation(s)
- U Punjabi
- Centre for Reproductive Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium.
- Department of Reproductive Medicine, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium.
| | - H Van Mulders
- Centre for Reproductive Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - L Van de Velde
- Centre for Reproductive Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - I Goovaerts
- Centre for Reproductive Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - K Peeters
- Centre for Reproductive Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
- Department of Reproductive Medicine, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - W Cassauwers
- Centre for Reproductive Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - T Lyubetska
- Centre for Reproductive Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - K Clasen
- Centre for Reproductive Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - P Janssens
- Centre for Reproductive Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - O Zemtsova
- Centre for Reproductive Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - E Roelant
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - D De Neubourg
- Centre for Reproductive Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
- Department of Reproductive Medicine, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
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8
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Starosta A, Gordon CE, Hornstein MD. Predictive factors for intrauterine insemination outcomes: a review. FERTILITY RESEARCH AND PRACTICE 2020; 6:23. [PMID: 33308319 PMCID: PMC7731622 DOI: 10.1186/s40738-020-00092-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/06/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Intrauterine insemination (IUI) is a frequently utilized method of assisted reproduction for patients with mild male factor infertility, anovulation, endometriosis, and unexplained infertility. The purpose of this review is to discuss factors that affect IUI outcomes, including infertility diagnosis, semen parameters, and stimulation regimens. METHODS We reviewed the published literature to evaluate how patient and cycle specific factors affect IUI outcomes, specifically clinical pregnancy rate, live birth rate, spontaneous abortion rate and multiple pregnancy rate. RESULTS Most data support IUI for men with a total motile count > 5 million and post-wash sperm count > 1 million. High sperm DNA fragmentation does not consistently affect pregnancy rates in IUI cycles. Advancing maternal and paternal age negatively impact pregnancy rates. Paternal obesity contributes to infertility while elevated maternal BMI increases medication requirements without impacting pregnancy outcomes. For ovulation induction, letrozole and clomiphene citrate result in similar pregnancy outcomes and are recommended over gonadotropins given increased risk for multiple pregnancies with gonadotropins. Letrozole is preferred for obese women with polycystic ovary syndrome. IUI is most effective for women with ovulatory dysfunction and unexplained infertility, and least effective for women with tubal factor and stage III-IV endometriosis. Outcomes are similar when IUI is performed with ovulation trigger or spontaneous ovulatory surge, and ovulation may be monitored by urine or serum. Most pregnancies occur within the first four IUI cycles, after which in vitro fertilization should be considered. CONCLUSIONS Providers recommending IUI for treatment of infertility should take into account all of these factors when evaluating patients and making treatment recommendations.
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Affiliation(s)
- Anabel Starosta
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Massachusetts, Boston, USA.
| | - Catherine E Gordon
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Massachusetts, Boston, USA
| | - Mark D Hornstein
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Massachusetts, Boston, USA
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Farber NJ, Flannigan R, Srivastava A, Wang H, Goldstein M. Vasovasostomy: kinetics and predictors of patency. Fertil Steril 2020; 113:774-780.e3. [PMID: 32228879 DOI: 10.1016/j.fertnstert.2019.11.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the timing of patency and late failure (secondary azoospermia) after vasovasostomy (VV) using standardized kinetics definitions. DESIGN Retrospective cohort study. SETTING University-affiliated hospital. PATIENT(S) Patients with obstructive azoospermia. INTERVENTION(S) Vasovasostomy. MAIN OUTCOME MEASURE(S) Univariate and multivariate logistic regression assessed predictors of patency and late failure. Patency was defined as any sperm return to the ejaculate; and >2 million total motile sperm (TMS) in ejaculate. Late failure after VV was defined as azoospermia; or <2 million TMS in ejaculate. RESULT(S) 429 men underwent VV, with median follow up of 242 days. Mean time to patency was 3.25 months versus 5.29 months in the "any sperm" versus ">2 million TMS" groups. Finding sperm intraoperatively during VV significantly improved patency rates in multivariable analysis (odds ratio [OR] 4.22). This association was further boosted when sperm was found bilaterally (OR 6.70). Late failure rate (azoospermia) was 10.6% at mean time of 14.1 months and 23% for <2 million, at mean time of 15.7 months. When assessing predictors of late failure, intraoperative motile sperm bilaterally was a statistically significant protective factor on multivariate analysis (hazard ratio 0.22). CONCLUSION(S) Vasovasostomy remains highly efficacious in treating obstructive azoospermia. Young patients, shorter obstructive intervals, and sperm identified intraoperatively predict improved outcomes. Clinicians can expect VV patency in 3 months and late failure within the first 2 years after surgery. However, patency rates, late failure rates, and kinetics vary by definition.
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Affiliation(s)
- Nicholas J Farber
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Ryan Flannigan
- Center for Male Reproductive Medicine and Microsurgery, Cornell Institute for Reproductive Medicine, Department of Urology, Weill Cornell Medicine, New York, New York
| | - Arnav Srivastava
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Hanhan Wang
- Center for Male Reproductive Medicine and Microsurgery, Cornell Institute for Reproductive Medicine, Department of Urology, Weill Cornell Medicine, New York, New York
| | - Marc Goldstein
- Center for Male Reproductive Medicine and Microsurgery, Cornell Institute for Reproductive Medicine, Department of Urology, Weill Cornell Medicine, New York, New York.
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Depuydt CE, Donders GGG, Verstraete L, Vanden Broeck D, Beert JFA, Salembier G, Bosmans E, Ombelet W. Infectious human papillomavirus virions in semen reduce clinical pregnancy rates in women undergoing intrauterine insemination. Fertil Steril 2019; 111:1135-1144. [DOI: 10.1016/j.fertnstert.2019.02.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/25/2019] [Accepted: 02/01/2019] [Indexed: 01/12/2023]
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11
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Oehninger S, Ombelet W. Limits of current male fertility testing. Fertil Steril 2019; 111:835-841. [DOI: 10.1016/j.fertnstert.2019.03.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 12/23/2022]
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12
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Kohn TP, Kohn JR, Ramasamy R. Effect of Sperm Morphology on Pregnancy Success via Intrauterine Insemination: A Systematic Review and Meta-Analysis. J Urol 2017; 199:812-822. [PMID: 29129781 DOI: 10.1016/j.juro.2017.11.045] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Men with abnormal sperm morphology are often counseled that natural conception and intrauterine insemination are ineffective, and in vitro fertilization is the only option. Our objective was to determine the effect of sperm morphology on the pregnancy success of intrauterine insemination. MATERIALS AND METHODS We systematically searched for studies published prior to January 2017 that 1) reported ultrasound verified clinical pregnancies per intrauterine insemination cycle, 2) assessed sperm morphology using the Kruger strict criteria and 3) described morphology at the greater than 4% and 4% or less and/or the 1% or greater and less than 1% thresholds. In all studies mean female age was between 25 and 40 years and mean total motile sperm count was greater than 10 million. Estimates were pooled using random effects meta-analysis. RESULTS Data were extracted from 20 observational studies involving a total of 41,018 cycles. When comparing men at the greater than 4% and 4% or less thresholds, the rate of ultrasound verified pregnancy per intrauterine insemination cycle was not statistically or clinically different (14.2% vs 12.1%, p = 0.06) and the risk difference was 3.0% (95% CI 1.4-4.6), indicating 3.0 additional pregnancies per 100 intrauterine insemination cycles. When comparing men at the 1% or greater and the less than 1% thresholds, there were no statistical or clinical differences in the rate of ultrasound verified pregnancy per cycle of intrauterine insemination (14.0% vs 13.9%, p = 0.97) or in the risk difference (1.6%, 95% CI -4.5-7.6). CONCLUSIONS There appears to be no clinical difference in intrauterine insemination pregnancy success among men with normal and abnormal sperm morphology when accounting for total motile sperm count and female age. Abnormal sperm morphology alone should not exclude couples from attempting intrauterine insemination.
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Affiliation(s)
- Taylor P Kohn
- Baylor College of Medicine, Houston, Texas; Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Jaden R Kohn
- Baylor College of Medicine, Houston, Texas; Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Ranjith Ramasamy
- Baylor College of Medicine, Houston, Texas; Department of Urology, University of Miami Miller School of Medicine, Miami, Florida.
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13
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Gatimel N, Moreau J, Parinaud J, Léandri RD. Sperm morphology: assessment, pathophysiology, clinical relevance, and state of the art in 2017. Andrology 2017; 5:845-862. [DOI: 10.1111/andr.12389] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/05/2017] [Accepted: 05/11/2017] [Indexed: 12/26/2022]
Affiliation(s)
- N. Gatimel
- Department of Reproductive Medicine; Paule de Viguier Hospital; Toulouse University Hospital; Toulouse France
- EA 3694 Human Fertility Research Group; Paule de Viguier Hospital; Toulouse University Hospital; Toulouse France
| | - J. Moreau
- Department of Reproductive Medicine; Paule de Viguier Hospital; Toulouse University Hospital; Toulouse France
- EA 3694 Human Fertility Research Group; Paule de Viguier Hospital; Toulouse University Hospital; Toulouse France
| | - J. Parinaud
- Department of Reproductive Medicine; Paule de Viguier Hospital; Toulouse University Hospital; Toulouse France
- EA 3694 Human Fertility Research Group; Paule de Viguier Hospital; Toulouse University Hospital; Toulouse France
| | - R. D. Léandri
- Department of Reproductive Medicine; Paule de Viguier Hospital; Toulouse University Hospital; Toulouse France
- EA 3694 Human Fertility Research Group; Paule de Viguier Hospital; Toulouse University Hospital; Toulouse France
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14
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Thijssen A, Creemers A, Van der Elst W, Creemers E, Vandormael E, Dhont N, Ombelet W. Predictive value of different covariates influencing pregnancy rate following intrauterine insemination with homologous semen: a prospective cohort study. Reprod Biomed Online 2017; 34:463-472. [DOI: 10.1016/j.rbmo.2017.01.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 01/27/2017] [Accepted: 01/27/2017] [Indexed: 10/20/2022]
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15
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Abstract
The evaluation of strict morphology for predicting successful pregnancy has been controversial, nevertheless remains an essential component of semen analysis. Patients with teratozoospermia (abnormal strict morphology) have traditionally been counseled to undergo assisted reproduction. However, recent studies suggest that patients with abnormal sperm morphology alone should not be precluded from attempting natural conception before undergoing assisted reproduction. The goal of this review is to provide an update on the evaluation of sperm morphology for prognosis in assisted reproductive techniques such as intrauterine insemination and in vitro fertilization with or without intracytoplasmic sperm injection. Additionally, we propose a logical approach to the evaluation of a patient with teratozoospermia seeking fertility treatment.
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16
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Lemmens L, Kos S, Beijer C, Brinkman JW, van der Horst FA, van den Hoven L, Kieslinger DC, van Trooyen-van Vrouwerff NJ, Wolthuis A, Hendriks JC, Wetzels AM, Kos S, Beijer C, Brinkman JW, van der Horst FA, van den Hoven L, Kieslinger DC, van Trooyen-van Vrouwerff NJ, Wolthuis A, Wetzels AM. Predictive value of sperm morphology and progressively motile sperm count for pregnancy outcomes in intrauterine insemination. Fertil Steril 2016; 105:1462-8. [DOI: 10.1016/j.fertnstert.2016.02.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/14/2016] [Accepted: 02/03/2016] [Indexed: 11/30/2022]
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17
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The impact of sperm morphology on the outcome of intrauterine insemination cycles with gonadotropins in unexplained and male subfertility. Eur J Obstet Gynecol Reprod Biol 2016; 197:120-4. [DOI: 10.1016/j.ejogrb.2015.12.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/03/2015] [Accepted: 12/10/2015] [Indexed: 11/22/2022]
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18
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Lockwood GM, Deveneau NE, Shridharani AN, Strawn EY, Sandlow JI. Isolated abnormal strict morphology is not a contraindication for intrauterine insemination. Andrology 2015; 3:1088-93. [PMID: 26384603 DOI: 10.1111/andr.12098] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 07/16/2015] [Accepted: 07/23/2015] [Indexed: 11/28/2022]
Abstract
This study sought to investigate whether isolated abnormal strict morphology (<5% normal forms) and very low strict morphology (0-1% normal forms) affects pregnancy rates in intrauterine insemination (IUI). This was a retrospective study performed at an Academic Medical Center/Reproductive Medicine Center. Four hundred and eight couples were included for 856 IUI cycles. 70 IUI cycles were performed in couples with abnormal strict morphology and otherwise normal semen parameters. Outcomes were measured as clinical pregnancy rate per IUI cycle as documented by fetal heart activity on maternal ultrasound. Clinical pregnancy rate did not significantly differ between the group with abnormal strict morphology [11/70 (15.7%)] and the normal morphology group [39/281 (13.9%)]. Additionally, there was no significant difference between the pregnancy rate in the abnormal morphology group compared to that of our overall institutional IUI pregnancy rate [145/856 (16.9%)]. Furthermore, there was no significant difference between pregnancy rate in the very low morphology group [3/14 (21.4%)] compared to those with normal morphology or the overall IUI pregnancy rate. Patients with isolated abnormal strict morphology have clinical pregnancy rates similar to those with normal morphology for IUI. Even in those with very low normal forms, consideration of IUI for assisted reproduction should not be excluded.
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Affiliation(s)
- G M Lockwood
- Department of Urology, Froedtert Hospital, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI, USA
| | - N E Deveneau
- Department of Obstetrics and Gynecology, Froedtert Hospital, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI, USA
| | - A N Shridharani
- Department of Urology, Froedtert Hospital, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI, USA
| | - E Y Strawn
- Department of Obstetrics and Gynecology, Froedtert Hospital, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI, USA
| | - J I Sandlow
- Department of Urology, Froedtert Hospital, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI, USA
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19
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Impact of sperm morphology on the likelihood of pregnancy after intrauterine insemination. Fertil Steril 2014; 102:1584-90.e2. [DOI: 10.1016/j.fertnstert.2014.09.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 09/11/2014] [Accepted: 09/11/2014] [Indexed: 11/22/2022]
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20
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Blasco V, Prados N, Carranza F, González-Ravina C, Pellicer A, Fernández-Sánchez M. Influence of follicle rupture and uterine contractions on intrauterine insemination outcome: a new predictive model. Fertil Steril 2014; 102:1034-40. [PMID: 25044083 DOI: 10.1016/j.fertnstert.2014.06.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 05/28/2014] [Accepted: 06/18/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To correlate the detection of follicle rupture and the number of uterine contractions per minute with the outcome of IUI and to build a predictive model for the outcome of IUI including these parameters. DESIGN Retrospective cohort study. SETTING Fertility clinic. PATIENT(S) We analyzed data from 610 women who underwent homologous or donor double IUI from 2005 to 2010 and whose data of uterine contractions or follicle rupture were recorded. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Live-birth rate. RESULT(S) Nine hundred seventy-nine IUI cycles were included. The detection of follicle rupture (odds ratio [OR], 1.98; 95% confidence interval [CI], 1.30-3.01) and the number of uterine contractions per minute (OR, 1.67; 95% CI, 1.02-2.74) assessed after the second insemination procedure of a double IUI were positively correlated with the live-birth rate. A multiple logistic regression model showed that sperm origin, maternal age, follicle count at hCG administration day, follicle rupture, and the number of uterine contractions observed after the second insemination procedure were significantly associated with the live-birth rate. CONCLUSION(S) Follicle rupture and uterine contractions are associated with the success of an IUI cycle. This may open new possibilities to improve the methodology of IUI.
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Affiliation(s)
| | - Nicolás Prados
- IVI Seville, Seville, Spain; Pablo de Olavide University, Seville, Spain
| | | | | | - Antonio Pellicer
- Instituto Valenciano de Infertilidad (IVI), Valencia, Spain; University of Valencia, Valencia, Spain
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21
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Slabbert M, du Plessis S, Huyser C. Large volume cryoprotectant-free vitrification: an alternative to conventional cryopreservation for human spermatozoa. Andrologia 2014; 47:594-9. [DOI: 10.1111/and.12307] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- M. Slabbert
- Department of Obstetrics and Gynaecology; University of Pretoria; Steve Biko Academic Hospital; Pretoria South Africa
| | - S.S. du Plessis
- Division of Medical Physiology; Department of Biomedical Sciences; Stellenbosch University; Cape Town South Africa
| | - C. Huyser
- Department of Obstetrics and Gynaecology; University of Pretoria; Steve Biko Academic Hospital; Pretoria South Africa
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22
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Kleppe M, van Hooff MH, Rhemrev JP. Effect of total motile sperm count in intra-uterine insemination on ongoing pregnancy rate. Andrologia 2014; 46:1183-8. [DOI: 10.1111/and.12212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- M. Kleppe
- Department of Obstetrics and Gynaecology; Maastricht University Medical Centre; Maastricht The Netherlands
- Department of Obstetrics and Gynaecology; Bronovo Hospital; Den Haag The Netherlands
| | - M. H. van Hooff
- Department of Obstetrics and Gynaecology; Sint Franciscus Gasthuis; Rotterdam The Netherlands
| | - J. P. Rhemrev
- Department of Obstetrics and Gynaecology; Bronovo Hospital; Den Haag The Netherlands
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23
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Semen quality and prediction of IUI success in male subfertility: a systematic review. Reprod Biomed Online 2013; 28:300-9. [PMID: 24456701 DOI: 10.1016/j.rbmo.2013.10.023] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 10/25/2013] [Accepted: 10/31/2013] [Indexed: 01/11/2023]
Abstract
Many variables may influence success rates after intrauterine insemination (IUI), including sperm quality in the native and washed semen sample. A literature search was performed to investigate the threshold levels of sperm parameters above which IUI pregnancy outcome is significantly improved and/or the cut-off values reaching substantial discriminative performance in an IUI programme. A search of MEDLINE, EMBASE and Cochrane Library revealed a total of 983 papers. Only 55 studies (5.6%) fulfilled the inclusion criteria and these papers were analysed. Sperm parameters most frequently examined were: (i) inseminating motile count after washing: cut-off value between 0.8 and 5 million; (ii) sperm morphology using strict criteria: cut-off value ⩾5% normal morphology; (iii) total motile sperm count in the native sperm sample: cut-off value of 5-10 million; and (iv) total motility in the native sperm sample: threshold value of 30%. The results indicate a lack of prospective studies, a lack of standardization in semen testing methodology and a huge heterogeneity of patient groups and IUI treatment strategies. More prospective cohort trials and prospective randomized trials investigating the predictive value of semen parameters on IUI outcome are urgently needed. It is generally believed that intrauterine insemination (IUI) with homologous semen should be a first-choice treatment to more invasive and expensive techniques of assisted reproduction in cases of cervical, unexplained and moderate male factor subfertility. The rationale for the use of artificial insemination is to increase gamete density at the site of fertilization. Scientific validation of this strategy is difficult because literature is rather confusing and inconclusive. Many variables may influence success rates after IUI treatment procedures. It seems logical that sperm quality has to be one of the main determinants to predict IUI success. Clinical practice would benefit from the establishment of threshold levels for sperm parameters above which IUI pregnancy outcome is significantly improved and below which a successful outcome is unlikely. We performed a literature search to investigate if such threshold levels are known. Most striking were the lack of standardization in semen-testing methodology and the huge heterogeneity of patient groups and IUI treatment strategies. The four sperm parameters most frequently examined were: (i) inseminating motile count after washing: cut-off value between 0.8 and 5 million; (ii) sperm morphology using strict criteria: cut-off value >4% normal morphology; (iii) total motile sperm count in native sperm sample: cut-off value of 5-10 million; and (iv) total motility in native sperm sample: threshold value of 30%. This review identified an urgent need for more and better prospective cohort trials investigating the predictive value of semen parameters on IUI pregnancy rate.
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24
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Ombelet W. Evidence-based recommendations for IUI in daily practice. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2013. [DOI: 10.1016/j.mefs.2013.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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25
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Cao S, Zhao C, Zhang J, Wu X, Zhou L, Guo X, Shen R, Ling X. A minimum number of motile spermatozoa are required for successful fertilisation through artificial intrauterine insemination with husband's spermatozoa. Andrologia 2013; 46:529-34. [PMID: 23701485 DOI: 10.1111/and.12109] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2013] [Indexed: 11/27/2022] Open
Affiliation(s)
- S. Cao
- State Key Laboratory of Reproductive Medicine; Department of Reproduction; Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University; Nanjing China
| | - C. Zhao
- State Key Laboratory of Reproductive Medicine; Department of Reproduction; Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University; Nanjing China
| | - J. Zhang
- State Key Laboratory of Reproductive Medicine; Department of Reproduction; Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University; Nanjing China
| | - X. Wu
- State Key Laboratory of Reproductive Medicine; Department of Reproduction; Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University; Nanjing China
| | - L. Zhou
- State Key Laboratory of Reproductive Medicine; Department of Reproduction; Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University; Nanjing China
| | - X. Guo
- State Key Laboratory of Reproductive Medicine; Department of Reproduction; Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University; Nanjing China
| | - R. Shen
- State Key Laboratory of Reproductive Medicine; Department of Reproduction; Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University; Nanjing China
| | - X. Ling
- State Key Laboratory of Reproductive Medicine; Department of Reproduction; Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University; Nanjing China
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26
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Sun Y, Li B, Fan LQ, Zhu WB, Chen XJ, Feng JH, Yang CL, Zhang YH. Does sperm morphology affect the outcome of intrauterine insemination in patients with normal sperm concentration and motility? Andrologia 2012; 44:299-304. [PMID: 22335521 DOI: 10.1111/j.1439-0272.2012.01280.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2011] [Indexed: 12/01/2022] Open
Abstract
The aim of this study was to assess the correlation of sperm morphology with the intrauterine insemination (IUI) outcome in patients with normal sperm concentration and motility. About 412 couples who underwent 908 IUI cycles were involved in the present study. A total of 110 clinical pregnancies were achieved with a pregnancy rate of 12.11% per cycle. The pregnancy rates per cycle were 7.60%, 12.67%, 13.62% and 13.13% in patients with <5%, 5-9%, 10-14% and >14% normal forms, respectively. The lowest pregnancy rate (7.60%) was obtained in the group with normal forms below 5%. However, this rate was not significantly different from other subgroups. Moreover, no pregnancies occurred in women >35 years old with normal sperm forms below 5%, in comparison with that in other subgroups of the same age. For women younger than 35 years old, no significant difference in pregnancy rate was observed in terms of different level of morphologically normal sperm. Our results show that for patients with normal sperm concentration and motility, IUI is recommended for first-line treatment when the woman is younger than 35 years, or morphologically normal sperm is ≥ 5%. IVF/ICSI should be performed when the normal forms are <5% and female age is > 35 years.
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Affiliation(s)
- Y Sun
- Reproductive Medical Center, The Third Affiliated Hospital of Guangzhou Medical College, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, China
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27
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Updates on the relation of weight excess and reproductive function in men: sleep apnea as a new area of interest. Asian J Androl 2011; 14:77-81. [PMID: 22138900 DOI: 10.1038/aja.2011.64] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Obesity has a negative effect on male reproductive function. It is associated with low testosterone levels and alteration in gonadotropin secretion. Male obesity has been linked to reduced male fertility. Data regarding the relation of obesity to sperm parameters are conflicting in terms of the nature and magnitude of the effect. New areas of interest are emerging that can help explain the variation in study results, such as genetic polymorphism and sleep apnea. Sleep disorders have been linked to altered testosterone production and hypogonadism in men. It was also correlated to erectile dysfunction. The relation of sleep disorders to male fertility and sperm parameters remains to be investigated. Men with hypogonadism and infertility should be screened for sleep apnea. Treatment of obesity and sleep apnea improves testosterone levels and erectile function.
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The potential use of intrauterine insemination as a basic option for infertility: a review for technology-limited medical settings. Obstet Gynecol Int 2011; 2009:584837. [PMID: 20011061 PMCID: PMC2778500 DOI: 10.1155/2009/584837] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 01/15/2009] [Indexed: 11/17/2022] Open
Abstract
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 offered three to six IUI cycles in technology-limited settings.
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29
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Kamath MS, Bhave P, Aleyamma T, Nair R, Chandy A, Mangalaraj AM, Muthukumar K, George K. Predictive factors for pregnancy after intrauterine insemination: A prospective study of factors affecting outcome. J Hum Reprod Sci 2011; 3:129-34. [PMID: 21234173 PMCID: PMC3017328 DOI: 10.4103/0974-1208.74154] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 09/23/2010] [Accepted: 10/18/2010] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE: To determine the predictive factors for pregnancy after controlled ovarian hyperstimulation (COH)/intrauterine insemination (IUI). DESIGN: Prospective observational study. SETTING: University-level tertiary care center. PATIENTS AND METHODS: 366 patients undergoing 480 stimulated IUI cycles between November 2007 and December 2008. INTERVENTIONS: Ovarian stimulation with gonadotrophins was initiated and a single IUI was performed 36 h after triggering ovulation. MAIN OUTCOME MEASURES: The primary outcome measures were clinical pregnancy and live birth rates. 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 (TMF). 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, P = 0.032) and the TMF (between 10 and 20 million, P = 0.002) significantly influenced the clinical pregnancy rate. CONCLUSION: Our results indicate that COH/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.
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Affiliation(s)
- Mohan S Kamath
- Reproductive Medicine Unit, Christian Medical College, Vellore, India
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30
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Amar-Hoffet A, Hédon B, Belaisch-Allart J. [Assisted reproductive technologies place]. J Gynecol Obstet Hum Reprod 2010; 39:S88-S99. [PMID: 21185490 DOI: 10.1016/s0368-2315(10)70034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
There are three kinds of infertility treatment: medical treatment, surgical treatment and assisted reproductive technology (ART). ART includes intra uterine insemination (IUI), in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). ART technologies made a lot of progress last years and their field of applications extended. Through literature reviews, IUI is recommended for unexplained infertility and discussed for male or cervical infertility. IVF is recommended for tubal and unexplained infertility. Limits between IVF and ICSI in case of male infertility remains unclear. In non mal infertility ICSI is not recommended.
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Affiliation(s)
- A Amar-Hoffet
- Hôpital Saint Joseph, Unité de médecine de la reproduction, 26 bd de Louvain, 13008 Marseille, France
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Park KE, Ku SY, Kim H, Jee BC, Suh CS, Kim SH, Choi YM, Kim JG, Moon SY. The use of tenaculum during intrauterine insemination may not affect the pregnancy outcome. Yonsei Med J 2010; 51:949-53. [PMID: 20879065 PMCID: PMC2995983 DOI: 10.3349/ymj.2010.51.6.949] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The association between tenaculum application to the cervix just before embryo transfer and lower pregnancy rate has been reported. However, studies on the use of tenaculum in intrauterine insemination (IUI) cycles are not available. This study attempted to investigate whether the use of tenaculum affects the clinical outcomes of IUI. MATERIALS AND METHODS Two hundred and thirty three CC/hMG/ IUI cycles of one hundred and forty three couples were recruited at Seoul National University Hospital from October 2006 to December 2008. Mock insemination and IUI with or without tenaculum application to the cervix were also performed, and clinical pregnancy rate was compared. RESULTS The incidence of difficult mock insemination at the beginning of cycle was higher in the tenaculum use group (p < 0.001). No significant statistical difference in the clinical pregnancy rate was observed between the groups with or without tenaculum application (12.1% vs. 18.5%; p = 0.175), which was not influenced by the difficulty of mock insemination. CONCLUSION The use of tenaculum during IUI may not affect the pregnancy outcome. Our results need to be confirmed by a prospective study in a larger population.
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Affiliation(s)
- Kyung Eui Park
- Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, Korea
| | - Seung-Yup Ku
- Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, Korea
- Institute of Reproductive Medicine and Population, Seoul National University, Seoul, Korea
| | - Hoon Kim
- Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, Korea
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, Korea
- Institute of Reproductive Medicine and Population, Seoul National University, Seoul, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, Korea
- Institute of Reproductive Medicine and Population, Seoul National University, Seoul, Korea
| | - Young Min Choi
- Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, Korea
- Institute of Reproductive Medicine and Population, Seoul National University, Seoul, Korea
| | - Jung Gu Kim
- Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, Korea
| | - Shin Yong Moon
- Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, Korea
- Institute of Reproductive Medicine and Population, Seoul National University, Seoul, Korea
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Sripada S, Townend J, Campbell D, Murdoch L, Mathers E, Bhattacharya S. Relationship between semen parameters and spontaneous pregnancy. Fertil Steril 2010; 94:624-30. [DOI: 10.1016/j.fertnstert.2009.02.085] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 02/24/2009] [Accepted: 02/25/2009] [Indexed: 10/20/2022]
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Nicopoullos JDM, Almeida P, Vourliotis M, Goulding R, Gilling-Smith C. A decade of sperm washing: clinical correlates of successful insemination outcome. Hum Reprod 2010; 25:1869-76. [DOI: 10.1093/humrep/deq134] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sperm chromatin structure assay and classical semen parameters: systematic review. Reprod Biomed Online 2010; 20:114-24. [DOI: 10.1016/j.rbmo.2009.10.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 04/09/2009] [Accepted: 09/23/2009] [Indexed: 11/19/2022]
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The effect of nasal oxytocin on pregnancy rates following intrauterine insemination: double-blind, randomized, clinical pilot study. Arch Gynecol Obstet 2009; 281:753-9. [DOI: 10.1007/s00404-009-1284-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 11/02/2009] [Indexed: 11/26/2022]
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Chromomycin A3 staining, sperm chromatin structure assay and hyaluronic acid binding assay as predictors for assisted reproductive outcome. Reprod Biomed Online 2009; 19:671-84. [DOI: 10.1016/j.rbmo.2009.07.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Freour T, Jean M, Mirallie S, Langlois ML, Dubourdieu S, Barriere P. Predictive value of CASA parameters in IUI with frozen donor sperm. ACTA ACUST UNITED AC 2009; 32:498-504. [DOI: 10.1111/j.1365-2605.2008.00886.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nitzschke M, Strowitzki T, von Wolff M. Spermiogramm und Seminalplasma. GYNAKOLOGISCHE ENDOKRINOLOGIE 2009. [DOI: 10.1007/s10304-008-0299-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Haim D, Leniaud L, Porcher R, Martin-Pont B, Wolf JP, Sifer C. Évaluation prospective de l’impact des paramètres spermatiques sur le succès des inséminations intra-utérines. ACTA ACUST UNITED AC 2009; 37:229-35. [DOI: 10.1016/j.gyobfe.2008.09.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Accepted: 09/22/2008] [Indexed: 11/26/2022]
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Hammoud AO, Wilde N, Gibson M, Parks A, Carrell DT, Meikle AW. Male obesity and alteration in sperm parameters. Fertil Steril 2008; 90:2222-5. [DOI: 10.1016/j.fertnstert.2007.10.011] [Citation(s) in RCA: 213] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Revised: 10/05/2007] [Accepted: 10/08/2007] [Indexed: 10/22/2022]
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Stimulated intrauterine insemination (SIUI) and donor insemination (DI) as first line management for a selected subfertile population: the Manchester experience. J Assist Reprod Genet 2008; 25:431-6. [PMID: 18830693 DOI: 10.1007/s10815-008-9251-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2008] [Accepted: 09/04/2008] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The objective of our study is to investigate the optimum number of stimulated intrauterine insemination (SIUI) or donor insemination (DI) cycles that can be offered to the couples prior to in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) in a tertiary referral unit for assisted reproduction. METHODS This is a retrospective analysis of 408 SIUI and 704 DI cycles performed in a tertiary referral unit for assisted reproduction. SIUI's were performed by controlled ovarian hyperstimulation and ovulation induction followed by insemination 36 h later. DI's were performed in natural or stimulated cycles after thawing frozen donor sperm. The main outcome measured was cumulative live birth rate (CLBR) per couple. RESULTS A maximum CLBR of 26.1% was achieved after the fourth cycle of SIUI. The CLBR of DI increased to 60.1% in the sixth cycle. CONCLUSIONS This study, in line with a number of other studies, is unable to demonstrate unequivocally whether increasing numbers of IUI or DI cycles are justified clinically or financially. There is a need for larger datasets from multiple centres along with rigorous randomised trials to compare treatment pathways. Until then, the resources spent on the provision of extra SIUI cycles may be better utilized by early referral to IVF.
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Ombelet W, Cooke I, Dyer S, Serour G, Devroey P. Infertility and the provision of infertility medical services in developing countries. Hum Reprod Update 2008; 14:605-21. [PMID: 18820005 PMCID: PMC2569858 DOI: 10.1093/humupd/dmn042] [Citation(s) in RCA: 347] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Worldwide more than 70 million couples suffer from infertility, the majority being residents of developing countries. Negative consequences of childlessness are experienced to a greater degree in developing countries when compared with Western societies. Bilateral tubal occlusion due to sexually transmitted diseases and pregnancy-related infections is the most common cause of infertility in developing countries, a condition that is potentially treatable with assisted reproductive technologies (ART). New reproductive technologies are either unavailable or very costly in developing countries. This review provides a comprehensive survey of all important papers on the issue of infertility in developing countries. METHODS Medline, PubMed, Excerpta Medica and EMBASE searches identified relevant papers published between 1978 and 2007 and the keywords used were the combinations of 'affordable, assisted reproduction, ART, developing countries, health services, infertility, IVF, simplified methods, traditional health care'. RESULTS The exact prevalence of infertility in developing countries is unknown due to a lack of registration and well-performed studies. On the other hand, the implementation of appropriate infertility treatment is currently not a main goal for most international non-profit organizations. Keystones in the successful implementation of infertility care in low-resource settings include simplification of diagnostic and ART procedures, minimizing the complication rate of interventions, providing training-courses for health-care workers and incorporating infertility treatment into sexual and reproductive health-care programmes. CONCLUSIONS Although recognizing the importance of education and prevention, we believe that for the reasons of social justice, infertility treatment in developing countries requires greater attention at National and International levels.
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Affiliation(s)
- Willem Ombelet
- Department of Obstetrics and Gynaecology, Genk Institute for Fertility Technology, Schiepse Bos 6, 3600 Genk, Belgium.
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Ombelet W, Campo R, Bosmans E, Nijs M. Intrauterine insemination (IUI) as a first-line treatment in developing countries and methodological aspects that might influence IUI success. ACTA ACUST UNITED AC 2008. [DOI: 10.1093/humrep/den165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Effect of heat-induced hypermotility on pregnancy rate in intrauterine insemination for male factor infertility associated with asthenospermia: a prospective, randomized, controlled study. J Assist Reprod Genet 2008; 25:235-8. [PMID: 18523884 DOI: 10.1007/s10815-008-9226-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Accepted: 05/02/2008] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To assess the effect of mild heat for the enhancement of sperm fertilizing capacity in intrauterine insemination for male factor infertility associated with asthenospermia. MATERIAL AND METHOD Prospective, controlled, clinical study. Male factor infertility associated with asthenozoospermia was the criteria for inclusion. Ninety-seven couples were randomized to the study group while 100 couples were randomized to serve as the control group. Semen samples from the study group were processed with Percoll gradient and were left for incubation at 40 degrees C for 2 h. Semen samples from the control group were processed with Percoll gradient method and were incubated at 37 degrees C. Main outcome measure was the pregnancy rate. RESULTS The mean concentration of total motile sperm (TMS) in the study group was 11.20 +/- 4.22 x 10(6) (range 7-18) after wash with Percoll while was increased to 62.41 +/- 12.49 x 10(6) (range 44-71) after heat treatment. The mean concentration of TMS in the control group was 13.90 +/- 5.66 x 10(6) (range 8-19) after wash with Percoll while was increased to 17.73 +/- 3.67 x 10(6) (range 14-22) after incubation at 37 degrees C. The difference in TMS concentrations between the study and the control group after incubation at different temperatures was statistically significant (p < 0.005). There were 24 pregnancies in the study group, providing a pregnancy rate of 24.7%. In the control group eight pregnancies were achieved (8%) (p = 0.001). CONCLUSION Mild heat was found remarkably effective in asthenozoospermic males for increasing the concentration of inseminated total motile sperm and the pregnancy rate correspondingly.
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Abstract
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 (OH) has been subject of discussion. Although the treatment itself is less invasive and expensive than others, its efficacy has not been proven. Furthermore, the adverse effects of OH such as ovarian hyperstimulation syndrome (OHSS ) and multiple pregnancy are a concern. 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 (TI), with or without OH. SEARCH STRATEGY We searched the Cochrane Menstrual and Disorders Subfertility Group Trials Special Register, the Cochrane Central Register of Controlled Trials (the Cochrane Library, 2006, issue 3), MEDLINE (1966 to May 2006), EMBASE (1980 to May 2006), SCIsearch and the reference lists of articles. We hand searched abstracts of the American Society for Reproductive Medicine, the European Society for Human Reproduction and Embryology. Authors of identified articles were contacted for unpublished data. SELECTION CRITERIA Randomised controlled trials (RCT's) with at least one of the following comparisons were included: 1) IUI versus TI or expectant management both in natural cycles 2) IUI versus TI both in cycles with OH 3) IUI in natural cycles versus TI + OH 4) IUI + OH versus TI in natural cycles 5) IUI in natural cycles versus IUI + OH. Couples with abnormal sperm parameters only were included. DATA COLLECTION AND ANALYSIS Two co-reviewers independently performed quality assessment and data extraction. Where possible data were pooled, and a meta-analysis was performed. Sensitivity and subgroup analyses were carried out where possible and appropriate. MAIN RESULTS Three trials of parallel design, and five trials of cross-over design with pre-cross-over data were included in the meta-analysis. Three compared IUI with TI both in stimulated cycles. The remaining four of these studies compared IUI versus IUI + OH . Three studies reported on our main outcome of interest live birth rate per couple. For the comparison IUI versus TI both in natural cycles no evidence of difference between the probabilities of pregnancy rates per woman after IUI compared with TI was found (Peto OR 5.3, 95% CI 0.42 to 67). No statistically significant of difference between pregnancy rates (PR) per couple for IUI + OH versus IUI could be found (Peto OR 1.47, 95% CI 0.92 to 2.37). For the comparison IUI versus TI both in stimulated cycles there was no evidence of statistically significant difference in pregnancy rates per couple either (Peto OR 1.67, 95% CI 0.83 to 3.37). There were insufficient data available for adverse outcomes such as OHSS, multiple pregnancy, miscarriage rate and ectopic pregnancy to perform a statistical analysis. For the other two comparisons no RCT's were found which reported pregnancy rates per couple. A further 10 studies which included one of the comparisons of interests were found. Since these studies reported pregnancy rates per cycle only these data could not be included in the meta-analysis. AUTHORS' CONCLUSIONS There was insufficient evidence of effectiveness to recommend or advise against IUI with or without OH above TI, or vice versa. Large, high quality randomised controlled trials, comparing IUI with or without OH with pregnancy rate per couple as the main outcome of interest are lacking. There is a need for such trials since firm conclusions cannot be drawn yet.
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Affiliation(s)
- A J Bensdorp
- FMHS University of Auckland, O&G, Level 12 Support Building ADHB, Park Rd, Grafton, Auckland, New Zealand.
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Abstract
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 (OH) has been subject of discussion. Although the treatment itself is less invasive and expensive than others, its efficacy has not been proven. Furthermore, the adverse effects of OH such as ovarian hyperstimulation syndrome (OHSS ) and multiple pregnancy are a concern. OBJECTIVES The aim of this review is to determine whether for couples with male subfertility, IUI improves the live birth rates or ongoing pregnancy rates compared with timed intercourse (TI), with or without OH. SEARCH STRATEGY We searched the Cochrane Menstrual and Disorders Subfertility Group Trials Special Register, the Cochrane Central Register of Controlled Trials (the Cochrane Library, 2006, issue 3), MEDLINE (1966 to May 2006), EMBASE (1980 to May 2006), SCIsearch and the reference lists of articles. We hand searched abstracts of the American Society for Reproductive Medicine, the European Society for Human Reproduction and Embryology. Authors of identified articles were contacted for unpublished data. SELECTION CRITERIA Randomised controlled trials (RCT's) with at least one of the following comparisons were included: 1) IUI versus TI or expectant management both in natural cycles 2) IUI versus TI both in cycles with OH 3) IUI in natural cycles versus TI + OH 4) IUI + OH versus TI in natural cycles 5) IUI in natural cycles versus IUI + OH Couples with abnormal sperm parameters only were included. DATA COLLECTION AND ANALYSIS Two co-reviewers independently performed quality assessment and data extraction. Where possible data were pooled, and a meta-analysis was performed. Sensitivity and subgroup analyses were carried out where possible and appropriate. MAIN RESULTS Three trials of parallel design, and five trials of cross-over design with pre-cross-over data were included in the meta-analysis. Three compared IUI with TI both in stimulated cycles. The remaining four of these studies compared IUI versus IUI + OH . Three studies reported on our main outcome of interest live birth rate per couple. For the comparison IUI versus TI both in natural cycles no evidence of difference between the probabilities of pregnancy rates per woman after IUI compared with TI was found (Peto OR 5.3, 95% CI 0.42 to 67). No statistically significant of difference between pregnancy rates (PR) per couple for IUI + OH versus IUI could be found (Peto OR 1.47, 95% CI 0.92 to 2.37). For the comparison IUI versus TI both in stimulated cycles there was no evidence of statistically significant difference in pregnancy rates per couple either (Peto OR 1.67, 95% CI 0.83 to 3.37). There were insufficient data available for adverse outcomes such as OHSS, multiple pregnancy, miscarriage rate and ectopic pregnancy to perform a statistical analysis. For the other two comparisons no RCT's were found which reported pregnancy rates per couple. A further 10 studies which included one of the comparisons of interests were found. Since these studies reported pregnancy rates per cycle only these data could not be included in the meta-analysis. AUTHORS' CONCLUSIONS There was insufficient evidence of effectiveness to recommend or advise against IUI with or without OH above TI, or vice versa. Large, high quality randomised controlled trials, comparing IUI with or without OH with pregnancy rate per couple as the main outcome of interest are lacking. There is a need for such trials since firm conclusions cannot be drawn yet.
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Affiliation(s)
- A J Bensdorp
- FMHS University of Auckland, O&G, Level 12 Support Building ADHB, Park Rd, Grafton, Auckland, New Zealand.
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Abstract
The current practice in medically assisted reproduction is still too exclusively focused on effectiveness and success rates. This has a number of considerable, and more importantly, avoidable drawbacks. Single embryo transfer was an important move away from this model to include safety and welfare of mother and child. Patient-friendly ART goes one big step further. It is composed of a mix of four criteria: cost-effectiveness, equity of access, minimal risk for mother and child and minimal burden for patients. All four components have a strong normative ethical basis: cost-effectiveness relies on the optimal use of community resources to maximise well-being; equity of access is based on justice, minimal risk is founded on the fundamental non-maleficence rule and minimal burden is largely based on the autonomy principle. The inclusion of the four criteria in decision-making about treatment would express these values in clinical practice.
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Affiliation(s)
- Guido Pennings
- Bioethics Institute Ghent, Ghent University, Blandijnberg 2, 9000 Gent, Belgium.
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Park SJ, Alvarez JR, Weiss G, Von Hagen S, Smith D, McGovern PG. Ovulatory status and follicular response predict success of clomiphene citrate-intrauterine insemination. Fertil Steril 2007; 87:1102-7. [PMID: 17261288 DOI: 10.1016/j.fertnstert.2006.11.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Revised: 11/09/2006] [Accepted: 11/09/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To test the hypothesis that anovulatory women would have good pregnancy rates (PRs), regardless of single or multiple follicular development, in response to clomiphene citrate (CC), whereas ovulatory women would have good PRs only when achieving multifollicular responses to CC. DESIGN Retrospective chart review. SETTING University-based infertility center. PATIENT(S) Two hundred and fifty-four women underwent 585 CC-IUI treatment cycles over a 3-year period. INTERVENTION Treatment with CC-IUI. MAIN OUTCOME MEASURE(S) Various factors were examined as predictors of clinical pregnancy rate (CPR) and live-birth rate (LBR) per cycle with the use of logistic regression. RESULT(S) Overall, the CPR was 11.1%, and the LBR was 8.7%. Of 65 clinical pregnancies, 81.5% resulted in live births (singletons, 67.7%; twins, 13.8%). There were no higher-order deliveries. In anovulatory women, the CPR and LBR were 15.7% and 13.6%, respectively. In ovulatory women, the CPR and LBR were 8.8% and 6.3%, respectively. As the number of large follicles increased from one to two, the LBR increased from 6.8% to 10.5%. Regarding the interaction of follicles with ovulatory status, anovulatory women had nearly double the CPR and LBR compared to those in ovulatory women, irrespective of the number of large follicles. CONCLUSION(S) Treatment with CC-IUI is more successful in anovulatory women than in ovulatory women. The multiple follicular response in both ovulatory and anovulatory women increases PRs.
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Affiliation(s)
- Susanna J Park
- Department of Obstetrics, Gynecology, and Women's Health, University of Medicine and Dentistry of New Jersey (UMDNJ)--New Jersey Medical School, Newark, New Jersey 07103, USA.
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Helmerhorst FM, van Vliet HAAM, Gornas T, Finken MJJ, Grimes DA. Intrauterine insemination versus timed intercourse for cervical hostility in subfertile couples. Obstet Gynecol Surv 2006; 61:402-14; quiz 423. [PMID: 16719942 DOI: 10.1097/01.ogx.0000219538.78851.43] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED The postcoital test has poor diagnostic and prognostic characteristics. Nevertheless, some physicians believe it can identify scanty or abnormal mucus that might impair fertility. One way to avoid "hostile" cervical mucus is intrauterine insemination. With this technique, the physician injects sperm directly into the uterine cavity through a small catheter passed through the cervix; the theory is to bypass the "hostile" cervical mucus. Although most gynecologic societies do not endorse use of intrauterine insemination for hostile cervical mucus, some physicians consider it an effective treatment for women with infertility thought the result of cervical mucus problems. The aim of this review was to determine the effectiveness of intrauterine insemination with or without ovarian stimulation in women with cervical hostility who failed to conceive.We searched Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library Issue 2, 2005, MEDLINE (1966 to June 2005), EMBASE (1980 to June 2005), POPLINE (to June 2005), and LILACS (to June 2005). In addition, we contacted experts and searched the reference list of relevant articles and book chapters. We included randomized and quasirandomized, controlled trials comparing intrauterine insemination with intercourse timed at the presumed fertile period. Participants were women with cervical hostility who failed to conceive for at least 1 year. We assessed the titles and abstracts of 386 publications and 2 reviewers independently abstracted data on methods and results from 5 studies identified for inclusion. The main outcome is pregnancy rate per couple. We did not pool the outcomes of the included 5 studies in a meta-analysis resulting from the methodological quality of the trials and variations in the patient characteristics and interventions. Narrative summaries of the outcomes are provided. Each study was too small for a clinically relevant conclusion. None of the studies provided information on important outcomes such as spontaneous abortion, multiple pregnancies, and ovarian hyperstimulation syndrome. There is no evidence from the published studies that intrauterine insemination is an effective treatment for cervical hostility. Given the poor diagnostic and prognostic properties of the postcoital test and the observation that the test has no benefit on pregnancy rates, intrauterine insemination (with or without ovarian stimulation) is unlikely to be a useful treatment for putative problems identified by postcoital testing. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completion of this article, the reader should be able to recall that there is a lack of adequate studies that support that intrauterine insemination (IUI) is an effective treatment of cervical hostility, explain that the postcoital test has poor diagnostic and prognostic properties, and state that the use of both tests has no benefit on pregnancy rates. EDITOR'S NOTE Although many assisted reproductive technology (ART) programs no longer perform postcoital tests, many perform intrauterine insemination (IUI), often with gonadotropins or clomiphene citrate, in their subfertile patients. Therefore, this review article will be of value to our readers who treat subfertile patients with IUI, whether or not they perform postcoital tests. For additional explanations of the statistical tests employed in this review, see D. Grimes, KF Schulz, Obstetrical and Gynecologic Survey, 57; Supplement 3: S35, September 2002; and D. Grimes, KF Schulz, Obstetrical and Gynecologic Survey, Supplement 2, S53-S69, September 2005.-RBJ.
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Affiliation(s)
- Frans M Helmerhorst
- Department of Gynaecology, Division of Reproductive Medicine, Leiden University Medical Center, Leiden, The Netherlands.
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Ombelet W, Martens G, De Sutter P, Gerris J, Bosmans E, Ruyssinck G, Defoort P, Molenberghs G, Gyselaers W. Perinatal outcome of 12,021 singleton and 3108 twin births after non-IVF-assisted reproduction: a cohort study. Hum Reprod 2005; 21:1025-32. [PMID: 16339165 DOI: 10.1093/humrep/dei419] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Perinatal outcome of pregnancies caused by assisted reproduction technique (ART) is substantially worse when compared with pregnancies following natural conception. We investigated the possible risks of non-IVF ART on perinatal health. We conducted a retrospective cohort study with two exposure groups: a study group of pregnancies after controlled ovarian stimulation (COS), with or without artificial insemination (AI), and a naturally conceived comparison group. We used the data from the regional registry of all hospital deliveries in the Dutch-speaking part of Belgium during the period from January 1993 until December 2003 to investigate differences in perinatal outcome of singleton and twin pregnancies. 12 021 singleton and 3108 twin births could be selected. Naturally conceived subjects were matched for maternal age, parity, fetal sex and year of birth. The main outcome measures were duration of pregnancy, birth weight, perinatal morbidity and perinatal mortality. Our overall results showed a significantly higher incidence of prematurity (<32 and <37 weeks), low and very low birth weight, transfer to the neonatal intensive care unit and most neonatal morbidity parameters for COS/AI singletons. Twin pregnancies resulting from COS/AI showed an increased rate of neonatal mortality, assisted ventilation and respiratory distress syndrome. After excluding same-sex twin sets, COS/AI twin pregnancies were at increased risk for extreme prematurity and very low birth weight. In conclusion, COS/AI singleton and twin pregnancies are significantly disadvantaged compared to naturally conceived children.
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Affiliation(s)
- Willem Ombelet
- Scientific Board of the Flemish Society of Obstetrics and Gynaecology, St Niklaas, Brussels.
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