Abstract
Purpose:Our purpose was to evaluate intrauterine insemination results obtained in our clinic and identify prognostic factors for the chance of pregnancy.
Methods:A retrospective study of data from 1989 to 1996 was undertaken. Only first attempts were included in this study, except for the part on the cumulative pregnancy rates. Couples with either one-sided tubapathology, hormonal dysfunction, idiopathic infertility, or andrological indication were selected. All women were stimulated with clomiphene citrate. Five hundred sixty-six couples who underwent 1763 cycles were included in the study.
Results:The overall pregnancy rate for first pregnancies was 6.9% per cycle and 21.4% per patient. For first intrauterine insemination attempts this was 8.8% per cycle/patient, varying between 5.0% for andrological indication and 10.6% for tubapathology, 10.0% for idiopatic indication, and 10.3% for hormonal indication. These differences were not significant. Age did not have a significant effect either, although there were no pregnancies observed in women 40 years or older. The number of inseminated spermatozoa significantly affected the pregnancy rate: <2 million, 4.6%; ≥2 to <10 million, 3.9%; and ≥10 million, 11.3%.
Conclusions:Unless semen characteristics are insufficient, intrauterine insemination is a useful treatment for infertile couples.
Keywords: age, indication, intrauterine insemination, pregnancy rate, sperm characteristics
Full Text
The Full Text of this article is available as a PDF (617.6 KB).
REFERENCES
- 1.Martinez AR, Bernardus RE, Vermeiden JPW, Schoemaker J. Basic questions on intrauterine insemination: An update. Obstet Gynaecol Surv. 1993;48:811–828. doi: 10.1097/00006254-199312000-00007. [DOI] [PubMed] [Google Scholar]
- 2.Campana A, Sakkas D, Stalberg A, Bianchi PG, Comte I, Pache T, Walker D. Intrauterine insemination: evaluation of the results according to the woman's age, sperm quality, total sperm count per insemination and life table analysis. Hum Reprod. 1996;11:732–736. doi: 10.1093/oxfordjournals.humrep.a019244. [DOI] [PubMed] [Google Scholar]
- 3.Mathieu C, Ecochard R, Bied V, Lornage J, Czyba JC. Cumulative conception rate following intrauterine artificial insemination with husband's spermatozoa: Influence of husband's age. Hum Reprod. 1995;10:1090–1097. doi: 10.1093/oxfordjournals.humrep.a136100. [DOI] [PubMed] [Google Scholar]
- 4.Frederick JL, Denker MS, Rojas A, Horta I, Stone SC, Asch RH, Balmaceda JP. Is there a role for ovarian stimulation and intrauterine insemination after age 40? Hum Reprod. 1994;9:2284–2286. doi: 10.1093/oxfordjournals.humrep.a138438. [DOI] [PubMed] [Google Scholar]
- 5.Brasch JG, Rawlins R, Tarchala S, Radwanska E. The relationship between total motile sperm count and the succes of intrauterine insemination. Fertil Steril. 1994;62:150–154. doi: 10.1016/s0015-0282(16)56831-9. [DOI] [PubMed] [Google Scholar]
- 6.Friedman AJ, Juneau-Norcross M, Sedensky B, Andrews N, Dorfman J, Cramer DW. Life table analysis of intrauterine insemination pregnancy rates for couples with cervical factor, male factor and idiopathic infertility. Fertil Steril. 1991;55:1005–1007. doi: 10.1016/s0015-0282(16)54314-3. [DOI] [PubMed] [Google Scholar]
- 7.Arici A, Byrd W, Bradshaw K, Kutteh WH, Marshburn P, Can BR. Evaluation of clomiphene citrate and human chorionic gonadotropin treatment: A prospective, randomized, crossover study during intrauterine insemination cycles. Fertil Steril. 1994;61:314–318. doi: 10.1016/s0015-0282(16)56524-8. [DOI] [PubMed] [Google Scholar]
- 8.Lalich RA, Marut EL, Prins GS, Scommegna A. Life table analysis of intrauterine insemination pregnancy rates. Am J Obstet Gynaecol. 1986;4:980–984. doi: 10.1016/0002-9378(88)90106-8. [DOI] [PubMed] [Google Scholar]
- 9.WHO Laboratory Manual for the Examination of Human Semen and Semen-Cervical Mucus Interaction. 2nd ed. Cambridge: Press Syndicate of the University of Cambridge; 1987. p. 27. [Google Scholar]
- 10.Hull MGR, Glazener CMA, Kelly NJ. Population study of causes, treatment, and outcome of infertility. BMJ. 1985;291(6510):1693–1697. doi: 10.1136/bmj.291.6510.1693. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Oei SG, Bloemenkamp KWM, Helmerhorst FM, Naaktgeboren N, Keirse MJNC. Evaluation of the postcoital test for assessment of “cervical factor” infertility. Eur J Obstet Gynaecol Reprod Biol. 1996;64:217–220. doi: 10.1016/0301-2115(95)02287-2. [DOI] [PubMed] [Google Scholar]
- 12.Gindoff PR, Jewelewicz R. Reproductive potential in the older woman. Fertil Steril. 1986;46:989–1001. doi: 10.1016/s0015-0282(16)49869-9. [DOI] [PubMed] [Google Scholar]
- 13.Navot D, Bergh PA, Williams MA, Garrisi GJ, Gusman I, Sander, et al. Poor oocyte quality rather than implantation failure as a cause of age related decline in female fertility. Lancet. 1991;337(8754):1375–1377. doi: 10.1016/0140-6736(91)93060-m. [DOI] [PubMed] [Google Scholar]
- 14.Corsan G, Trias A, Trout S, Kemmann E. Ovulation induction combined with intrauterine insemination in women of 40 years of age and older: is it worthwhile? Hum Reprod. 1996;11:1109–1112. doi: 10.1093/oxfordjournals.humrep.a019306. [DOI] [PubMed] [Google Scholar]
- 15.Burr RW, Siegberg R, Flaherty SP, Wang XJ, Matthews CD. The influence of sperm morphology and the number of motile sperm inseminated on the outcome of intrauterine insemination combined with mild ovarian stimulation. Fertil Steril. 1996;65:127–132. doi: 10.1016/s0015-0282(16)58039-x. [DOI] [PubMed] [Google Scholar]
- 16.Agarwell SK, Buyalos RP. Clomiphene citrate with intrauterine insemination: Is it effective therapy in women above the age of 35 years? Fertil Steril. 1996;65:759–763. doi: 10.1016/s0015-0282(16)58210-7. [DOI] [PubMed] [Google Scholar]