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González-Ravina C, Santamaría-López E, Pacheco A, Ramos J, Carranza F, Murria L, Ortiz-Vallecillo A, Fernández-Sánchez M. Effect of Sperm Selection by Magnetic-Activated Cell Sorting in D-IUI: A Randomized Control Trial. Cells 2022; 11:cells11111794. [PMID: 35681488 PMCID: PMC9180176 DOI: 10.3390/cells11111794] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/20/2022] [Accepted: 05/27/2022] [Indexed: 02/05/2023] Open
Abstract
Clinical outcome in assisted reproduction techniques (ARTs) is mainly influenced by the quality of gametes used. It is known that a high percentage of sperm DNA fragmentation (DNAf) decreases the success of ART clinical results. Therefore, techniques such as magnetic-activated cell sorting (MACS) help to improve results in cases of patients with a high percentage of DNAf. Cryopreservation of sperm in donor intrauterine insemination (D-IUI) treatments increases sperm DNAf, so patients using these sperm samples can benefit from using this technique. This prospective randomized national multicenter study analyzed clinical outcomes of 181 D-IUI treatments. MACS was performed after density gradient centrifugation (DGC) in 90 thawed semen donor samples (MACSG), whereas only DGC was performed in 91 thawed semen donor samples (CG). To our knowledge, this is the first study analyzing the effect of MACS on D-IUI cycles. Our results show no significant differences in gestation, live birth, or miscarriage rates between the two groups. We believe that further studies with a larger sample size are needed to evaluate the application of MACS in combination with standard IUI donor sperm preparations in fertility clinics.
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Affiliation(s)
- Cristina González-Ravina
- IVI-RMA Seville, Avda. Américo Vespucio 19, 41092 Seville, Spain; (C.G.-R.); (J.R.); (F.C.); (M.F.-S.)
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain; (L.M.); (A.O.-V.)
- Departamento de Biología Molecular e Ingeniería Bioquímica, Universidad Pablo de Olavide, 41013 Seville, Spain
| | - Esther Santamaría-López
- IVI-RMA Seville, Avda. Américo Vespucio 19, 41092 Seville, Spain; (C.G.-R.); (J.R.); (F.C.); (M.F.-S.)
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain; (L.M.); (A.O.-V.)
- Correspondence: ; Tel.: +34-954-286-274
| | - Alberto Pacheco
- IVI-RMA Madrid, Avenida del Talgo 68, 28023 Madrid, Spain;
- Facultad Ciencias de la Salud, Universidad Alfonso X “El Sabio”, Villanueva de la Cañada, 28016 Madrid, Spain
| | - Julia Ramos
- IVI-RMA Seville, Avda. Américo Vespucio 19, 41092 Seville, Spain; (C.G.-R.); (J.R.); (F.C.); (M.F.-S.)
| | - Francisco Carranza
- IVI-RMA Seville, Avda. Américo Vespucio 19, 41092 Seville, Spain; (C.G.-R.); (J.R.); (F.C.); (M.F.-S.)
| | - Lucía Murria
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain; (L.M.); (A.O.-V.)
| | - Ana Ortiz-Vallecillo
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain; (L.M.); (A.O.-V.)
| | - Manuel Fernández-Sánchez
- IVI-RMA Seville, Avda. Américo Vespucio 19, 41092 Seville, Spain; (C.G.-R.); (J.R.); (F.C.); (M.F.-S.)
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain; (L.M.); (A.O.-V.)
- Departamento de Biología Molecular e Ingeniería Bioquímica, Universidad Pablo de Olavide, 41013 Seville, Spain
- Departamento de Cirugía, Universidad de Sevilla, Avda. Sánchez Pizjuan S/N, 41009 Seville, Spain
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Kop PAL, van Wely M, Nap A, Soufan AT, de Melker AA, Mol BWJ, Bernardus RE, De Brucker M, Janssens PMW, Pieters JJPM, Repping S, van der Veen F, Mochtar MH. Intracervical insemination versus intrauterine insemination with cryopreserved donor sperm in the natural cycle: a randomized controlled trial. Hum Reprod 2022; 37:1175-1182. [PMID: 35459949 PMCID: PMC9789751 DOI: 10.1093/humrep/deac071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 03/09/2022] [Indexed: 01/01/2023] Open
Abstract
STUDY QUESTION Is intracervical insemination (ICI) non-inferior to IUI with cryopreserved donor sperm in the natural cycle in terms of live birth? SUMMARY ANSWER ICI with cryopreserved donor sperm in the natural cycle was inferior to IUI in terms of live birth. WHAT IS KNOWN ALREADY Both ICI and IUI in the natural cycle are performed as first-line treatments in women who are eligible for donor sperm treatment. High-quality data on the effectiveness of ICI versus IUI with cryopreserved donor sperm in the natural cycle in terms of live birth is lacking. STUDY DESIGN, SIZE, DURATION We performed an open-label multicentre randomized non-inferiority trial in the Netherlands and Belgium. PARTICIPANTS/MATERIALS, SETTING, METHODS We randomly allocated women who were eligible for donor sperm treatment with cryopreserved donor semen to six cycles of ICI in the natural cycle or six cycles of IUI in the natural cycle. The primary outcome was conception within 8 months after randomization leading to a live birth. Secondary outcomes were ongoing pregnancy, multiple pregnancy, clinical pregnancy, miscarriage and time to conception leading to live birth. We calculated relative risks (RRs) and risk differences (RDs) with 95% CI. Non-inferiority would be shown if the lower limit of the 95% RD CI was <-12%. MAIN RESULTS AND THE ROLE OF CHANCE Between June 2014 and February 2019, we included 421 women, of whom 211 women were randomly allocated to ICI and 210 to IUI. Of the 211 women allocated to ICI, 2 women were excluded, 126 women completed treatment according to protocol and 75 women did not complete 6 treatment cycles. Of the 210 women allocated to IUI, 3 women were excluded, 140 women completed treatment according to protocol and 62 women did not complete 6 treatment cycles. Mean female age was 34 years (SD ±4) in both interventions. Conception leading to live birth occurred in 51 women (24%) allocated to ICI and in 81 women (39%) allocated to IUI (RR 0.63, 95% CI: 0.47 to 0.84). This corresponds to an absolute RD of -15%; 95% CI: -24% to -6.9%, suggesting inferiority of ICI. ICI also resulted in a lower live birth rate over time (hazard ratio 0.58, 95% CI: 0.41-0.82). Our per-protocol analysis showed that, within the 8 months treatment horizon, 48 women (38%) had live births after ICI and 79 women (56%) had live births after IUI (RR 0.68, 95% CI: 0.52-0.88; RD -18%, 95% CI: -30% to -6%). LIMITATIONS, REASONS FOR CAUTION The study was non-blinded owing to the nature of the interventions. We consider it unlikely that this has introduced performance bias, since pregnancy outcomes are objective outcome measures. WIDER IMPLICATIONS OF THE FINDINGS Since ICI in the natural cycle was inferior to IUI in the natural cycle with cryopreserved donor sperm in terms of live birth rate, IUI is the preferred treatment. STUDY FUNDING/COMPETING INTEREST(S) This trial received funding from the Dutch Organization for Health Research and Development (ZonMw project number 837002407). B.W.J.M. is supported by an NHMRC Investigator grant (GNT1176437), reports consultancy for ObsEva and has received research funding from Guerbet, Ferring and Merck. The other authors do not declare a COI. TRIAL REGISTRATION NUMBER NTR4462. TRIAL REGISTRATION DATE 11 March 2014. DATE OF FIRST PATIENT’S ENROLMENT 03 June 2014.
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Affiliation(s)
- P A L Kop
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam Reproduction & Development Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M van Wely
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam Reproduction & Development Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A Nap
- Department of Obstetrics and Gynaecology, Rijnstate, Arnhem, The Netherlands
| | - A T Soufan
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam Reproduction & Development Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A A de Melker
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam Reproduction & Development Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - B W J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia,Aberdeen Centre for Women’s Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | | | - P M W Janssens
- Department of Obstetrics and Gynaecology, Rijnstate, Arnhem, The Netherlands
| | - J J P M Pieters
- Fertility Clinic, Vivaneo Medisch Centrum Kinderwens Leiderdorp, Leiderdorp, The Netherlands
| | - S Repping
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam Reproduction & Development Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - F van der Veen
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam Reproduction & Development Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M H Mochtar
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam Reproduction & Development Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands,Correspondence address. Center for Reproductive Medicine, Amsterdam Reproduction & Development Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. E-mail:
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Meads C, Thorogood LR, Lindemann K, Bewley S. Why Are the Proportions of In-Vitro Fertilisation Interventions for Same Sex Female Couples Increasing? Healthcare (Basel) 2021; 9:healthcare9121657. [PMID: 34946383 PMCID: PMC8702152 DOI: 10.3390/healthcare9121657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022] Open
Abstract
Same-sex female couples who wish to become pregnant can choose donor insemination or in-vitro fertilization (IVF)-a technique intended for infertile women. In general, women in same-sex female partnerships are no more likely to be infertile than those in opposite sex partnerships. This article investigates data available from the Government Regulator of UK fertility clinics-the Human Fertilization and Embryology Authority, which is the only data available worldwide on same-sex female couples and their fertility choices. IVF is increasing both in absolute numbers and relative proportions year on year in the UK, compared to licensed donor insemination for same-sex female couples. As IVF has greater human and financial costs than donor insemination, policies should not encourage it as the first choice for fertile women requiring sperm. Commercial transactions are taking place where fertile lesbians receive cut price, and arguably unnecessary, IVF intervention in exchange for selling their eggs to be used for other infertile customers. If women are not told about the efficacy of fresh vs. frozen semen, and the risks of egg 'sharing' or intra-couple donation, exploitation becomes possible.
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Affiliation(s)
- Catherine Meads
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge CB1 1PT, UK
- Correspondence:
| | | | | | - Susan Bewley
- Department of Women and Children’s Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London SE1 7EH, UK;
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Ayeleke RO, Asseler JD, Cohlen BJ, Veltman‐Verhulst SM. Intra-uterine insemination for unexplained subfertility. Cochrane Database Syst Rev 2020; 3:CD001838. [PMID: 32124980 PMCID: PMC7059962 DOI: 10.1002/14651858.cd001838.pub6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Intra-uterine insemination (IUI) is a widely-used fertility treatment for couples with unexplained subfertility. Although IUI is less invasive and less expensive than in vitro fertilisation (IVF), the safety of IUI in combination with ovarian hyperstimulation (OH) is debated. The main concern about IUI treatment with OH is the increase in multiple pregnancy rates. OBJECTIVES To determine whether, for couples with unexplained subfertility, the live birth rate is improved following IUI treatment with or without OH compared to timed intercourse (TI) or expectant management with or without OH, or following IUI treatment with OH compared to IUI in a natural cycle. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL and two trials registers up to 17 October 2019, together with reference checking and contact with study authors for missing or unpublished data. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing IUI with TI or expectant management, both in stimulated or natural cycles, or IUI in stimulated cycles with IUI in natural cycles in couples with unexplained subfertility. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, quality assessment and data extraction. Primary review outcomes were live birth rate and multiple pregnancy rate. MAIN RESULTS We include 15 trials with 2068 women. The evidence was of very low to moderate quality. The main limitation was very serious imprecision. IUI in a natural cycle versus timed intercourse or expectant management in a natural cycle It is uncertain whether treatment with IUI in a natural cycle improves live birth rate compared to treatment with expectant management in a natural cycle (odds ratio (OR) 1.60, 95% confidence interval (CI) 0.92 to 2.78; 1 RCT, 334 women; low-quality evidence). If we assume the chance of a live birth with expectant management in a natural cycle to be 16%, that of IUI in a natural cycle would be between 15% and 34%. It is uncertain whether treatment with IUI in a natural cycle reduces multiple pregnancy rates compared to control (OR 0.50, 95% CI 0.04 to 5.53; 1 RCT, 334 women; low-quality evidence). IUI in a stimulated cycle versus timed intercourse or expectant management in a stimulated cycle It is uncertain whether treatment with IUI in a stimulated cycle improves live birth rates compared to treatment with TI in a stimulated cycle (OR 1.59, 95% CI 0.88 to 2.88; 2 RCTs, 208 women; I2 = 72%; low-quality evidence). If we assume the chance of achieving a live birth with TI in a stimulated cycle was 26%, the chance with IUI in a stimulated cycle would be between 23% and 50%. It is uncertain whether treatment with IUI in a stimulated cycle reduces multiple pregnancy rates compared to control (OR 1.46, 95% CI 0.55 to 3.87; 4 RCTs, 316 women; I2 = 0%; low-quality evidence). IUI in a stimulated cycle versus timed intercourse or expectant management in a natural cycle In couples with a low prediction score of natural conception, treatment with IUI combined with clomiphene citrate or letrozole probably results in a higher live birth rate compared to treatment with expectant management in a natural cycle (OR 4.48, 95% CI 2.00 to 10.01; 1 RCT; 201 women; moderate-quality evidence). If we assume the chance of a live birth with expectant management in a natural cycle was 9%, the chance of a live birth with IUI in a stimulated cycle would be between 17% and 50%. It is uncertain whether treatment with IUI in a stimulated cycle results in a lower multiple pregnancy rate compared to control (OR 3.01, 95% CI 0.47 to 19.28; 2 RCTs, 454 women; I2 = 0%; low-quality evidence). IUI in a natural cycle versus timed intercourse or expectant management in a stimulated cycle Treatment with IUI in a natural cycle probably results in a higher cumulative live birth rate compared to treatment with expectant management in a stimulated cycle (OR 1.95, 95% CI 1.10 to 3.44; 1 RCT, 342 women: moderate-quality evidence). If we assume the chance of a live birth with expectant management in a stimulated cycle was 13%, the chance of a live birth with IUI in a natural cycle would be between 14% and 34%. It is uncertain whether treatment with IUI in a natural cycle results in a lower multiple pregnancy rate compared to control (OR 1.05, 95% CI 0.07 to 16.90; 1 RCT, 342 women; low-quality evidence). IUI in a stimulated cycle versus IUI in a natural cycle Treatment with IUI in a stimulated cycle may result in a higher cumulative live birth rate compared to treatment with IUI in a natural cycle (OR 2.07, 95% CI 1.22 to 3.50; 4 RCTs, 396 women; I2 = 0%; low-quality evidence). If we assume the chance of a live birth with IUI in a natural cycle was 14%, the chance of a live birth with IUI in a stimulated cycle would be between 17% and 36%. It is uncertain whether treatment with IUI in a stimulated cycle results in a higher multiple pregnancy rate compared to control (OR 3.00, 95% CI 0.11 to 78.27; 2 RCTs, 65 women; low-quality evidence). AUTHORS' CONCLUSIONS Due to insufficient data, it is uncertain whether treatment with IUI with or without OH compared to timed intercourse or expectant management with or without OH improves cumulative live birth rates with acceptable multiple pregnancy rates in couples with unexplained subfertility. However, treatment with IUI with OH probably results in a higher cumulative live birth rate compared to expectant management without OH in couples with a low prediction score of natural conception. Similarly, treatment with IUI in a natural cycle probably results in a higher cumulative live birth rate compared to treatment with timed intercourse with OH. Treatment with IUI in a stimulated cycle may result in a higher cumulative live birth rate compared to treatment with IUI in a natural cycle.
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Affiliation(s)
- Reuben Olugbenga Ayeleke
- University of AucklandDepartment of Obstetrics and GynaecologyPrivate Bag 92019AucklandNew Zealand
| | - Joyce Danielle Asseler
- Academic Medical CenterDepartment of Obstetrics and GynaecologyMeibergdreef 9AmsterdamNetherlands1105AZ
| | - Ben J Cohlen
- Isala Clinics, Location SophiaDepartment of Obstetrics and GynaecologyDr van Heesweg 2Isala ZwolleNetherlands
| | - Susanne M Veltman‐Verhulst
- Department of Reproductive Medicine and GynecologyUniversity Medical Center UtrechtRoom F5.126, PO Box 85500,UtrechtNetherlands3508 GA
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Moreau J, Gatimel N, Simon C, Cohade C, Lesourd F, Parinaud J, Léandri R. Potential chances for natural fertility influence results of intrauterine inseminations. Eur J Obstet Gynecol Reprod Biol X 2019; 4:100058. [PMID: 31673689 PMCID: PMC6817667 DOI: 10.1016/j.eurox.2019.100058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/23/2019] [Accepted: 05/25/2019] [Indexed: 12/26/2022] Open
Abstract
Objective Intra-uterine insemination (IUI) is widely used for different indications. The aim of the present study was to evaluate the efficiency of intra-uterine insemination as a function of indication and origin of the inseminated spermatozoa. Study design The retrospective study involved 827 first attempts of IUI in 827 couples between January 2011 and July 2017 in the Toulouse university hospital. Of these, 642 used fresh sperm from the husband, 40 frozen sperm from the husband and 145 frozen sperm from donors. The measured outcome parameter was live birth rate per attempt. Results When comparing couples lacking functional gametes (due to male or female causes), to couples who could potentially conceive spontaneously, i.e. subfertile, the latter were found to have a significantly lower live birth rate (18% vs 26%; P < 0.05). Even when adjusted for demographic parameters, which differed significantly between the 2 groups (female age, percentage of women suffering from primary infertility, BMI, number of inseminated motile spermatozoa and stimulation duration), this difference remained statistically significant (OR = 0.639 [0.425-0.961]; P = 0.0316). Conclusion When compared to couples lacking functional gametes, subfertile couples have poor IUI outcomes, suggesting a hidden cause of infertility, despite no apparent differences in ovarian reserve, tubal potency, results of ovarian stimulation and normal conventional sperm parameters. Further studies are required to better characterise and identify this subgroup of women with poor IUI outcomes.
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Affiliation(s)
- Jessika Moreau
- Department of Reproductive Medicine, Toulouse University Hospital, Toulouse, France.,EA 3694 Human Fertility Research Group, Paul Sabatier University, Toulouse, France
| | - Nicolas Gatimel
- Department of Reproductive Medicine, Toulouse University Hospital, Toulouse, France.,EA 3694 Human Fertility Research Group, Paul Sabatier University, Toulouse, France
| | - Cynthia Simon
- Department of Reproductive Medicine, Toulouse University Hospital, Toulouse, France
| | - Clémentine Cohade
- Department of Reproductive Medicine, Toulouse University Hospital, Toulouse, France
| | - Florence Lesourd
- Department of Reproductive Medicine, Toulouse University Hospital, Toulouse, France
| | - Jean Parinaud
- Department of Reproductive Medicine, Toulouse University Hospital, Toulouse, France.,EA 3694 Human Fertility Research Group, Paul Sabatier University, Toulouse, France
| | - Roger Léandri
- Department of Reproductive Medicine, Toulouse University Hospital, Toulouse, France.,EA 3694 Human Fertility Research Group, Paul Sabatier University, Toulouse, France
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Kop P, van Wely M, Nap A, Mol BW, Bernardus R, Brucker MD, Janssens P, Cohlen B, Pieters J, Repping S, van der Veen F, Mochtar MH. The AID study: protocol for a randomised controlled trial of intrauterine insemination in the natural cycle compared with intracervical insemination in the natural cycle. BMJ Open 2019; 9:e026065. [PMID: 31340957 PMCID: PMC6661593 DOI: 10.1136/bmjopen-2018-026065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION At present, studies comparing intrauterine insemination in the natural cycle versus intracervical insemination in the natural cycle in women undergoing artificial insemination with donor sperm are scarce. METHODS AND ANALYSIS We perform a randomised controlled non-inferiority trial among five secondary and tertiary fertility clinics in the Netherlands and one tertiary fertility clinic in Belgium. Women eligible for artificial insemination with donor sperm are included. We perform six cycles of artificial insemination with donor sperm within a time horizon of 8 months comparing intrauterine insemination in the natural cycle with intracervical insemination in the natural cycle. The primary outcome is ongoing pregnancy leading to live birth conceived within eight months after randomisation. Secondary outcomes are clinical pregnancy rate, miscarriage rate, multiple pregnancy rate, pregnancy complications (preterm birth, birth weight <2500 g, pregnancy induced hypertension, (pre-) eclampsia, Hemolysis Elevated Liver enzymes Low Platelets (HELLP)), time to ongoing pregnancy, direct and indirect costs. To demonstrate the non-inferiority of intracervical insemination with a margin of 12%, we need 208 women per arm. ETHICS AND DISSEMINATION The study has been approved by the Medical Ethical Committee of the Academic Medical Centre and from the Dutch Central Committee on research involving human subjects (47330-018-13). The boards of the participating hospitals approved the study. Results will be disseminated through peer-reviewed publications and presentations at international scientific meetings. TRIAL REGISTRATION NUMBER NTR4462.
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Affiliation(s)
- Petronella Kop
- Center for Reproductive Medicine, Amsterdam Reproduction & Development Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Madelon van Wely
- Center for Reproductive Medicine, Amsterdam Reproduction & Development Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Annemiek Nap
- Department of Gynaecology and Obstetrics, Rijnstate, Arnhem, Gelderland, Netherlands
| | - Ben Willem Mol
- Department of Obstetrics and gynaecology, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Rob Bernardus
- Fertility clinic, Nij Barrahus, Wolvega, Netherlands
| | - Michael De Brucker
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Pim Janssens
- Clinical Chemistry and Haematology, Hospital Rijnstate, Arnhem, Gelderland, Netherlands
| | - Ben Cohlen
- Obstetrics and Gynaecology, Isala Hospitals, Zwolle, Overijssel, Netherlands
| | - Jacqueline Pieters
- Fertility clinic, Vivaneo Medisch Centrum Kinderwens, Leiderdorp, Netherlands
| | - Sjoerd Repping
- Center for Reproductive Medicine, Amsterdam Reproduction & Development Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Fulco van der Veen
- Center for Reproductive Medicine, Amsterdam Reproduction & Development Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Monique H Mochtar
- Center for Reproductive Medicine, Amsterdam Reproduction & Development Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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