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Mathyk BA, Cetin E, Youssef Y, Imudia AN, Encalada Soto D, Mikhail E, Moawad G. Beyond the surface: Does stage I-II endometriosis impact fertility? Exploring the challenges of mild disease. Best Pract Res Clin Obstet Gynaecol 2024:102501. [PMID: 38760260 DOI: 10.1016/j.bpobgyn.2024.102501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/21/2024] [Accepted: 05/02/2024] [Indexed: 05/19/2024]
Abstract
Endometriosis is one of the most common gynecologic conditions that women face throughout their lives. Despite advances in technology, diagnosis and treatment of this relapsing and remitting condition is still challenging for many women. This review focuses on literature pertaining to minimal/mild (stage I/II) endometriosis and its impact on fertility. The effectiveness of medical interventions to improve infertility and obstetric outcomes in both natural and assisted reproductive technologies cycles remains debated. The recent ESHRE guidelines suggests that operative laparoscopy could be considered for rASRM stage I/II endometriosis as it improves ongoing pregnancy rates.
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Affiliation(s)
- Begum Aydogan Mathyk
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
| | - Esra Cetin
- Department of Obstetrics and Gynecology, Hurley Medical Center, Michigan State University, 1 Hurley Plaza, Flint, MI, 48503, USA
| | - Youssef Youssef
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, 11220, USA
| | - Anthony N Imudia
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Diana Encalada Soto
- Division of Gynecologic Subspecialties, Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Emad Mikhail
- Division of Gynecologic Subspecialties, Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC, 20037, USA; The Center for Endometriosis and Advanced Pelvic Surgery, Washington, DC, 22101, USA
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Huang C, Shi Q, Xing J, Yan Y, Shen X, Shan H, Sun H, Mei J. The relationship between duration of infertility and clinical outcomes of intrauterine insemination for younger women: a retrospective clinical study. BMC Pregnancy Childbirth 2024; 24:199. [PMID: 38486148 PMCID: PMC10938817 DOI: 10.1186/s12884-024-06398-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 03/07/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The objective of this research was to elucidate the association between the length of infertility and the outcomes of intrauterine insemination (IUI) in women of varying ages - a topic that has been the subject of investigation for numerous years, yet lacks a definitive consensus. METHODS A retrospective cohort investigation involving 5268 IUI cycles was undertaken at the Reproductive Medicine Center of Nanjing Drum Tower Hospital from 2016 to 2022. Utilizing the smooth fitting curve along with threshold and saturation effect analysis, the correlation between infertility duration and IUI clinical pregnancy rates was discerned. Moreover, patients were bifurcated into two cohorts based on their respective infertility durations. A secondary examination was also performed employing propensity-score matching to mitigate the impact of confounding variables. Subsequent threshold and saturation effect analysis was carried out across various subgroups, segmented on the basis of age differentiation. RESULTS When the duration of infertility was more than 5 years, the clinical pregnancy rate decreased with the increase of infertility duration (aOR: 0.894, 95%CI: 0.817-0.991, p = 0.043). The multivariate regression analysis suggested that longer duration of infertility (≥ 5 years) was significantly correlated with the lower clinical pregnancy rate (aOR: 0.782, 95% CI: 0.643-0.950, p = 0.01). After the propensity-score matching, the clinical pregnancy rate of women with longer infertility duration were also higher. When the duration of infertility was more than 5 years, the clinical pregnancy rate of women younger than 35 years old decreased with the increase of infertility duration (aOR: 0.906, 95%CI: 0.800-0.998, p = 0.043). CONCLUSIONS The clinical pregnancy rate and live birth rate of IUI in young women (< 35 years old) who have been infertile for more than 5 years significantly decrease with the prolongation of infertility time. Therefore, for young women who have been infertile for more than 5 years, IUI may not be the best choice.
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Affiliation(s)
- Chenyang Huang
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, China
| | - Qingqing Shi
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, China
| | - Jun Xing
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, China
| | - Yuan Yan
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, China
| | - Xiaoyue Shen
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, China
| | - Huizhi Shan
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, China
| | - Haixiang Sun
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, China.
| | - Jie Mei
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, China.
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Evans MB, Hosseinzadeh P, Flannagan K, Jahandideh S, Burruss E, Peck JD, Hansen KR, Hill M, Devine K. Assessment of clinical pregnancies in up to eight ovarian stimulation with intrauterine insemination treatment cycles in those unable to proceed with in vitro fertilization. Fertil Steril 2024:S0015-0282(24)00099-2. [PMID: 38365110 DOI: 10.1016/j.fertnstert.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE To study the primary objective of clinical pregnancy (CP) rate per ovarian stimulation with intrauterine insemination (OS-IUI) treatment cycle in patients with repetitive cycles up to a maximum of 8 cycles. DESIGN Retrospective cohort. SETTING Large fertility clinic. PATIENTS A total of 37,565 consecutive OS-IUI cycles from 18,509 patients were included in this study. INTERVENTIONS Those with anovulatory diagnoses, tubal factor infertility, male factor infertility, using donor sperm, canceled cycles, and those with missing data for either baseline characteristics or outcome were excluded. The CP rate was analyzed using generalized estimating equations and controlled for age, stimulation protocol, and body mass index. MAIN OUTCOMES MEASURES Clinical pregnancy was defined as intrauterine gestation with fetal heartbeat visible on ultrasound. RESULTS A total of 37,565 consecutive OS-IUI cycles from 2002 through 2019 at a private practice facility were evaluated. All cycles met inclusion criteria and were used in generalized estimating equation modeling. Patients aged <35 years comprised 47.6% of the cohort. After adjustment for confounders, the mean predicted probability of CP for cycles one to 8 was 15.7% per cycle. The mean predicted probability of CP in aggregated data from cycles 2 to 4 was only 1.7% lower compared with cycle 1 as the referent (16.7% vs. 15.0%, 95% confidence interval [CI] 2nd: 0.88 {0.82, 0.95}, 3rd: 0.86 {0.79, 0.93}, 4th: 0.88 {0.79, 0.98}). However, the 15.0% mean predicted probability of CP for the second through the fourth cycle was concordant with the mean for all included cycles (15.7%). The mean predicted probability of CP of cycles 5 to 8 was not significantly different compared with the referent (16.7% vs. 16.1%, 95% CI 5th: 0.97 [0.85, 1.11], 6th: 0.93 [0.79, 1.10], 7th: 1.01 [0.81, 1.26], 8th: 1.01 [0.76, 1.34]). The modeling of consecutive cycles suggested that the adjusted cumulative predicted probability of CP from OS-IUI continues to increase with each of the 8 successive cycles. CONCLUSION Clinical pregnancy rates are satisfactory in up to 8 consecutive OS-IUI treatment cycles. These data are useful for counseling, especially in those patients for whom in vitro fertilization is not financially or ethically feasible.
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Affiliation(s)
- M Blake Evans
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma.
| | - Pardis Hosseinzadeh
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kerry Flannagan
- Shady Grove Fertility, Rockville, Maryland; Shady Grove Fertility, Washington, District of Columbia
| | - Samad Jahandideh
- Shady Grove Fertility, Rockville, Maryland; Shady Grove Fertility, Washington, District of Columbia
| | - Emilie Burruss
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma City
| | - Jennifer D Peck
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Karl R Hansen
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Micah Hill
- Program in Reproductive Endocrinology and Infertility, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Kate Devine
- Shady Grove Fertility, Rockville, Maryland; Shady Grove Fertility, Washington, District of Columbia
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Yu C, Bai L, Mei-Zhou J, Yu-Wang X, Chen L, Zhang J. Analysis of factors associated with IUI pregnancy outcomes in elderly and young patients. BMC Womens Health 2024; 24:86. [PMID: 38310215 PMCID: PMC10838432 DOI: 10.1186/s12905-024-02934-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/27/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVE The objective of this study was to investigate the correlation between various factors and the clinical outcomes of Intrauterine Insemination (IUI) in both young and aged patients, aiming to provide a theoretical basis for clinical consultations. METHODS This retrospective analysis examined a total of 4,221 IUI cycles conducted at the Reproductive Center of Changzhou Maternal and Child Health Hospital between January 2016 and December 2020. The patients were categorized into two groups based on age: the elder group (≥ 35 years) and the young group (< 35 years). RESULTS The findings of this study revealed a significant association between woman's age and BMI with pregnancy outcomes (0.93, 95% CI: 0.89-0.97) (1.04, 95% CI: 1.01-1.06). Moreover, in young women, both age and Body Mass Index (BMI)were found to be related to pregnancy outcomes (0.97, 95% CI: 0.89-0.97) (1.08, 95% CI: 1.01-1.06). Additionally, BMI and the number of cycles in aged IUI patients were found to be associated with pregnancy outcomes. The pregnancy rate in the second cycle was approximately 1.9 times higher than that in the first cycle (1.9, 95% CI: 0.97-3.77), and in the third cycle, it was approximately 3 times higher than that in the first cycle (3.04, 95% CI: 1.43-6.42). CONCLUSIONS In conclusion, there is an association between woman's age and BMI and the clinical outcomes of IUI. However, the number of cycles did not affect the pregnancy outcomes in young women. Conversely, in elder women, the number of cycles was found to be related to the IUI pregnancy outcomes, with significantly higher pregnancy rates observed in the second and third cycles compared to the first cycle.
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Affiliation(s)
- Chunmei- Yu
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China
| | - Lijing- Bai
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China
| | - Jian Mei-Zhou
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China
| | - Xiao Yu-Wang
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China
| | - Li Chen
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China.
| | - Jinghua- Zhang
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China.
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Taniguchi M, Kanasaki H, Oride A, Okada H, Imamura K, Kyo S. Impact of current and previous sperm findings on outcomes of intrauterine insemination. Reprod Med Biol 2024; 23:e12574. [PMID: 38590943 PMCID: PMC11000811 DOI: 10.1002/rmb2.12574] [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: 11/11/2023] [Revised: 02/01/2024] [Accepted: 03/18/2024] [Indexed: 04/10/2024] Open
Abstract
Purpose To examine the association between semen characteristics and outcomes of intrauterine insemination (IUI). Methods This retrospective analysis examined 1380 IUI procedures involving 421 couples. The association of clinical pregnancy with pre- and post-wash sperm characteristics was assessed. Results Pre- and post-wash sperm characteristics did not differ between IUI cycles that resulted in pregnancy and those that did not. When the motility of pre-wash sperm was below the normal range (<42%) established by the World Health Organization (WHO), the pregnancy rate was significantly lower. In the IUI cycles when post-wash sperm motility was below the WHO standard, pregnancy was not achieved. The frequency of improvement in post-wash sperm motility in repeated IUI cycles appeared to correlate with the success of future IUI cycles. At the fourth IUI cycle, pregnancy was not achieved unless the post-wash sperm motility was normal in at least two of three attempts. When post-wash sperm concentration was below the normal range, the woman's age did not affect the IUI outcomes. Conclusions Sperm motility above the lower limit of the WHO criteria in post-wash semen samples is an important factor in IUI outcomes.
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Affiliation(s)
- Maki Taniguchi
- Department of Obstetrics and GynecologyShimane University Faculty of MedicineIzumoJapan
| | - Haruhiko Kanasaki
- Department of Obstetrics and GynecologyShimane University Faculty of MedicineIzumoJapan
| | - Aki Oride
- Department of Obstetrics and GynecologyShimane University Faculty of MedicineIzumoJapan
| | - Hiroe Okada
- Department of Obstetrics and GynecologyShimane University Faculty of MedicineIzumoJapan
| | - Kayo Imamura
- Department of Obstetrics and GynecologyUnnan City HospitalUnnanJapan
| | - Satoru Kyo
- Department of Obstetrics and GynecologyShimane University Faculty of MedicineIzumoJapan
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Stalzer A, Seybold D, Gantt P, Broce M, Cronkright A. Anti-Müllerian Hormone: A Predictor of Successful Intrauterine Insemination. Cureus 2023; 15:e47200. [PMID: 38022255 PMCID: PMC10652159 DOI: 10.7759/cureus.47200] [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] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION The anti-Müllerian hormone (AMH) produced by the granulosa cells of ovarian follicles has been shown to correlate with ovarian reserve and is often measured for fertility therapies. In this study, we evaluated the relationship between serum AMH values and the clinical pregnancy (CP) rates of female partners with unexplained infertility undergoing intrauterine insemination utilizing varying ovarian simulation protocols. METHODS This is a retrospective cohort study conducted among couples who underwent intrauterine insemination therapy over a period of four years at Charleston Area Medical Center, a tertiary care medical center in West Virginia, USA. Logistic regression was used to determine the best predictor of CP. RESULTS A total of 509 intrauterine inseminations resulting in 81 (15.9%) Cps were analyzed. The cycles with a CP had higher mean AMH values (3.7+3.5 vs. 2.2+2.1; p<0.001). The majority of patients were nulliparous (77.0%) with a mean age of 33.6+5.0 years. After including only patients with unexplained infertility (the predominate infertility diagnosis; n=255 (50.1% of the cycles)) and stimulation cycles >10, the final sample size for the analysis was 245/509=48.1%. Following a receiver operating characteristic (ROC) curve analysis, the optimal AMH cut-off point was 2.1 ng/mL with an area under the curve (AUC) equal to 0.61 and 95% confidence intervals (CIs) of 0.55- 0.67 (p=0.002). The CP rate was significantly higher with the AMH >2.1 ng/mL (20.0%) compared to <2.1 ng/mL (10.0%; p=0.041). With Clomid/human gonadotropins/human chorionic gonadotropin (hCG) trigger treatment, the CP rate quadrupled (odds ratio (OR): 4.6; 95% CI: 2.1-9.7; p<0.001). CONCLUSION This study indicates that higher AMH levels and a more aggressive ovarian stimulation protocol for intrauterine insemination therapy (IUI) have a better probability of resulting in CP.
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Affiliation(s)
- Allison Stalzer
- Obstetrics and Gynecology, Charleston Area Medical Center/West Virginia University, Charleston, USA
| | - Dara Seybold
- Institute for Academic Medicine, Charleston Area Medical Center, Charleston, USA
| | - Pickens Gantt
- Obstetrics and Gynecology, Charleston Area Medical Center/West Virginia University, Charleston, USA
| | - Mike Broce
- Institute for Academic Medicine, Charleston Area Medical Center, Charleston, USA
| | - Ashley Cronkright
- Internal Medicine, Charleston Area Medical Center/West Virginia University, Charleston, USA
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Joseph T, Karuppusami R, Kunjummen AT, Kamath MS. Impact of tubal patency test selection on the live birth rate following intrauterine insemination in couples with unexplained infertility: a retrospective cohort study. Arch Gynecol Obstet 2023; 308:621-629. [PMID: 37310451 DOI: 10.1007/s00404-023-07091-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/30/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE We planned a study to evaluate the impact of selecting hysterosalpingography (HSG) over diagnostic laparoscopy during initial fertility evaluation on IUI treatment outcomes in couples diagnosed with unexplained infertility. METHODS The study comprised a retrospective cohort and included couples evaluated for infertility at our tertiary level hospital between January 2008 and December 2019. Couples diagnosed with unexplained infertility based on tubal patency tests (either HSG or diagnostic laparoscopy) were included. We compared outcomes following ovarian stimulation (OS) and intrauterine insemination (IUI) between women who underwent HSG versus laparoscopy for up to three treatment cycles. RESULTS A total of 7413 women were screened, out of which 1002 women were diagnosed with unexplained infertility. We did not find a significant statistical difference in the clinical pregnancy (16.7% vs. 11.7%; OR (odds ratio) 1.51; 95% CI (confidence interval) 0.90-2.5) or live birth rate per IUI cycle (15.1% vs. 10.7%; OR 1.51, 95% CI 0.9-2.6) in women who underwent HSG for tubal evaluation as compared to laparoscopy. After adjustment for potential confounders through multivariate analysis, we found that outcomes were comparable between the HSG and laparoscopy. CONCLUSION The current study did not find any significant difference in treatment outcomes following OS and IUI in women with unexplained infertility who underwent HSG compared to laparoscopy for the assessment of the tubal patency during the initial fertility workup. The finding suggests minimal or no impact of selecting HSG over diagnostic laparoscopy as a tubal patency test on the subsequent IUI outcomes.
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Affiliation(s)
- Treasa Joseph
- Department of Reproductive Medicine and Surgery, Christian Medical College Hospital, Vellore, 632004, India
| | - Reka Karuppusami
- Department of Biostatistics, Christian Medical College, Vellore, 632002, India
| | - Aleyamma T Kunjummen
- Department of Reproductive Medicine and Surgery, Christian Medical College Hospital, Vellore, 632004, India
| | - Mohan S Kamath
- Department of Reproductive Medicine and Surgery, Christian Medical College Hospital, Vellore, 632004, India.
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Gordon CE, Hammer KC, James K, Lanes A, Vagios S, Starosta A, Hornstein M, Souter I. Optimizing pregnancy outcomes in intrauterine insemination cycles by stratifying pre-wash total motile count and patient-specific factors: a patient counseling tool. J Assist Reprod Genet 2022; 39:2811-2818. [PMID: 36342575 PMCID: PMC9790824 DOI: 10.1007/s10815-022-02636-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 10/04/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this study is to clarify which pre-wash total motile count are associated with improved clinical pregnancy rate (CPR) and live birth rate (LBR) based on maternal age, AMH level, stimulation regimen, and infertility diagnosis. METHODS This was a retrospective cohort study of first completed IUI cycles at two academic fertility centers from 5/2015 to 9/2019. Cycles were stratified by pre-wash TMC, maternal age, AMH level, stimulation regimen, and infertility diagnosis. The primary outcome was CPR and secondary outcomes were live birth and miscarriage. RESULTS One thousand one hundred fifty-four cycles were analyzed. Of the 162 cycles that resulted in a CPR (14.0%), most had an insemination TMC > 20 million. Compared to TMC > 20 million, there was no difference in CPR or LBR for lower TMC categories, excluding the TMC < 2 million group, in which there were no pregnancies. When TMC was stratified by deciles, there was also no difference in CPR and LBR, including within the lowest decile (TMC 0.09-8.6 million). Younger age and higher ovarian reserve parameters were associated with higher pregnancy and LBR when stratified by TMC. There was no difference in pregnancy and LBR when considering different stimulation protocols. CONCLUSIONS Our data suggest that pregnancy and LBR are equivalent above a TMC of 2 million. Data stratified by TMC and patient parameters can be used to counsel patients pursuing ART.
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Affiliation(s)
- Catherine E. Gordon
- Brigham and Women’s Hospital Center for Infertility and Reproductive Surgery, 75 Francis St, Boston, MA 02115 USA
| | - Karissa C. Hammer
- Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital, Yawkey Suite 10a, 55 Fruit St, Boston, MA 02114 USA
| | - Kaitlyn James
- Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital, Yawkey Suite 10a, 55 Fruit St, Boston, MA 02114 USA
| | - Andrea Lanes
- Brigham and Women’s Hospital Center for Infertility and Reproductive Surgery, 75 Francis St, Boston, MA 02115 USA
| | - Stylianos Vagios
- Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital, Yawkey Suite 10a, 55 Fruit St, Boston, MA 02114 USA
| | - Anabel Starosta
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, 20 York St, New Haven, CT 06510 USA
| | - Mark Hornstein
- Brigham and Women’s Hospital Center for Infertility and Reproductive Surgery, 75 Francis St, Boston, MA 02115 USA
| | - Irene Souter
- Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital, Yawkey Suite 10a, 55 Fruit St, Boston, MA 02114 USA
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Zippl AL, Wachter A, Rockenschaub P, Toth B, Seeber B. Predicting success of intrauterine insemination using a clinically based scoring system. Arch Gynecol Obstet 2022; 306:1777-1786. [PMID: 36069921 PMCID: PMC9519724 DOI: 10.1007/s00404-022-06758-z] [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] [Received: 05/06/2022] [Accepted: 08/16/2022] [Indexed: 11/28/2022]
Abstract
Purpose To develop a predictive score for the success of intrauterine insemination (IUI) based on clinical parameters. Methods We performed a retrospective cohort study evaluating the homologous IUI cycles performed at a single university-based reproductive medical center between 2009 and 2017. The primary outcome measure was pregnancy, defined as positive serum human chorionic gonadotropin (hCG) 12–14 days after IUI. Predictive factors for pregnancy after IUI were identified, and a predictive score was developed using a multivariable continuation ratio model. Results Overall, 1437 IUI cycles in 758 couples were evaluated. We found a per cycle pregnancy rate of 10.9% and a cumulative pregnancy rate of 19.4%. In a multivariable analysis, the probability of pregnancy was negatively associated with female age ≥ 35 years (OR 0.63, 95% CI 0.41–0.97, p = 0.034), endometriosis, unilateral tubal factor, or anatomical alteration (OR 0.54, 95% CI 0.33–0.89, p = 0.016), anti-Mullerian hormone (AMH) < 1 ng/ml (OR 0.50, 95% CI 0.29–0.87, p = 0.014), and total progressive motile sperm count (TPMSC) < 5 mil (OR 0.47, 95% CI 0.19–0.72, p = 0.004). We developed a predictive clinical score ranging from 0 to 5. Following 3 cycles, couples in our cohort with a score of 5 had a cumulative probability of achieving pregnancy of nearly 45%. In contrast, couples with a score of 0 had a cumulative probability of only 5%. Conclusion IUI success rates vary widely depending on couples’ characteristics. A simple to use score could be used to estimate a couple’s chance of achieving pregnancy via IUI, facilitating individualized counseling and decision-making.
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Affiliation(s)
- Anna Lena Zippl
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Alfons Wachter
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | | | - Bettina Toth
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Beata Seeber
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Oxidative Stress and Human Ovarian Response—From Somatic Ovarian Cells to Oocytes Damage: A Clinical Comprehensive Narrative Review. Antioxidants (Basel) 2022; 11:antiox11071335. [PMID: 35883826 PMCID: PMC9311552 DOI: 10.3390/antiox11071335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022] Open
Abstract
Basic scientific research on human reproduction and oxidative damage has been extensively performed; however, a more clinical view is still lacking. As a result, exhaustive data on the influence of oxidative stress on human ovarian response and, consequently, on fertility are still lacking. This narrative review aims at summarizing the role of oxidative stress in different conditions associated to female infertility and to list some of the main antioxidant agents. A systematic literature search was performed in May 2022 to retrieve studies regarding the oxidative stress and the human ovarian response from somatic ovarian cells to oocytes damage. Only human studies were included and the authors focused their review, in particular, on clinical implications in order to define a new research perspective on the assessment of any eventual strategy to preserve women’s fertility. Thereby, the authors evaluated the contribution of DNA repair pathways in improving women’s fertility by reducing the DNA damage associated with aging or diseases, such as endometriosis or polycystic ovary syndrome, and eventually, in prolonging the reproductive lifespan after cancer treatment.
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Meitei HY, Uppangala S, Lakshmi RV, Guddattu V, Hegde P, Kumar P, Adiga P, Kalthur G, Schlatt S, Adiga SK. Sperm characteristics in normal and abnormal ejaculates are differently influenced by length of ejaculatory abstinence. Andrology 2022; 10:1351-1360. [PMID: 35776678 DOI: 10.1111/andr.13222] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 05/06/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND No association between the length of ejaculatory abstinence (LEA) and semen characteristics has been confirmed. A short LEA has been linked to improved sperm characteristics and a higher pregnancy rate, but its negative influence on sperm chromatin maturity and longevity may adversely affect reproductive outcomes. OBJECTIVES We sought to determine the influence of LEA on: (i) semen parameters in normozoospermic and abnormal ejaculates; and (ii) the outcomes of sperm-preparation methods in a large number of sub-fertile men undergoing infertility workups. MATERIALS AND METHODS This retrospective registry-based cohort study analyzed the data of 10,674 ejaculates from 7,972 sub-fertile men, who were then segregated into normozoospermic, oligozoospermic, asthenozoospermic, and oligo-asthenozoospermic cohorts. Variations in semen characteristics and post-wash outcomes were studied between 4 LEA intervals across 0-15 days. RESULTS An age-adjusted analysis of covariance (ANCOVA) model linked significant increases in ejaculate volume, sperm concentration (except in the oligozoospermic cohort), and total sperm number to an increased LEA (p < 0.05). LEA was negatively associated with motility (except in the asthenozoospermic cohort) and vitality (p < 0.05). Large-headed spermatozoa were less common with an increased LEA only in the oligoasthenozoopermic cohort (p < 0.05). In the normozoospermic cohort, a longer LEA led to fewer sperm with amorphous heads but more sperm with tapered heads and cytoplasmic droplets (p < 0.05). LEA extension resulted in greater sperm DNA fragmentation in the abnormal cohort (p < 0.01). The post-wash sperm concentration and total motile sperm count were significantly improved with a longer LEA in the normozoopsermic cohort (p < 0.05). DISCUSSION AND CONCLUSION Considering the findings in this study and existing literature, a generalized recommendation for long LEA has no clinical value. The LEA should be individualized based on the ejaculate profile and the need for specific clinical intervention. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Huidrom Yaiphaba Meitei
- Department of Reproductive Science, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Shubhashree Uppangala
- Department of Reproductive Science, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India
| | - R Vani Lakshmi
- Department of Data Science, Prasanna School of Public health, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Vasudeva Guddattu
- Department of Data Science, Prasanna School of Public health, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Padmaraj Hegde
- Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Pratap Kumar
- Department of Reproductive Medicine and Surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Prashanth Adiga
- Department of Reproductive Medicine and Surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Guruprasad Kalthur
- Department of Reproductive Science, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Stefan Schlatt
- Centre of Reproductive Medicine and Andrology (CeRA), University of Münster, Münster, Germany
| | - Satish Kumar Adiga
- Department of Reproductive Science, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India
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12
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Nesbit CB, Blanchette-Porter M, Esfandiari N. Ovulation induction and intrauterine insemination in women of advanced reproductive age: a systematic review of the literature. J Assist Reprod Genet 2022; 39:1445-1491. [PMID: 35731321 PMCID: PMC9365895 DOI: 10.1007/s10815-022-02551-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022] Open
Abstract
PURPOSE The objective of this review is to define live birth rate (LBR) and clinical pregnancy rate (CPR) for women ≥ 40 undergoing ovulation induction (OI)/intrauterine insemination (IUI). METHODS A systematic review was performed in accordance with PRISMA guidelines using PubMed and Google Scholar. The primary and secondary outcomes of interest were LBR and CPR, respectively. RESULTS There were 636 studies screened of which 42 were included. In 8 studies which provided LBR for partner sperm, LBR/cycle ranged from 0 to 8.5% with majority being ≤ 4%. Cumulative LBR was 3.6 to 7.1% over 6 cycles with the majority of pregnancies in the first 4. In the four studies providing LBR for donor sperm cycles, LBR/cycle ranged from 3 to 7% with cumulative LBR of 12 to 24% over 6 cycles. The majority of pregnancies occurred in the first 6 cycles. There were three studies with LBR or CPR/cycle ≥ 1% for women ≥ 43. No studies provided data above this range for women ≥ 45. In 4 studies which compared OI/IUI and IVF, the LBR from IVF was 9.2 to 22% per cycle. In 7 studies which compared outcomes by stimulation protocol, no significant differences were seen. CONCLUSION For women ≥ 40 using homologous sperm, the highest probability of live birth is via IVF. However, if IVF is not an option, OI/IUI may be considered for up to 4 cycles in those using partner sperm or 6 cycles with donor sperm. For women > 45, OI/IUI is likely futile but a limited trial may be considered for psychological benefit while encouraging consideration of donor oocyte IVF or adoption. Use of gonadotropins does not appear to be more effective than oral agents in this age group.
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Affiliation(s)
- Carleigh B Nesbit
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT, 05401, USA
- The Robert Larner College of Medicine at the University of Vermont, Burlington, VT, 05405, USA
| | - Misty Blanchette-Porter
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT, 05401, USA
- The Robert Larner College of Medicine at the University of Vermont, Burlington, VT, 05405, USA
| | - Navid Esfandiari
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT, 05401, USA.
- The Robert Larner College of Medicine at the University of Vermont, Burlington, VT, 05405, USA.
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Milosavljević JZ, Milosavljević MN, Arsenijević PS, Milentijević MN, Stefanović SM. The effects of selective serotonin reuptake inhibitors on male and female fertility: a brief literature review. Int J Psychiatry Clin Pract 2022; 26:43-49. [PMID: 33480810 DOI: 10.1080/13651501.2021.1872647] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: The aim of this review was to determine whether selective serotonin reuptake inhibitors (SSRIs) affect the ability to conceive in men and women of reproductive age, as well as to find out whether there are certain differencies between them in terms of effects on fertility. Methods: Our review was based on systematic search of literature in four online databases: Medline (PubMed), Scopus, Web of Science and SCIndex (Serbian Citation Index). Results: Several clinical studies reported that SSRIs can decrease the number and viability of sperm, and cause a disruption of their morphological structure. Regarding the effect of these antidepressants on female fertility, some experimental findings suggest that paroxetine and escitalopram may have a negative effect on the ability to conceive due to their stimulatory effect on fallopian tube motility. However, several observational studies favor the use of SSRIs in women with depression/anxiety undergoing in vitro fertilization (IVF) given their efficiency in suppressing these unpleasant symptoms without a relevant negative impact on IVF outcomes. Conclusions: SSRIs should be avoided male patients of reproductive age who wish to conceive, while the use of these antidepressants seems to be justified in women with depression or anxiety who have undergone IVF.Key pointsSSRIs could cause dose and duration-dependent reversible adverse effects on male fertility parameters.In depressed or anxious male patients of reproductive age who wish to conceive mirtazapine or bupropion should be used because of their lower potential to cause sexual side effects.The results of certain experimental studies indicate that paroxetine and escitalopram may have a negative effect on the fertility of female patients.The use of SSRIs in women with depression or anxiety who have undergone IVF seems to be justified, because these psychiatric disorders reduce the likelihood of becoming pregnant.
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Affiliation(s)
- Jovana Z Milosavljević
- Department of Anatomy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Miloš N Milosavljević
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Petar S Arsenijević
- Department of Gynecology and Obstetrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Milica N Milentijević
- Department of Infectology, School of Medicine, University of Priština, Priština, Serbia
| | - Srđan M Stefanović
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Kunjummen A, Sarkar S, Joseph T, Yadav B, Kamath M. Comparison of treatment outcomes following ovarian stimulation with intrauterine insemination in minimal or mild endometriosis versus unexplained infertility: A retrospective cohort study. J Hum Reprod Sci 2022; 15:272-277. [DOI: 10.4103/jhrs.jhrs_102_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/10/2022] [Accepted: 09/11/2022] [Indexed: 11/04/2022] Open
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15
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He W, Chen S, Huang J, Zhang X, Hu L, Xue Z, Qiu Y. Association Between Type of Infertility and Live Birth in Couples With a Single Intrauterine Insemination Resulting in Pregnancy: A Propensity Score Matching Cohort Study. Front Endocrinol (Lausanne) 2022; 13:926183. [PMID: 35909526 PMCID: PMC9329630 DOI: 10.3389/fendo.2022.926183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Few studies have described the relationship between the type of infertility and live birth in patients treated with intrauterine insemination (IUI). We focused on this issue and attempted to explore it. METHODS This retrospective study enrolled 2,256 infertile patients who underwent their first IUI cycle and were subsequently diagnosed with a clinical pregnancy at Ji'an Women and Child Health Care Hospital between 2007 and 2018. Inductees were divided into primary infertility (1,680 patients) and secondary infertility groups (876 patients). Following 1:1 propensity score matching to obtain balanced data, the COX proportional hazards model, landmark analysis, and subgroup analysis were used to assess the association between infertility types and live birth rates. Subsequently, a sensitivity analysis was employed to evaluate the potential effect of unmeasured confounding on outcomes. RESULTS Of the 1,486 patients who were identified as a matched cohort, 743 were in the primary infertility group and the remaining patients were in another group. A total of 1,143 patients had live births during 431,009 person-days of follow-up (average 290.0 days). Throughout the follow-up period, patients with secondary infertility demonstrated more live births than patients with primary infertility (hazard ratio [HR], 1.16; 95% confidence interval [CI], 1.04 to 1.30; P = .007). More details were observed in the landmark analysis. Live birth rates were similar in both groups within 316 days of follow-up (HR, 0.84; 95% CI, 0.62 to 1.14; P = .269), whereas the opposite was found between 316 days of follow-up and delivery day (HR, 1.19; 95% CI, 1.06 to 1.34; P = .004). This was also obtained in a subgroup analysis of patients younger than 35 years old and patients treated with natural cycles (NCs) and IUIs. CONCLUSION Among the infertile patients who underwent a single natural or stimulated cycle followed by IUI and had later pregnancies, full-term young secondary infertility mothers (<35 years of age) had a greater chance of having viable babies than the primary infertility ones. The latter may get more benefits when undergoing ovarian stimulation and IUI rather than NC-IUI.
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Affiliation(s)
- Wen He
- Department of Regenerative Medicine, Tongji University School of Medicine, Shanghai, China
| | - Song Chen
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jianping Huang
- Reproductive Medicine Center, Ji’an Women and Child Health care Hospital, Jiangxi, China
| | - Xiaofang Zhang
- Reproductive Medicine Center, Ji’an Women and Child Health care Hospital, Jiangxi, China
| | - Lili Hu
- Reproductive Medicine Center, Ji’an Women and Child Health care Hospital, Jiangxi, China
| | - Zhigang Xue
- Department of Regenerative Medicine, Tongji University School of Medicine, Shanghai, China
- Reproductive Medicine Center, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Zhigang Xue, ; Yu Qiu,
| | - Yu Qiu
- Reproductive Medicine Center, Ji’an Women and Child Health care Hospital, Jiangxi, China
- *Correspondence: Zhigang Xue, ; Yu Qiu,
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16
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Madhuri MS, Thyagaraju C, Naidu A, Dasari P. The effect of endometrial scratching on pregnancy rate after failed intrauterine insemination: A Randomised Controlled Trail. Eur J Obstet Gynecol Reprod Biol 2021; 268:37-42. [PMID: 34798531 DOI: 10.1016/j.ejogrb.2021.10.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 09/07/2021] [Accepted: 10/24/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Endometrial injury (ES) has been suggested as intervention to increase probability of pregnancy in women undergoing assisted reproductive technologies. Majority of studies reported that ES improves outcome in Invitro fertilisation,Intrauterine Insemination(IUI) and natural conceptions: however, the size and quality of studies are poor which questions the presence of any beneficial effect. The present study was done to evaluate the effect of endometrial scratching on pregnancy rate after previous failed Intrauterine Insemination and to assess the pain and bleeding following the procedure. MATERIAL AND METHODS Randomized controlled trial. One hundred sixty-eight women (Eighty-four in each group) with primary/secondary infertility were recruited and randomized into intervention and control group using block randomization. Intervention group underwent ES using pipelle's canula on D8 or D9 of menstrual cycle. Three cycles of ovulation induction with Clomiphene citrate and gonadotrophins followed by IUI was done. The primary end point was clinical pregnancy rate. Pain and bleeding after the procedure were evaluated as secondary outcomes.The study was conducted from June 2017 to June 2019. MAIN RESULTS The cumulative clinical pregnancy rate in ES group was 22.2 % in comparison 9.8 % in control group. In the intent to treat analysis, with a p value of 0.03 calculated from Chi-square test(p < 0.05) there was statistically significant difference in the pregnancy rate between Intervention and Control group. Efficacy of intervention was found to be Fourteen Percent (14 %). Fifty-one women (63 %) had marked a VAS pain score of 4-5 and Twelve women(12.2 %) experienced mild spotting post procedure. Two patients in ES group had miscarriage and no case of multiple pregnancy in both the groups. CONCLUSION Endometrial Scratching improves clinical pregnancy rate in patients with Unexplained infertility and mild male factor infertility with previous failed IUI cycles. ES will be an inexpensive alternative to IVF for couples after IUI failures especially in developing countries, with an acceptable pregnancy rate and does not demand any special qualification or equipment and can be trained easily in primary settings. Larger and adequately powered studies are needed to elucidate the beneficial effects of endometrial scratching on implantation.
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Affiliation(s)
- M S Madhuri
- Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India
| | - Chitra Thyagaraju
- Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India.
| | - Archana Naidu
- Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India
| | - Papa Dasari
- Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India
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17
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Vatsa R, Sethi A. Impact of endometriosis on female fertility and the management options for endometriosis-related infertility in reproductive age women: a scoping review with recent evidences. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2021. [DOI: 10.1186/s43043-021-00082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Endometriosis is a chronic inflammatory condition with varied presentation, which ultimately leads to chronic pelvic pain and infertility. It is a psychological and economic burden to the women and their families.
Main body of abstract
The literature search was performed on the following databases: MEDLINE, Google Scholar, Scopus, EMBASE, Global health, the COCHRANE library, and Web of Science. We searched the entirety of those databases for studies published until July 2020 and in English language. The literature search was conducted using the combination of the Medical Subject heading (MeSH) and any relevant keywords for “endometriosis related infertility and management” in different orders. The modalities of treatment of infertility in these patients are heterogeneous and inconclusive among the infertility experts. In this article, we tried to review the literature and look for the evidences for management of infertility caused by endometriosis. In stage I/II endometriosis, laparoscopic ablation leads to improvement in LBR. In stage III/IV, operative laparoscopy better than expectant management, to increase spontaneous pregnancy rates. Repeat surgery in stage III/IV rarely increases fecundability as it will decrease the ovarian reserve, and IVF will be better in these patients. The beneficial impact of GnRH agonist down-regulation in ART is undisputed. Dienogest is an upcoming and new alternative to GnRH agonist, with a better side effect profile. IVF + ICSI may be beneficial as compared to IVF alone. Younger patients planned for surgery due to pain or any other reason should be given the option of fertility preservation.
Short conclusion
In women with endometriosis-related infertility, clinician should individualize management, with patient-centred, multi-modal, and interdisciplinary integrated approach.
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18
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Butts SF. Health disparities of African Americans in reproductive medicine. Fertil Steril 2021; 116:287-291. [PMID: 34253327 DOI: 10.1016/j.fertnstert.2021.06.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 02/04/2023]
Abstract
The first paper describing an association between African American race, infertility prevalence, and outcomes of fertility treatments was published more than 20 years ago, calling initial attention to differences in how infertility is experienced, diagnosed, and managed in African Americans. Since that initial publication, multiple other studies have explored African American race and its association with elements of the fertility spectrum-disparities that have been durable over time. The goal of this review is to provide an overview of the evolution of aspects of this research focusing on the outcomes of infertility treatments and barriers to access. A consideration of the system-based practice issues that interface with timely fertility evaluation and treatment in ways that challenge reproductive health equity will be presented.
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Affiliation(s)
- Samantha F Butts
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania.
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19
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Mohammadi F, Mehdinia Z, Ghasemi S, Zolfaghari Z, Amjadi FS, Ashrafi M, Zandieh Z. Relationship between sperm parameters and clinical outcomes of Intra Uterine Insemination (IUI). CASPIAN JOURNAL OF INTERNAL MEDICINE 2021; 12:70-76. [PMID: 33680401 PMCID: PMC7919170 DOI: 10.22088/cjim.12.1.70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Intrauterine insemination (IUI) is a widely utilized method for treating the infertile couples. The aim of the present study was to determine the pregnancy and abortion rates after IUI and to examine the relationship of sperm parameters with these rates. Methods: This retrospective study was performed on 911 infertile couples undergoing IUI treatment in Shahid Akbarabadi IVF Centre from May 2017 to May 2019. To evaluate the correlation of sperm parameters with the clinical pregnancy and abortion rates, odds ratio (OR) with 95% confidence intervals (CI) was calculated. Results: In this study, the pregnancy rate following IUI was 15.7% (143/911), and among women who achieved pregnancy, the abortion rate was 42.0% (60/143). According to the multiple logistic regression analysis, none of the sperm parameters was associated with the pregnancy rate. Couples with either male or female factor infertility etiologies were more likely to get pregnant than those with unexplained infertility. Regarding the abortion rate, multiple logistic regression analysis revealed that normal sperm count was related to a lower abortion rate (adjusted OR=0.25, 95% CI=0.07–0.91). Conclusion: The present study did not reveal a significant relationship between none of the sperm parameters and pregnancy rate after IUI treatment. However, among women who got pregnant, continuation of the pregnancy was associated with the normal sperm count. Furthermore, analysis of all semen parameters together in comparison to one parameter alone might be more accurate to predict pregnancy or abortion. Further prospective cohort studies with a large number of couples are required.
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Affiliation(s)
- Fatemeh Mohammadi
- Department of Anatomy, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.,These two authors contributed equally to this article
| | - Zohreh Mehdinia
- Department of Anatomy, Faculty of Medicine, International campus, Iran University of Medical Sciences, Tehran, Iran.,These two authors contributed equally to this article
| | - Samaneh Ghasemi
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Science, Tehran, Iran
| | - Zahra Zolfaghari
- Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Fatemeh Sadat Amjadi
- Department of Anatomy, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Science, Tehran, Iran
| | - Mahnaz Ashrafi
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Science, Tehran, Iran
| | - Zahra Zandieh
- Department of Anatomy, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Science, Tehran, Iran
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20
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Ranjbari S, Khatibi T, Vosough Dizaji A, Sajadi H, Totonchi M, Ghaffari F. CNFE-SE: a novel approach combining complex network-based feature engineering and stacked ensemble to predict the success of intrauterine insemination and ranking the features. BMC Med Inform Decis Mak 2021; 21:1. [PMID: 33388057 PMCID: PMC7778826 DOI: 10.1186/s12911-020-01362-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 12/03/2020] [Indexed: 01/22/2023] Open
Abstract
Background Intrauterine Insemination (IUI) outcome prediction is a challenging issue which the assisted reproductive technology (ART) practitioners are dealing with. Predicting the success or failure of IUI based on the couples' features can assist the physicians to make the appropriate decision for suggesting IUI to the couples or not and/or continuing the treatment or not for them. Many previous studies have been focused on predicting the in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) outcome using machine learning algorithms. But, to the best of our knowledge, a few studies have been focused on predicting the outcome of IUI. The main aim of this study is to propose an automatic classification and feature scoring method to predict intrauterine insemination (IUI) outcome and ranking the most significant features. Methods For this purpose, a novel approach combining complex network-based feature engineering and stacked ensemble (CNFE-SE) is proposed. Three complex networks are extracted considering the patients' data similarities. The feature engineering step is performed on the complex networks. The original feature set and/or the features engineered are fed to the proposed stacked ensemble to classify and predict IUI outcome for couples per IUI treatment cycle. Our study is a retrospective study of a 5-year couples' data undergoing IUI. Data is collected from Reproductive Biomedicine Research Center, Royan Institute describing 11,255 IUI treatment cycles for 8,360 couples. Our dataset includes the couples' demographic characteristics, historical data about the patients' diseases, the clinical diagnosis, the treatment plans and the prescribed drugs during the cycles, semen quality, laboratory tests and the clinical pregnancy outcome. Results Experimental results show that the proposed method outperforms the compared methods with Area under receiver operating characteristics curve (AUC) of 0.84 ± 0.01, sensitivity of 0.79 ± 0.01, specificity of 0.91 ± 0.01, and accuracy of 0.85 ± 0.01 for the prediction of IUI outcome. Conclusions The most important predictors for predicting IUI outcome are semen parameters (sperm motility and concentration) as well as female body mass index (BMI).
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Affiliation(s)
- Sima Ranjbari
- School of Industrial and Systems Engineering, Tarbiat Modares University, Tehran, Iran
| | - Toktam Khatibi
- School of Industrial and Systems Engineering, Tarbiat Modares University, Tehran, Iran.
| | - Ahmad Vosough Dizaji
- Department of Genetics At Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Hesamoddin Sajadi
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mehdi Totonchi
- Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran. .,Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
| | - Firouzeh Ghaffari
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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21
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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: 23] [Impact Index Per Article: 5.8] [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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Delaroche L, Caillou H, Lamazou F, Genauzeau E, Meicler P, Oger P, Dupont C, Humaidan P. Live birth after intrauterine insemination: is there an upper cut-off for the number of motile spermatozoa inseminated? Reprod Biomed Online 2020; 42:S1472-6483(20)30522-8. [PMID: 34756398 DOI: 10.1016/j.rbmo.2020.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
RESEARCH QUESTION To date, most studies have investigated the minimum number of spermatozoa available for intrauterine insemination (IUI), with no data on the maximum number of motile spermatozoa inseminated (NMSI) having been published. This study aimed to determine whether an upper cut-off for the NMSI during IUI exists above which the live birth rate (LBR) is negatively affected. DESIGN Retrospective analysis of autologous IUI cycles performed between January 2010 and July 2018 in women <43 years old with a NMSI >1 million. The main outcome was the LBR per IUI cycle as a function of the NMSI. RESULTS A total of 2592 IUI cycles performed in 1017 couples were included. The LBR increased with NMSI up to 30 million without any upper threshold (AUC = 0.5441). The LBR per IUI cycle were 14.5%, 17.9% and 22.7% for NMSI of >1 to ≤10, >10 to ≤20 and >20 to ≤30 million, respectively (P = 0.003). By univariate analysis, the NMSI, female age, number of mature follicles and oestradiol concentrations on day of ovulation triggering, cycle number and infertility aetiology influenced the LBR. Multivariate analysis showed that the LBR was 1.49 and 1.78 times higher when IUI was performed with a NMSI >10 to ≤20 million (odds ratio [OR] 1.49; 95% confidence interval [CI] 1.10-2.02]) and >20 to ≤30 million (OR 1.78; 95% CI 1.08-2.94), respectively, compared with IUI with a NMSI >1 to ≤10 million. CONCLUSIONS The LBR after IUI can be optimized by inseminating a maximum of motile spermatozoa up to 30 million. Thus, in this specific cohort, IUI preparations should not be diluted when more than 10 million motile spermatozoa are obtained.
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Affiliation(s)
- Lucie Delaroche
- Ramsay Générale de Santé, Hôpital Privé de Parly 2, Institut Fertilité Maternité Parly 2, 21 Rue Moxouris, Le Chesnay 78150, France; Centre de Biologie Médicale, Hôpital Privé de Parly 2, 21 Rue Moxouris, Le Chesnay 78150, France.
| | - Hugo Caillou
- Capionis, 80b Rue Paul Camelle, Bordeaux 33100, France
| | - Frédéric Lamazou
- Ramsay Générale de Santé, Hôpital Privé de Parly 2, Institut Fertilité Maternité Parly 2, 21 Rue Moxouris, Le Chesnay 78150, France
| | - Emmanuel Genauzeau
- Ramsay Générale de Santé, Hôpital Privé de Parly 2, Institut Fertilité Maternité Parly 2, 21 Rue Moxouris, Le Chesnay 78150, France; Centre de Biologie Médicale, Hôpital Privé de Parly 2, 21 Rue Moxouris, Le Chesnay 78150, France
| | - Philippe Meicler
- Ramsay Générale de Santé, Hôpital Privé de Parly 2, Institut Fertilité Maternité Parly 2, 21 Rue Moxouris, Le Chesnay 78150, France
| | - Pierre Oger
- Ramsay Générale de Santé, Hôpital Privé de Parly 2, Institut Fertilité Maternité Parly 2, 21 Rue Moxouris, Le Chesnay 78150, France
| | - Charlotte Dupont
- Sorbonne Université, Saint Antoine Research Centre, INSERM équipe Lipodystrophies Génétiques et Acquises, Service de Biologie de la Reproduction-CECOS, AP-HP, Hôpital Tenon, Paris F-75020, France
| | - Peter Humaidan
- Fertility Clinic, Skive Regional Hospital, Resenvej 25, 7800 Skive, Denmark and Faculty of Health, Aarhus University, Aarhus, Denmark
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Effect of ejaculatory abstinence period on sperm DNA fragmentation and pregnancy outcome of intrauterine insemination cycles: A prospective randomized study. Arch Gynecol Obstet 2020; 303:269-278. [PMID: 32902676 DOI: 10.1007/s00404-020-05783-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/31/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE To evaluate the effect of the ejaculatory abstinence period on sperm DNA fragmentation and pregnancy rates in IUI cycles. METHODS One hundred and twenty couples with unexplained infertility were prospectively randomized into two groups on the second day of their cycle. In group A, patients had 1-day ejaculatory abstinence period; in group B patients had 3-day ejaculatory abstinence period. Each patient was stimulated with gonadotropins, and IUI was performed. The primary outcome measure was clinical pregnancy and sperm DNA fragmentation rate. RESULTS The pregnancy rate was 17.3% and 18.5% in group A and group B, respectively. No significant difference was found among the groups (p = 0.803). The sperm DNA fragmentation rate for group A (20.71 ± 11.01) and group B (23.78 ± 12.64) were almost similar (p = 0.187). The sperm DNA fragmentation rate was 24.89 ± 12.89 in pregnant couples and 21.71 ± 11.69 in non-pregnant couples (p = 0.288). CONCLUSION Even after a short abstinence period of 1 day, compared to the standard abstinence period of 3 days, pregnancy rates are similar among unexplained infertility couples undergoing ovarian stimulation and IUI. CLINICALTRIALS The study was registered at ClinicalTrials.gov with ID NCT04361292. Date of registration: 27 April 2020. The study was registered retrospectively.
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Immediata V, Patrizio P, Parisen Toldin MR, Morenghi E, Ronchetti C, Cirillo F, Baggiani A, Albani E, Levi-Setti PE. Twenty-one year experience with intrauterine inseminations after controlled ovarian stimulation with gonadotropins: maternal age is the only prognostic factor for success. J Assist Reprod Genet 2020; 37:1195-1201. [PMID: 32215826 DOI: 10.1007/s10815-020-01752-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/17/2020] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To report our experience on homologous intrauterine insemination (IUI) with gonadotropin controlled ovarian stimulation (COS) cycles and to examine different variables which could predict IUI success. MATERIALS AND METHODS This is a retrospective analysis of IUIs performed between January 1997 and December 2017. A total of 7359 COS IUI's procedures (2901 couples) were reviewed. Clinical pregnancy, live birth rate and age, body mass index (BMI), smoking habit, duration of infertility, sperm characteristics before and after treatment (total motile count, morphology, and vitality), day 3 FSH, total gonadotropin dose, and number of follicles were assessed by multivariate logistic regression analysis, and data were expressed as odds ratio (OR). RESULTS The mean female age at the time of COS was 35.10 ± 3.93 years. The most common single infertility diagnoses were unexplained infertility (53.55%), mild male factor (19.69%), and anovulation (10.95%). The total progressive motile sperm count (TPMC) was > 1 × 106/ml (mean 1.34 ± 1.08 × 106/ml). The clinical pregnancy rate was 9.38%, and the live birth rate was 7.19% per cycle. Twin pregnancies were 12.17%. Cumulative pregnancy was 21.89% and cumulative live birth rate was 17.58% per couple. Clinical pregnancy and live birth rates were significantly associated with female age [OR 0.97 (95% CI 0.95-0.99) and 0.95 (95% CI 0.93-0.97), respectively] and day 3 FSH [OR 0.91 (95% CI 0.87-0.94) e 0.90 (95% CI 0.87-0.94), respectively]. CONCLUSIONS Clinical pregnancy rate and live birth rates after COS-IUIs were significantly influenced by female age and FSH levels. TRIAL REGISTRATION Clinical trial registration number: NCT03836118.
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Affiliation(s)
- Valentina Immediata
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Humanitas Fertility Center, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Pasquale Patrizio
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, Yale University, New Haven, CT, USA
| | - Maria Rosaria Parisen Toldin
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Humanitas Fertility Center, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Emanuela Morenghi
- Biostatistics Unit, Humanitas Cinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Camilla Ronchetti
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Humanitas Fertility Center, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Federico Cirillo
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Humanitas Fertility Center, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Annamaria Baggiani
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Humanitas Fertility Center, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Elena Albani
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Humanitas Fertility Center, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Paolo Emanuele Levi-Setti
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Humanitas Fertility Center, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy. .,Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, Yale University, New Haven, CT, USA.
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Vargas-Tominaga L, Alarcón F, Vargas A, Bernal G, Medina A, Polo Z. Associated factors to pregnancy in intrauterine insemination. JBRA Assist Reprod 2020; 24:66-69. [PMID: 31693317 PMCID: PMC6993163 DOI: 10.5935/1518-0557.20190060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective To define the factors associated with clinical pregnancy after intrauterine insemination. Methods Retrospective study involving 633 infertility couples, which made up to 1053 cycles of intrauterine insemination. We analyzed the clinical pregnancy rate associated with different factors through the Chi-square test or Fisher's exact test. Results The clinical pregnancy rate was 8.2% per insemination cycle and 13.6% per treated couple. The factors with greater association to clinical pregnancy were to have more than two follicles, to perform the procedure without difficulty, to have 3 years or less of infertility, cervical factor as indication, use of gonadotropins and age less than 38 years. Conclusion Intrauterine insemination requires to be accompanied by proper selection and couples' preparation.
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Affiliation(s)
| | | | - Andrea Vargas
- Centro de Fertilidad y Ginecología del Sur, Cusco, Peru
| | - Gaby Bernal
- Centro de Fertilidad y Ginecología del Sur, Cusco, Peru
| | - Andrea Medina
- Centro de Fertilidad y Ginecología del Sur, Cusco, Peru
| | - Zarela Polo
- Centro de Fertilidad y Ginecología del Sur, Cusco, Peru
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Predictive factors for pregnancy after controlled ovarian stimulation and intrauterine insemination: A retrospective analysis of 4146 cycles. J Gynecol Obstet Hum Reprod 2019; 48:811-815. [DOI: 10.1016/j.jogoh.2019.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/26/2019] [Accepted: 05/02/2019] [Indexed: 11/18/2022]
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Bonow MP, Donne RDD, Rosa VBD, Lucca JA, Hillesheim CM, Schuffner A. Intrauterine insemination as a primary viable option to infertile couples: evaluation of patients in a private center. JBRA Assist Reprod 2019; 23:328-332. [PMID: 31050962 PMCID: PMC6798586 DOI: 10.5935/1518-0557.20190014] [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] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE This study aimed to identify which parameters positively affect the clinical pregnancy rates of IUI cycles and find which couples should opt for IUI. METHODS This retrospective observational study included 261 patients submitted to 381 IUI cycles with fresh or cryopreserved partner semen (IU-H) from January 2012 to February 2017 in a private center in Curitiba-PR, Brazil. RESULTS Idiopathic infertility was the most frequent finding (35.9%). Patients younger than 40 years accounted for 87.9% of the IUI cycles (n=335) and 16.1% of the clinical pregnancies (n=54). The pregnancy rate was three times higher in patients with an endometrium thickness ≥8 mm compared to patients with endometrium thickness <8mm. Sperm motility >55% was linked to higher pregnancy rates (p=0.002). Concerning gonadotropins, 159 (48.4%) took rFSH, 127 (38.7%) hMG, and 42 (12.8%) uFSH, with pregnancy rates of 21.3%, 10.4% and 10.5%, respectively. CONCLUSION Patients under 40 years of age with endometrium thickness ≥8 mm, sperm motility >55%, and on rFSH had significantly higher pregnancy rates (p<0.05).
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Affiliation(s)
- Marília Porto Bonow
- Gynecology and Obstetrics Post Graduation Program of Federal University of Paraná (UFPR) PR - Brazil.,Positivo University (UP). Curitiba - PR - Brazil.,Conceber Reproductive Medicine Center. Curitiba - PR - Brazil
| | | | | | | | - Cristian Maio Hillesheim
- Conceber Reproductive Medicine Center. Curitiba - PR - Brazil.,Department of Obstetrics and Gynaecology of Federal University of Paraná (UFPR) - Curitiba - PR- Brazil
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Thomas S, Sebastian T, Karthikeyan M, Mangalaraj AM, Aleyamma TK, Kamath MS. Effectiveness of spontaneous ovulation as monitored by urinary luteinising hormone versus induced ovulation by administration of human chorionic gonadotrophin in couples undergoing gonadotrophin-stimulated intrauterine insemination: a randomised controlled trial. BJOG 2019; 126 Suppl 4:58-65. [PMID: 31169952 DOI: 10.1111/1471-0528.15830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare effectiveness of spontaneous ovulation monitored by urinary luteinising hormone (LH) versus induced ovulation by administration of human chorionic gonadotrophin (hCG) in couples undergoing gonadotrophin-stimulated intrauterine insemination (IUI). DESIGN Randomised controlled trial. SETTING University-level infertility unit. POPULATION Couples with unexplained infertility, mild endometriosis, mild male factor infertility and polycystic ovarian syndrome. METHODS Couples were randomised to an LH group (Group A), in which urinary LH was measured daily to detect spontaneous ovulation, or an hCG group (Group B), in which urinary hCG was administered as a trigger. MAIN OUTCOME MEASURES Clinical pregnancy rate. Secondary outcomes - ongoing pregnancy, live birth, multiple pregnancy and miscarriage rates. RESULTS A total of 392 couples were randomised with 196 in each arm. The clinical pregnancy rate per woman randomised was 14/196 (7.1%) in the LH arm versus 15/196 (7.6%) in the hCG arm (P = 0.847, which was not statistically significant). Similarly, the ongoing pregnancy rates [13/196 (6.6%) versus 14/196 (7.1%); P = 0.84] and the live birth rates [13/196 (6.6%) versus 14/196 (7.1%); P = 0.84] between the two groups did not show any significant difference. The duration of stimulation and gonadotrophin dosage also did not differ significantly between the two methods. CONCLUSION There was no significant difference in clinical pregnancy rates when urinary LH and hCG trigger were compared as methods to time insemination in women undergoing gonadotropin-stimulated IUI. TWEETABLE ABSTRACT A randomised controlled study showing similar effectiveness between two different methods of timing IUI.
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Affiliation(s)
- S Thomas
- Department of Reproductive Medicine, Christian Medical College, Vellore, India
| | - T Sebastian
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - M Karthikeyan
- Department of Reproductive Medicine, Christian Medical College, Vellore, India
| | - A M Mangalaraj
- Department of Reproductive Medicine, Christian Medical College, Vellore, India
| | - T K Aleyamma
- Department of Reproductive Medicine, Christian Medical College, Vellore, India
| | - M S Kamath
- Department of Reproductive Medicine, Christian Medical College, Vellore, India
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Seckin B, Tokmak A, Yumusak OH. The role of anti-Müllerian hormone in prediction of pregnancy in young and older women with unexplained infertility undergoing intrauterine insemination. J Chin Med Assoc 2019; 82:300-304. [PMID: 30946209 DOI: 10.1097/jcma.0000000000000023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Serum anti-Müllerian hormone (AMH) level is considered to be a reliable marker of ovarian reserve. However, there are conflicting reports on the role of AMH level in predicting pregnancy after intrauterine insemination (IUI) cycles. The aim of this study is to investigate the clinical value of AMH in predicting pregnancy in younger and older women with unexplained infertility undergoing gonadotropin stimulation and IUI. METHODS The medical records of 84 women who underwent first gonadotropin-stimulated IUI cycle owing to unexplained infertility were retrospectively evaluated. The relation of AMH levels with clinical pregnancy rate was analyzed. RESULTS The overall clinical pregnancy rate was 19%. There was no significant difference in AMH levels between the pregnant and nonpregnant women (2.0 ± 1.0 vs 2.8 ± 2.0 ng/mL, respectively, p = 0.250). A further analysis according to age also failed to reveal significant differences in AMH levels between pregnant and nonpregnant women for both the younger (<35 years, n = 61) and the older (≥35 years, n = 23) subgroups (p = 0.714 and 0.532, respectively). Post-hoc power analysis showed a power of 0.80 with a 5% level of significance and a 0.8 effect size. CONCLUSION These findings indicate that AMH levels cannot predict pregnancy in women with unexplained infertility undergoing gonadotropin-stimulated IUI cycle. In addition, AMH is not a strong predictive factor for pregnancy either in younger or older women.
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Yilmaz N, Ersoy E, Tokmak A, Sargin A, Ozgu-Erdinc AS, Erkaya S, Ibrahim Yakut H. Do Serum Vitamin D Levels Have Any Effect on Intrauterine Insemination Success? INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2018; 12:164-168. [PMID: 29707935 PMCID: PMC5936616 DOI: 10.22074/ijfs.2018.5256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 08/23/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Recent studies have shown that vitamin D has an essential role in the reproductive system. In this study, we aimed to investigate the effect of vitamin D levels in patients undergoing ovulation induction (OI), and subsequent intrauterine insemination (IUI) procedure. MATERIALS AND METHODS One hundred and four infertile and one hundred and three fertile women were recruited in this cross-sectional study which was conducted in a tertiary level maternity hospital. Infertile patients were divided into pregnant and non-pregnant subgroups after treatment. Individual characteristics and 25-hydroxyvitamin D3 [25 (OH) D3] levels were compared between the groups. RESULTS The vast majority of our study population consisted of women who had vitamin D deficiency (96.6%). There was no statistically significant difference between infertile and fertile groups in terms of serum 25 (OH) D3 levels (P=0.512). Similarly, no significant difference was observed between the pregnant and non-pregnant subgroups of infertile patients regarding 25 (OH) D3 levels (P=0.267). CONCLUSION There is no association between female infertility and serum vitamin D levels. Vitamin D does not predict pregnancy in infertile women undergoing OI with IUI. Further research which will provide a comparison between much more women who have deficient and sufficient 25 (OH) D3 levels is warranted.
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Affiliation(s)
- Nafiye Yilmaz
- Department of Obstetrics and Gynaecology, Zekai Tahir Burak Women's Healthcare Training and Research Hospital, Ankara, Turkey
| | - Ebru Ersoy
- Department of Obstetrics and Gynaecology, Zekai Tahir Burak Women's Healthcare Training and Research Hospital, Ankara, Turkey. Electronic Address:
| | - Aytekin Tokmak
- Department of Obstetrics and Gynaecology, Zekai Tahir Burak Women's Healthcare Training and Research Hospital, Ankara, Turkey
| | - Ayla Sargin
- Department of Obstetrics and Gynaecology, Zekai Tahir Burak Women's Healthcare Training and Research Hospital, Ankara, Turkey
| | - A Seval Ozgu-Erdinc
- Department of Obstetrics and Gynaecology, Zekai Tahir Burak Women's Healthcare Training and Research Hospital, Ankara, Turkey
| | - Salim Erkaya
- Department of Obstetrics and Gynaecology, Zekai Tahir Burak Women's Healthcare Training and Research Hospital, Ankara, Turkey
| | - Halil Ibrahim Yakut
- Zekai Tahir Burak Women's Healthcare Training and Research Hospital, Ankara, Turkey
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Wadhwa L, Fauzdar A, Wadhwa SN. An Intrauterine Insemination Audit at Tertiary Care Hospital: A 4½ Years' Retrospective Analysis of 800 Intrauterine Insemination Cycles. J Hum Reprod Sci 2018; 11:279-285. [PMID: 30568359 PMCID: PMC6262672 DOI: 10.4103/jhrs.jhrs_34_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND There are many variables that may influence the success rates of intrauterine insemination (IUI) treatment. Therefore, a regular audit program is needed for planning effective infertility treatment and improving pregnancy outcomes. AIMS AND OBJECTIVES The main objective of this study was to identify the crucial predicting factors that can influence the IUI success. MATERIALS AND METHODS A retrospective analysis of 800 IUI cycles done from January, 2013 to August, 2017 in 651 couples with various etiologies of infertility. The common etiologies included female factor of ovulatory dysfunction, tubal, endocrinal, male factor, male and female factors combined, and unexplained factors. Ovulation induction was done either by clomiphene citrate (CC) alone or in combination of CC with gonadotropins or pure gonadotropins only. Human chorionic gonadotropin trigger was given when at least one dominant follicle measuring ≥18 mm with an endometrial thickness of >7 mm was obtained. IUI was done post 36 h of trigger. The double-density gradient method was the preferred method of sperm preparation. RESULTS In 800 cycles in corresponding 651 couples, the total outcome was 113 pregnancies (14.1%) per cycle with overall pregnancy rate (PR) per couple of 17.3%. The highest PR was observed in the patient with ovulatory dysfunction (21.2%), followed by patients with combined factor (15.1%) and male factor (14.7%). In the study, a higher PR was achieved in the female ≤25 years (18.9%) P < 0.04 with significant findings with duration of infertility ≤5 years (15.1%) having primary infertility (14.5%) with low body mass index <25 (14.1%). IUI success rate was highest in the first cycle (14.6%) followed by second cycle (14.0%) and third cycle (3.5%). CONCLUSION IUI audit enables the characterization of prognostic factors to achieve improved PR. This study identifies the factors that can predict improved pregnancy outcome in women age ≤25 years and endometrium thickness between 9 and 11 mm. We also recommend IUI as a first line of infertility treatment for couples in low-income setting provided the women age and duration of infertility are acceptably low.
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Affiliation(s)
- Leena Wadhwa
- IVF and Fertility Research Centre, ESIC-PGIMSR Model Hospital, New Delhi, India
| | - Ashish Fauzdar
- IVF and Fertility Research Centre, ESIC-PGIMSR Model Hospital, New Delhi, India
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Endometriosis and infertility: Insights into the causal link and management strategies. Best Pract Res Clin Obstet Gynaecol 2018; 51:25-33. [PMID: 30245115 DOI: 10.1016/j.bpobgyn.2018.06.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 06/07/2018] [Indexed: 01/01/2023]
Abstract
When evaluating the correlation between endometriosis and infertility with application of the evidence-based guidelines to establish causality in medicine, it becomes apparent that endometriosis causes infertility. This is supported by a strong and consistent association between the two in various settings (prevalence, natural conception, intrauterine insemination (IUI), and assisted reproductive technologies (ARTs)), evidence for a temporal relation, arguments for a dose-response gradient, and proven effects of the removal of lesions on infertility. Next to surgical treatment of endometriosis lesions, medically assisted reproduction treatments such as IUI and ART such as in vitro fertilization are cornerstones of the management of endometriosis-related infertility. Because the revised American Society for Reproductive Medicine (rASRM) staging system is poorly correlated with pregnancy rates as opposed to the Endometriosis Fertility Index (EFI), the latter should be used as the preferred clinical tool to counsel patients on their postoperative fertility management options.
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Vitagliano A, Saccone G, Noventa M, Borini A, Coccia ME, Nardelli GB, Saccardi C, Bifulco G, Litta PS, Andrisani A. Pituitary block with gonadotrophin-releasing hormone antagonist during intrauterine insemination cycles: a systematic review and meta-analysis of randomised controlled trials. BJOG 2018; 126:167-175. [PMID: 29862633 DOI: 10.1111/1471-0528.15269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several randomised controlled trials (RCTs) have investigated the usefulness of pituitary block with gonadotrophin-releasing hormone (GnRH) antagonists during intrauterine insemination (IUI) cycles, with conflicting results. OBJECTIVE The aim of the present systematic review and meta-analysis of RCTs was to evaluate the effectiveness of GnRH antagonist administration as an intervention to improve the success of IUI cycles. SEARCH STRATEGY Electronic databases (MEDLINE, Scopus, EMBASE, Sciencedirect) and clinical registers were searched from their inception until October 2017. SELECTION CRITERIA Randomised controlled trials of infertile women undergoing one or more IUI stimulated cycles with GnRH antagonists compared with a control group. DATA COLLECTION AND ANALYSIS The primary outcomes were ongoing pregnancy/live birth rate (OPR/LBR) and clinical pregnancy rate (CPR). Pooled results were expressed as odds ratio (OR) or mean differences with 95% confidence interval (95% CI). Sources of heterogeneity were investigated through sensitivity and subgroups analysis. The body of evidence was rated using GRADE methodology. Publication bias was assessed with funnel plot, Begg's and Egger's tests. MAIN RESULTS Fifteen RCTs were included (3253 IUI cycles, 2345 participants). No differences in OPR/LBR (OR 1.14, 95% CI 0.82-1.57, P = 0.44) and CPR (OR 1.28, 95% CI 0.97-1.69, P = 0.08) were found. Sensitivity and subgroup analyses did not provide statistical changes in pooled results. The body of evidence was rated as low (GRADE 2/4). No publication bias was detected. CONCLUSION Pituitary block with GnRH antagonists does not improve OPR/LBR and CPR in women undergoing IUI cycles. TWEETABLE ABSTRACT Pituitary block with GnRH antagonists does not improve the success of IUI cycles.
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Affiliation(s)
- A Vitagliano
- Department of Women and Children's Health, Unit of Gynaecology and Obstetrics, University of Padua, Padua, Italy
| | - G Saccone
- Department of Neuroscience Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - M Noventa
- Department of Women and Children's Health, Unit of Gynaecology and Obstetrics, University of Padua, Padua, Italy
| | - A Borini
- 9.Baby, Family and Fertility Centre Bologna, Bologna, Italy
| | - M E Coccia
- Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynaecology, Careggi University Hospital, University of Florence, Florence, Italy
| | - G B Nardelli
- Department of Women and Children's Health, Unit of Gynaecology and Obstetrics, University of Padua, Padua, Italy
| | - C Saccardi
- Department of Women and Children's Health, Unit of Gynaecology and Obstetrics, University of Padua, Padua, Italy
| | - G Bifulco
- Department of Neuroscience Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - P S Litta
- Department of Women and Children's Health, Unit of Gynaecology and Obstetrics, University of Padua, Padua, Italy
| | - A Andrisani
- Department of Women and Children's Health, Unit of Gynaecology and Obstetrics, University of Padua, Padua, Italy
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[First line management without IVF of infertility related to endometriosis: Result of medical therapy? Results of ovarian superovulation? Results of intrauterine insemination? CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018; 46:331-337. [PMID: 29551300 DOI: 10.1016/j.gofs.2018.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Using the structured methodology of French guidelines (HAS-CNGOF), the aim of this chapter was to formulate good practice points (GPP), in relation to optimal non-ART management of endometriosis related to infertility, based on the best available evidence in the literature. MATERIALS AND METHODS This guideline was produced by a group of experts in the field including a thorough systematic search of the literature (from January 1980 to March 2017). Were included only women with endometriosis related to infertility. For each recommendation, a grade (A-D, where A is the highest quality) was assigned based on the strength of the supporting evidence. RESULTS Management of endometriosis related to infertility should be multidisciplinary and take account into the pain, the global evaluation of infertile couple and the different phenotypes of endometriotic lesions (good practice point). Hormonal treatment for suppression of ovarian function should not prescribe to improve fertility (grade A). After laproscopy for endometriosis related to infertility, the Endometriosis Fertility Index should be used to counsel patients regarding duration of conventional treatments before undergoing ART (grade C). After laparoscopy surgery for infertile women with AFS/ASRM stage I/II endometriosis or superficial peritoneal endometriosis, controlled ovarian stimulation with or without intrauterine insemination could be used to enhance non-ART pregnancy rate (grade C). Gonadotrophins should be the first line therapy for the stimulation (grade B). The number of cycles before referring ART should not exceed up to 6 cycles (good practice point). No recommendation can be performed for non-ART management of deep infiltrating endometriosis or endometrioma, as suitable evidence is lacking. DISCUSSION AND CONCLUSION Non-ART management is a possible option for the management of endometriosis related to infertility. Endometriosis Fertilty Index could be a useful tool for subsequent postoperative fertility management. Controlled ovarian stimulation can be proposed.
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Ling Y, Mee H, Nisa DS, Ni L. Live birth rates of assisted reproductive technology treatment and spontaneous conception among subfertile couples in Singapore: A follow-up study. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2018. [DOI: 10.4103/2305-0500.241178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Effect of Gonadotropin Types and Indications on Homologous Intrauterine Insemination Success: A Study from 1251 Cycles and a Review of the Literature. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3512784. [PMID: 29387719 PMCID: PMC5745683 DOI: 10.1155/2017/3512784] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/14/2017] [Accepted: 11/21/2017] [Indexed: 12/23/2022]
Abstract
Objective To evaluate the IUI success factors relative to controlled ovarian stimulation (COS) and infertility type, this retrospective cohort study included 1251 couples undergoing homologous IUI. Results We achieved 13% clinical pregnancies and 11% live births. COS and infertility type do not have significant effect on IUI clinical outcomes with unstable intervention of various couples' parameters, including the female age, the IUI attempt rank, and the sperm quality. Conclusion Further, the COS used seemed a weak predictor for IUI success; therefore, the indications need more discussion, especially in unexplained infertility cases involving various factors. Indeed, the fourth IUI attempt, the female age over 40 years, and the total motile sperm count <5 × 106 were critical in decreasing the positive clinical outcomes of IUI. Those parameter cut-offs necessitate a larger analysis to give infertile couples more chances through IUI before carrying out other ART techniques.
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Tanbo T, Fedorcsak P. Endometriosis-associated infertility: aspects of pathophysiological mechanisms and treatment options. Acta Obstet Gynecol Scand 2017; 96:659-667. [DOI: 10.1111/aogs.13082] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/14/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Tom Tanbo
- Department of Reproductive Medicine; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - Peter Fedorcsak
- Department of Reproductive Medicine; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
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Geisler ME, Ledwidge M, Bermingham M, McAuliffe M, McMenamin MB, Waterstone JJ. Intrauterine insemination-No more Mr. N.I.C.E. guy? Eur J Obstet Gynecol Reprod Biol 2017; 210:342-347. [PMID: 28122315 DOI: 10.1016/j.ejogrb.2017.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 01/12/2017] [Accepted: 01/14/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the per cycle chance of a live birth and to identify factors that may support a more individualised application of IUI in view of National Institute for Health and Care Excellence (NICE) updated guideline on fertility 2013. STUDY DESIGN A retrospective, cohort study of 851 couples (1688 cycles) with unexplained, mild endometriosis, one patent Fallopian tube (with ovulation occurring in the corresponding ovary), mild male factor or ovulatory dysfunction, who initiated their first cycle of IUI/COH during the study period 2009-2013 and completed up to 3 cycles. Exclusion criteria included donor sperm and diminished ovarian reserve. Success factors and probabilities were determined based on live birth rates. RESULTS Mean age was 33.8±3.3years and mean duration of subfertility was 2.28±1.47years. Independent associates of successful outcome factors were lower age (AOR 0.93; 95%CI 0.89-0.98, p=0.007) and multiparity (AOR 1.72; 95%CI 1.17-2.52). Live-birth rates declined independently of other factors from 15.3% (n=130/851) in cycle 1-7.0% (n=19/273) in cycle 3 (AOR 0.76; 95%CI, 0.62-0.93, p=0.008). Per cycle probabilities of live birth ranged from 21.4% to 5.1% dependent on age, cycle number and previous parity. The unadjusted cumulative pregnancy rate for live birth per cycle started, over three cycles, was 34.9% with a multiple live birth rate per cycle started of 5.4%. The associates of live birth amongst those with unexplained sub-fertility only (n=632, first cycle attempt) were also analysed, yielding similar results. CONCLUSIONS IUI/COH is a simple treatment that produces good live birth rates, especially in younger patients and/or those with previous parity. More than 90% of total live births with IUI/COH is achieved during the first two cycles. As a retrospective, observational study, there is no comparator group and therefore we cannot comment on the relative efficacy of up to three IUI cycles over expectant management in a similar cohort. Our study suggests that probabilities of success can be used to individualise treatment decisions and that there is merit in continuing to offer IUI before resorting to IVF for certain patients.
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Affiliation(s)
- Minna E Geisler
- Cork Fertility Centre, Fernhurst Clinic, College Road, Cork, Ireland.
| | - Mark Ledwidge
- University College Dublin, School of Medicine and Medical Science, Belfield, Dublin, Ireland
| | - Margaret Bermingham
- University College Dublin, School of Medicine and Medical Science, Belfield, Dublin, Ireland
| | - Mary McAuliffe
- Cork Fertility Centre, Fernhurst Clinic, College Road, Cork, Ireland
| | - Moya B McMenamin
- Cork Fertility Centre, Fernhurst Clinic, College Road, Cork, Ireland
| | - John J Waterstone
- Cork Fertility Centre, Fernhurst Clinic, College Road, Cork, Ireland
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Pregnancy Predictors after Intrauterine Insemination in Cases of Unexplained Infertility: A Prospective Study. Int J Reprod Med 2016; 2016:5817823. [PMID: 27738654 PMCID: PMC5050366 DOI: 10.1155/2016/5817823] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 08/11/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction. Aim of the study was to find the effect of various prognostic factors in cases of unexplained infertility undergoing controlled ovarian stimulation (COS) with intrauterine insemination (IUI). Methods. 146 cases of unexplained infertility were included. A maximum of 3 cycles of IUI were done with clomiphene citrate/HMG. Ovulation trigger was given when the largest follicle diameter was >18 mm, and IUI was planned 36 hours later. Luteal phase support was given for 15 days, urine pregnancy test was done on day 15, ultrasonography was done at 7 weeks, and pregnancy was followed up till delivery. Results. A total of 146 couples have undergone 239 cycles of IUI out of which 27 had UPT positive after 15 days. 14.8% had 1st-trimester abortion while 3.7% were ectopic. 86.3% were singleton pregnancies and 13.6% were twins. CPR was 11.29% per cycle and 18.4% per couple; LBR was 9.2% per cycle. Apart from duration of stimulation (p = 0.037) and number of treatment cycles (p = 0.045), no other factors had significant prognostic value. Conclusion. For unexplained infertility, IUI can be done to provide patients with the time that they need before moving on to IVF while providing a respectable chance of pregnancy.
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Atasever M, Kalem MN, Hatırnaz Ş, Hatırnaz E, Kalem Z, Kalaylıoğlu Z. Factors affecting clinical pregnancy rates after IUI for the treatment of unexplained infertility and mild male subfertility. J Turk Ger Gynecol Assoc 2016; 17:134-8. [PMID: 27651720 PMCID: PMC5019828 DOI: 10.5152/jtgga.2016.16056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 07/25/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of the present retrospective study was to evaluate intrauterine insemination (IUI) clinical experiences and to define the variables for predicting success. MATERIAL AND METHODS The present study was an observational trial performed in a private IVF center on subfertile couples who had applied for treatment between 2002 and 2012, in which the data of 503 IUI cases were retrospectively reviewed. Couples who had been diagnosed with unexplained and mild male subfertility were included. The primary outcome measure was the clinical pregnancy rate in an attempt to form a predictive model for the odds of a clinical pregnancy. Recorded parameters were used to determine the prediction model. RESULTS Utilizing univariate logistic regression analysis, clinical pregnancy was positively associated with the duration of infertility (OR=1.09, p=0.089), secondary infertility (OR=1.77, p=0.050), and +4 sperm motility after preparation (OR=1.03, p=0.091). Following an adjustment analysis involving a multivariate logistic regression, clinical pregnancy was still found to positively associate with secondary infertility (OR=2.51, p=0.008). CONCLUSION IUI success in secondary infertile couples who were in the unexplained infertility and mild male subfertility groups was higher than that in primary infertile couples, and the chances of pregnancy increased as sperm numbers with +4 motility increased. It is difficult to concomitantly evaluate all these parameters and to determine a predictive parameter in IUI independent from other factors.
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Affiliation(s)
- Melahat Atasever
- Department of Obstetrics and Gynecology, Giresun University School of Medicine, Giresun, Turkey
| | - Müberra Namlı Kalem
- Department of Obstetrics and Gynecology, Turgut Özal University School of Medicine, Ankara, Turkey
| | | | | | - Ziya Kalem
- Gürgan Clinic IVF Center, Ankara, Turkey
| | - Zeynep Kalaylıoğlu
- Department of Statistics, Middle East Technical University, Ankara, Turkey
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Mitwally MFM, Casper RF. Aromatase Inhibition Reduces the Dose of Gonadotropin Required for Controlled Ovarian Hyperstimulation. ACTA ACUST UNITED AC 2016; 11:406-15. [PMID: 15350255 DOI: 10.1016/j.jsgi.2004.03.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the use of the aromatase inhibitor, letrozole, in conjunction with follicle-stimulating hormone (FSH) injection, and FSH alone for controlled ovarian hyperstimulation (COH) in patients with polycystic ovarian syndrome (PCOS) or ovulatory infertility. METHODS This nonrandomized study included two study groups: 26 patients with PCOS and 63 with ovulatory infertility (unexplained infertility [41 patients], male factor infertility [17 patients], and endometriosis [5 patients]), who received letrozole in addition to FSH; and two control groups: 46 PCOS patients and 308 with ovulatory infertility (unexplained infertility [250 patients], male factor infertility [42 patients], and endometriosis [16 patients], who received FSH only. All patients had intrauterine insemination (IUI). Main outcome measures included dose of FSH used per cycle, number of preovulatory follicles greater than 16 mm in diameter, cancellation rate, and pregnancy rate. RESULTS The FSH dose required for ovarian stimulation was significantly lower when letrozole was used in both study groups compared to the control groups without a significant difference in number of follicles greater than 16 mm. IUI cancellation rate was significantly lower with letrozole treatment in PCOS patients. In women with PCOS, clinical pregnancy rate per completed IUI cycle was 26.5% in the letrozole plus FSH group versus 18.5% in the FSH-only group. In ovulatory infertility patients, the pregnancy rate was similar in both study and control groups (11%). CONCLUSION We believe that inhibition of estrogen synthesis by aromatase inhibition will release the estrogenic negative feedback, resulting in an increase in endogenous FSH secretion. Moreover, by inhibiting conversion of androgens into estrogens, accumulating androgens may increase follicular sensitivity to FSH. Such a protocol has the potential to lower FSH treatment cost and may improve response for low responders who require high FSH doses during ovarian stimulation.
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Affiliation(s)
- Mohamed F M Mitwally
- Reproductive Sciences Division, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
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Bozkurt B, Erdem M, Mutlu MF, Erdem A, Guler I, Mutlu I, Oktem M. Comparison of age-related changes in anti-Müllerian hormone levels and other ovarian reserve tests between healthy fertile and infertile population. HUM FERTIL 2016; 19:192-8. [DOI: 10.1080/14647273.2016.1217431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Banu Bozkurt
- Department of Obstetrics & Gynaecology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Erdem
- Department of Obstetrics & Gynaecology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Firat Mutlu
- Department of Obstetrics and Gynaecology, Yuksek Ihtisas University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Erdem
- Department of Obstetrics & Gynaecology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ismail Guler
- Department of Obstetrics & Gynaecology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ilknur Mutlu
- IVF Unit, Novaart IVF and Women Health Centre, Ankara, Turkey
| | - Mesut Oktem
- Department of Obstetrics & Gynaecology, Gazi University Faculty of Medicine, Ankara, Turkey
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Mutlu MF, Erdem M, Erdem A, Mutlu I, Guler I, Demirdağ E. The impact of premature progesterone rise on the outcome of intrauterine insemination cycles with controlled ovarian hyperstimulation in unexplained infertility. Eur J Obstet Gynecol Reprod Biol 2016; 203:44-8. [DOI: 10.1016/j.ejogrb.2016.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/23/2016] [Accepted: 05/13/2016] [Indexed: 10/21/2022]
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Evaluation of intrauterine insemination practices: a 1-year prospective study in seven French assisted reproduction technology centers. Fertil Steril 2016; 105:1589-93. [DOI: 10.1016/j.fertnstert.2016.01.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/31/2015] [Accepted: 01/29/2016] [Indexed: 11/18/2022]
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Predicting suitable timing for artificial reproductive technology treatment in aged infertile women. Reprod Med Biol 2016; 15:253-259. [PMID: 29259442 DOI: 10.1007/s12522-016-0241-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 03/14/2016] [Indexed: 10/22/2022] Open
Abstract
It has been widely accepted that the age of women plays a fundamental role in fecundity, and age-related fertility decline has one of the most significant and detrimental effects on the success rate of infertility treatment. Therefore, treatment cycles of non-in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment for infertile women of advanced aged have been limited due to their lack of efficacy, and they are often optimized, compared to IVF/ICSI treatment. Recent trends in infertility treatment apparently indicate that IVF/ICSI treatment, including egg donation, is frequently offered to aged women for first-line management, despite its heavy burden, but hasty IVF/ICSI treatment should be avoided, considering its socioeconomic problems. It is important to distinguish women who could conceive by non-IVF/ICSI treatment, although the optimization of non-IVF/ICSI treatment protocols remains poorly understood. This review focuses on extracting aged patients who have higher chance of conceiving with non-IVF/ICSI treatment and providing necessary and sufficient infertility treatment. After initial evaluation for fertility, including tubal factor, male factor, the presence of endometriosis and/or adenomyosis, and ovarian reserve, the outcomes of fertility treatment can be predicted to some extent in aged infertile women.
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Hansen KR, He ALW, Styer AK, Wild RA, Butts S, Engmann L, Diamond MP, Legro RS, Coutifaris C, Alvero R, Robinson RD, Casson P, Christman GM, Huang H, Santoro N, Eisenberg E, Zhang H. Predictors of pregnancy and live-birth in couples with unexplained infertility after ovarian stimulation-intrauterine insemination. Fertil Steril 2016; 105:1575-1583.e2. [PMID: 26949110 DOI: 10.1016/j.fertnstert.2016.02.020] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 02/11/2016] [Accepted: 02/11/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify baseline characteristics of couples that are likely to predict conception, clinical pregnancy, and live birth after up to four cycles of ovarian stimulation with IUI in couples with unexplained infertility. DESIGN Secondary analyses of data from a prospective, randomized, multicenter clinical trial investigating pregnancy, live birth, and multiple pregnancy rates after ovarian stimulation-IUI with clomiphene citrate, letrozole, or gonadotropins. SETTING Outpatient clinical units. PATIENT(S) Nine-hundred couples with unexplained infertility who participated in the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation clinical trial. INTERVENTION(S) As part of the clinical trial, treatment was randomized equally to one of three arms and continued for up to four cycles or until pregnancy was achieved. MAIN OUTCOME MEASURE(S) Conception, clinical pregnancy, and live-birth rates. RESULT(S) In a multivariable logistic regression analysis, after adjustment for other covariates, age, waist circumference, income level, duration of infertility, and a history of prior pregnancy loss were significantly associated with at least one pregnancy outcome. Other baseline demographic and lifestyle characteristics including smoking, alcohol use, and serum levels of antimüllerian hormone were not significantly associated with pregnancy outcomes. CONCLUSION(S) While age and duration of infertility were significant predictors of all pregnancy outcomes, many other baseline characteristics were not. The identification of level of income as a significant predictor of outcomes independent of race and education may reflect differences in the underlying etiologies of unexplained infertility or could reveal disparities in access to fertility and/or obstetrical care. CLINICAL TRIAL REGISTRATION NCT01044862.
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Affiliation(s)
- Karl R Hansen
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
| | - Amy Linnea W He
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
| | - Aaron K Styer
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Robert A Wild
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Samantha Butts
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lawrence Engmann
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, Georgia
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey, Pennsylvania
| | - Christos Coutifaris
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ruben Alvero
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, Colorado
| | - Randal D Robinson
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, Texas
| | - Peter Casson
- Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont
| | - Gregory M Christman
- Department of Obstetrics and Gynecology, Shands Hospital, University of Florida, Gainesville, Florida
| | - Hao Huang
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, Colorado
| | - Esther Eisenberg
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
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The impact of timing of insemination in relation to ovulation on the cycle pregnancy rate of intrauterine insemination and intrauterine tuboperitoneal insemination in unexplained infertility. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2016. [DOI: 10.1016/j.mefs.2015.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Ghaffari F, Sadatmahalleh SJ, Akhoond MR, Eftekhari Yazdi P, Zolfaghari Z. Evaluating The Effective Factors in Pregnancy after Intrauterine Insemination: A Retrospective Study. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2015; 9:300-8. [PMID: 26644852 PMCID: PMC4671382 DOI: 10.22074/ijfs.2015.4544] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 05/05/2015] [Indexed: 11/28/2022]
Abstract
Background Controlled ovarian hyperstimulation (COH) in conjunction with intrauterine inseminations (IUI) are commonly used to treat infertile couples. In this study we
evaluated the relationship between IUI outcome and special causes of infertility. We also
aimed to examine parameters that might predict success following IUI. Materials and Methods In this cross-sectional study, we included 994 IUI cycles in 803
couples who referred to the infertility Institute. All statistical analyses were performed by
using SPSS program, t tests and chi-square. Stepwise multiple linear regression analysis
was performed to compare the association between dependent and independent variables.
Logistic regression was conducted to build a prediction model of the IUI outcome. Results Overall pregnancy rate per completed cycle (16.5%) and live birth rate per
cycle (14.5%). The mean age in the pregnant group was significantly lower than that of
the non-pregnant group (P=0.01).There was an association between cause of infertility
and clinical pregnancies (P<0.001). Logistic regression identified four significant factors in determining the success of the IUI [menstrual irregularites (OR:2.3, CI:1.6-3.4,
P<0.001), duration of infertility (OR:0.8, CI:0.8-0.9, P<0.001), total dose of gonadotropin (OR:1.02, CI:1.003-1.04, P=0.02) and semen volume (OR:1.1, CI:1.008-1.2,
P=0.03)] which were the most predictive of IUI success. Conclusion Our study defined prognostic factors for pregnancy in COH+IUI. These
variables can be integrated into a mathematical model to predict the chance of pregnancy
rate in subsequent COH+IUI cycles.
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Affiliation(s)
- Firoozeh Ghaffari
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Shahideh Jahanian Sadatmahalleh
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran ; Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Reza Akhoond
- Department of Statistics, Mathematical Science and Computer Faculty, Shahid Chamran University, Ahwaz, Iran
| | - Poopak Eftekhari Yazdi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Zahra Zolfaghari
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Kianpour M, Nematbakhsh M, Ahmadi SM. Asymmetric dimethylarginine (ADMA), nitric oxide metabolite, and estradiol levels in serum and peritoneal fluid in women with endometriosis. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2015; 20:484-9. [PMID: 26257805 PMCID: PMC4525348 DOI: 10.4103/1735-9066.160997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 01/07/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Increase in nitric oxide (NO) concentration accompanied by alteration in peritoneal immune defense reactions is involved in the pathogenesis of endometriosis. Asymmetric dimethylarginine is an endogenous competitive inhibitor of NO synthase. This study was designed to compare NO metabolite (nitrite), asymmetric dimethylarginine, and estradiol concentrations in serum and peritoneal fluid (PF) of patients with and without endometriosis. MATERIALS AND METHODS Subjects were assigned to two groups based on their laparoscopic results. The groups consisted of women with and without endometriosis (90 and 89 participants, respectively). The serum and peritoneal levels of nitrite (stable NO metabolite), asymmetric dimethylarginine, and estradiol were measured using enzyme-linked immunosorbent assay (ELISA) kits. These parameters were analyzed and compared between the groups statistically using SPSS software version 16. RESULTS Both nitrite and asymmetric dimethylarginine levels were significantly higher in the serum of the participants from both groups than those in the PF group (P < 0.05). However, no significant difference in the asymmetric dimethylarginine level was detected between the two groups. In addition, the PF level of nitrite increased significantly in patients with endometriosis when compared with non-endometriosis subjects (P < 0.05). The PF levels of estradiol in both groups were significantly higher than the serum levels of estradiol (P < 0.05). CONCLUSIONS The NO metabolite level of PF implies the possible role of NO in the pathogenesis of endometriosis.
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Affiliation(s)
- Maryam Kianpour
- Nursing and Midwifery Care Research and Department of Midwifery, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Nematbakhsh
- Water and Electrolytes Research Center and Department of Physiology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Pregnancy Rate after Controlled Ovarian Hyperstimulation and Intrauterine Insemination for the Treatment of Endometriosis following Surgery. BIOMED RESEARCH INTERNATIONAL 2015; 2015:282301. [PMID: 26247014 PMCID: PMC4515270 DOI: 10.1155/2015/282301] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 02/18/2015] [Accepted: 03/11/2015] [Indexed: 11/18/2022]
Abstract
Objective. To compare pregnancy rate after controlled ovarian hyperstimulation and intrauterine insemination (COH-IUI) with no treatment in patients with endometriosis-associated infertility treated with laparoscopy. Design. A clinical cohort study. Setting. University-level tertiary care center. Patients. 238 women with various stages of endometriosis after laparoscopic treatment. Interventions. Either COH-IUI or follow-up for 12 months. Main Outcome Measures. The primary outcome measures were clinical pregnancy and live birth rate. Predictive factors evaluated were female age, maternal BMI, and duration of infertility. Results. The pregnancy rate attained after the integrated laparoscopy–COH-IUI approach was 53.4%, while it was significantly lower (38.5%) in the control group. Similarly, a significant difference was observed in live births (48.3% versus 34.2%). Patients with severe endometriosis were less likely to achieve pregnancy (38%) and live birth (35%) than their counterparts with milder forms (57% and 53%). Conclusions. In patients with endometriosis-based infertility, surgery followed by COH-IUI is more effective than surgery alone.
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