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intrauterine insemination with donor sperm:only the number of motile spermatozoa inseminated influences both pregnancy and live-birth rates

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Asian Journal of Andrology 2022年第3期24卷 287-293页

作者： Marie Cardey-Lefort Berengere Ducrocq Audrey Uk Helen Behal Anne-Laure Barbotin Geoffroy Robin Reproductive Biology Institute Lille University HospitalLille F-59037France Lille University Lille University HospitalULR 2694-METRICSLille F-59000France Endocrine Gynecology and Reproductive Medicine Unit Lille University HospitalLille F-59037France

intrauterine insemination with donor sperm(IUI-D)is an assisted reproductive technology(ART)offered to couples with definitive male infertility or risk of genetic disease transmission.Here,we sought to evaluate our practice in IUI-D and identify factors that influenced the success rate.We performed a retrospective,single-center study of all IUI-D procedures performed at Lille University Medical Center(Lille,France)between January 1,2007,and December 31,2017.Single and multivariate analyses with a mixed logistic model were used to identify factors associated with clinical pregnancies and live births.We included 322 couples and 1179 IUI-D procedures.The clinical pregnancy rate was 23.5%,and the live birth rate was 18.9%per IUI-D.In a multivariate analysis,the women’s age was negatively associated with the live birth rate.The number of motile spermatozoa inseminated was the only factor associated with both clinical pregnancies and live births,with a chosen threshold of 0.75 million.The clinical pregnancy and live birth rates were,respectively,17.3%and 13.0%below the number of motile spermatozoa inseminated threshold and 25.9%and 21.0%at or above the threshold(all P=0.005).The number of motile spermatozoa inseminated was the only factor that significantly influenced both pregnancies and live-birth rates after IUI-D.Indeed,below a threshold of 0.75 million motile spermatozoa inseminated,those rates were significantly lower.Application of this number of motile spermatozoa inseminated threshold may help centers to allocate donations more effectively while maintaining reasonable waiting times for patients.

关键词： intrauterine insemination male infertility number of motile spermatozoa inseminated sperm donor

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intrauterine insemination Treatment Strategy for Women over 35 Years Old： Based on a Large Sample Multi-center Retrospective Analysis

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Chinese Medical Journal 2016年第23期129卷 2873-2875页

作者： Shuo Yang Hong-Ying Peng Ying Li Li-Ying Zhou Li Yuan Yan-Min Ma Hui-Chun Wang Rong Li Ping Liu Jie Qiao Reproductive Medical Center Peking University Third Hospital Beijing 100191 China Reproductive Medical Center Haidian Maternal and Child Health Hospital Beijing 100080 China Reproductive Medical Center Beijing Obstetrics and Gynecology Hospital Beijing 100006 China Reproductive Medical Center Tianjin Fifth Central Hospital Tianjin 300450 China

As we all known, maternal age and ovarian reserve are two of the most important prognosis i-hctors for fertility, in 1980, the study of Menken et al. showed the female fertility declined after 32 years old, especially... 详细信息

关键词： Clinical Pregnancy Rate intrauterine insemination Live Birth Rate Maternal Age

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Clinical pregnancy rate of women with unexplained infertility with or without cervical mucus aspiration before intrauterine insemination: A randomized controlled trial

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Asian pacific Journal of Reproduction 2022年第6期11卷 247-252页

作者： Richa Vatsa Vanita Suri Shalini Gainder Aashima Arora Japleen Kaur Neelam Choudhary Shruti Sharma Department of Obstetrics and Gynaecology Postgraduate Institute of Medical Education and ResearchChandigarh 120012India Department of Obstetrics and Gynaecology All India Institute of Medical SciencesNew Delhi 110029India Department of Obstetrics and Gynaecology Dr B R Ambedkar Institute of Medical Sciences56 ASector 56SAS NagarPunjab 160055India

Objective:To detect effect of removing cervical mucus before performing intrauterine insemination(IUI)on pregnancy rate in patients with unexplained infertility.Methods:The randomized controlled trial was conducted in Infertility Division of Department of Obstetrics and Gynaecology of a tertiary care hospital.Totally 80 patients of unexplained infertility were recruited.By computer generated block randomization in block size of 4 and 6,patients were randomly allocated at time of starting ovarian stimulation into the cervical mucus removal group or the non-removal of cervical mucus group before IUI,40 in each group.Ovarian stimulation with clomiphene 100 mg from day 2-6 of menstrual cycle along with human menopausal gonadotropin 150 IU was given alternate day starting from day 7.Follicular monitoring was done and further doses given as per response;trigger was planned when 1-3 follicle reach a diameter of>18 mm.IUI was planned after trigger.IUI was done as per the group allocated.Mucus cleaning was done in the cervical mucus removal group by aspirating mucus with IUI syringe and sterile cotton swab before IUI.The primary outcome was clinical pregnancy rate.Number of difficult IUIs and cycle cancellation due to ovarian hyperstimulation were also noted.Results:IUI was not done in 4 patients due to hyperstimulation.Pregnancies per IUI cycle occurred in 7.9%(3/38)in the cervical mucus removal group and 21.1%(8/38)in the non-removal of cervical mucus group.There was no statistically significant difference in clinical pregnancy rate between two groups(P=0.19).Conclusions:There is a trend towards a lower clinical pregnancy rate with removal of cervical mucus before IUI in women of unexplained infertility though the difference is not statistically significant.Further studies with large sample size need to be done on this intervention.

关键词： Unexplained infertility intrauterine insemination Cervical mucus removal Pregnancy outcome Randomized controlled trial

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Double versus single homologous intrauterine insemination for male factor infertility： a systematic review and meta-analysis

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Asian Journal of Andrology 2013年第4期15卷 533-538,I0010页

作者： Apostolos Zavos Alexandros Daoonte Antonios Garas Christina Verykouki Evangelos Papanikolao~ Georgios Anifandis Nikolaos P Polyzos Obstetrics and Gynecology University Hospital of Larissa Larissa 41110 Greece Aristotle University of Thessaloniki Assisted Reproduction Unit 1st OB-GYN Department Thessaloniki 56429 Greece and University Hospital Dutch-Speaking Free University of Brussels Brussels City 1090 Belgium

Male factor infertility affects 30%-50% of infertile couples worldwide, and there is an increasing interest in the optimal management of these patients. In studies comparing double and single intrauterine insemination （IUI）, a trend towards higher pregnancy rates in couples with male factor infertility was observed. Therefore, we set out to perform a meta-analysis to examine the superiority of double versus single IUI with the male partner＇s sperm in couples with male factor infertility. An odds ratio （OR） of 95% confidence intervals （CIs） was calculated for the pregnancy rate. Outcomes were analysed by using the ManteI-Haesel or DerSimonian-Laird model accordingto the heterogeneity of the results. Overall, five trials involving 1125 IUI cycles were included in the meta-analysis. There was a two-fold increase in pregnancies after a cycle with a double IUI compared with a cycle with a single IUI （OR. 2.0; 95% CI. 1.07-3.75; P〈O.03）. Nevertheless, this result was mainly attributed to the presence of a large trial that weighted as almost 50% in the overall analysis. Sensitivity analysis, excluding this large trial, revealed only a trend towards higher pregnancy rates among double IUI cycles （OR. 1.58; 95% CI. 0.59-4.21）, but without statistical significance （P=0.20）. Our systematic review highlights that the available evidence regarding the use of double IUI in couples with male factor infertility is fragmentary and weak. Although there may be a trend towards higher pregnancy rates when the number of IUIs per cycle is increased, further large and well-designed randomized trials are needed to provide solid evidence toide current clinical practice.

关键词： homologous intrauterine insemination male infertility meta-analysis systematic review

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Successful pregnancy and birth after intrauterine insemination using caput epididymal sperm by percutaneous aspiration

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Asian Journal of Andrology 2003年第1期5卷 73-75页

作者： Yi QIU, Dan-Tong YANG, Su-Mei WANG, Hui-Qing SUN, Yi-Fang JIA Shandong Institute for Family Planning Research, Jinan 250002, China Shandong Institute for Family Planning Research Jinan 250002 China. qiuyimail@***

Aim: To manage male infertility with obstructive azoospermia by means of percutaneous epididymal sperm aspiration (PESA) and intrauterine insemination (IUI). Methods: Ninety azoospermic patients with congenital bilateral absence of the vas deferens (BAVD, n=58) or bilateral caudal epididymal obstruction (BCEO, n=32) requesting for fine needle aspiration (FNA), PESA and IUI were recruited. The obstruction was diagnosed by vasography and determination of the fructose, carnitine and alpha-glucosidase levels in the seminal fluid. Results: The mean sperm motility, density, abnormal sperm and total sperm count of the caput epdidymis were 16 %±22 %, (12±31) ×106/mL, 55 %±36 % and (16±14)×106, respectively. In the 90 couples, a total of 74 PESA procedures and 66 cycles of IUI were performed. Three pregnancies resulted, including one twin pregnancy giving birth to two healthy boys, one single pregnancy with a healthy girl and another single pregnancy aborted at week 6 of conception. The pregnancy rate per IUI cycle was 4.5 %. Conclusion: The birth of normal, healthy infants by IUI using PESA indicates that the caput epididymal sperm possess fertilization capacity. The PESA-IUI programme is a practical and economical procedure for the management of patients with obstructive azoospermia.

关键词： percutaneous epididymal sperm aspiration intrauterine insemination obstructive azoospermia caput epididymis, fertilization

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Treatment of Infertile Women with Unilateral Tubal Occlusion Diagnosed by Hysterosalpingography:The Role of intrauterine insemination

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Current Medical Science 2020年第4期40卷 767-772页

作者： Yi-hua LIN Jing-xin YE Ze-xuan WU Yun CHEN Xi XIA Wei-ping QIAN Department of Reproductive Center Peking University Shenzhen HospitalShenzhen 518036China Department of Ultrasound Peking University Shenzhen HospitalShenzhen 518036China

Summary:The optimal assisted reproductive treatment strategy for infertile women with unilateral tubal obstruction remains uncertain.To investigate the role of intrauterine insemination(IUI)in the treatment of infertile women with unilateral tubal occlusion,the data of 148 couples were retrospectively collected and analyzed.Seventy-eight infertile women with unilateral occlusion diagnosed by hysterosalpingography(HSG)were categorized as the study group and 70 others with unexplained infertility as the control group.The study group was divided into a proximal occlusion subgroup and a mid-distal occlusion subgroup for further analysis.The main outcomes,namely the clinical pregnancy rate(CPR),ongoing pregnancy rate(OPR),and live birth rate(LBR)per cycle,were analyzed.Our results showed a tendency of lower CPR,OPR,and LBR in the study group than in the control group,without statistical significance.Further investigations revealed that the unilateral proximal occlusion subgroup had similar CPR,OPR,and LBR as the control group,while the unilateral mid-distal occlusion subgroup had significantly lower CPR(5.1%vs.20.0%,P=0.035),OPR(5.1%vs.20.0%,P=0.035),and LBR(5.1%vs.20.0%,P=0.035)than the control group.In conclusion,the clinical outcomes of IUI were worse in patients with unilateral tubal occlusion than in those with unexplained infertility.This might be primarily caused by the worse outcome of patients with unilateral mid-distal tubal occlusion instead of proximal occlusion.

关键词： hysterosalpingography intrauterine insemination unilateral tubal factor infertility

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Ovarian pregnancy rupture following ovulation induction and intrauterine insemination:A case report

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World Journal of Clinical Cases 2021年第29期9卷 8894-8900页

作者： Bin Wu Ke Li Xiao-Fen Chen Jie Zhang Jing Wang Yue Xiang Hong-Gui Zhou Reproductive Medicine Centre Department of Obstetrics and GynecologyThe Affiliated Hospital of North Sichuan Medical CollegeNanchong 637000Sichuan ProvinceChina Non-invasive and Microinvasive Laboratory of Gynecology The Affiliated Hospital of North Sichuan Medical CollegeNanchong 637000Sichuan ProvinceChina Department of Pathology The Affiliated Hospital of North Sichuan Medical CollegeNanchong 637000Sichuan ProvinceChina

BACKGROUND Ovarian pregnancy after assisted reproductive technology treatment has rarely been reported;ovarian pregnancy following intrauterine insemination(IUI)is even rarer,and only nine cases have previously been reported.CASE SUMMARY We report a case of ovarian pregnancy rupture after ovulation induction and IUI.The patient presented with bilateral lower abdominal pain and was referred to the emergency department.Ultrasound examination revealed ovarian pregnancy and intraperitoneal bleeding.Laparoscopy revealed an ovarian pregnancy with hemoperitoneum,which was subsequently removed.Pelvic adhesions were detected intraoperatively,which were treated immediately.The patient spontaneously conceived an intrauterine pregnancy 3 mo later,which was ongoing at the time of writing this study.CONCLUSION Close attention should be paid to any history of pelvic inflammatory disease before commencing IUI treatment,and patients with such a history should be closely followed up after IUI.Early measurement of serumβ-human chorionic gonadotropin levels and ultrasonic examination are essential for timely diagnosis of ovarian pregnancy after ovulation induction and IUI to avoid more serious complications.

关键词： Ovarian pregnancy Rupture intrauterine insemination Ovulation induction Early diagnosis Case report

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Timed Intercourse versus intrauterine insemination with Mild Ovarian Stimulation for Unexplained Infertility

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Open Journal of Obstetrics and Gynecology 2022年第12期12卷 1279-1288页

作者： Hany Mahmoud Abd El Hamid Manal Abdel-Wanees Alsayed Hesham Mohammed Hamed Shaimaa Belal Department of Obstetrics and Gynecology El-Sahel Teaching Hospital Cairo Egypt Department of Obstetrics and Gynecology Faculty of Medicine Helwan University Helwan Egypt

Background: Infertility is unexplained in about 22% - 28% of infertile couples. Spontaneous pregnancy may occur in them. If did not happen, Expectant management will be via clomiphene citrate (CC) administration, intrauterine insemination (IUI), and IVF & ICSI. Aim: to assess the effectiveness of intrauterine insemination with mild controlled ovarian stimulation compared with expectant management in couples with unexplained infertility more than one year. Methods: 160 couples with unexplained infertility were selected, The couples were randomly divided into two groups: Group (A) “80 couples”: intrauterine insemination (IUI) with mild controlled ovarian stimulation (combination of CC + hMG) using prepared semen and was performed 36 hours after hCG injection, Group (B) “80 couples”: Couples had no ovulation induction. They encouraged for timed intercourse in the most fertile days of female cycle guided by folliculometry for 6 months. Data were collected quantitatively, coded and analyzed using SPSS. The power of study is 80% and 95% confidence interval. Result: The pregnancy rate was calculated in both groups: In group (A) (IUI/COS): OPR (Ongoing pregnancy rates) was 27.5% and PR (pregnancy rates)/cycle was 8.6%. In group (B) (Expectant management): OPR was 25% and PR/cycle was 5.3%. Conclusion: Mild controlled ovarian stimulation CC + hMG with IUI offers no statistical significance in terms of pregnancy outcomes over expectant management in this study however significance in the response to stimulation.

关键词： intrauterine insemination Ovarian Stimulation Unexplained Infertility

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Can the Prediction of intrauterine insemination Results by Used Aniline Blue Stain (ABS) and Sperm Chromatin Dispersion (SCD) Levels?

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Advances in Reproductive Sciences 2023年第1期11卷 1-10页

作者： Talal Z. Al-Darawsha Nurten Dayioglu Bushra R. Al-Azzawi Tulay Irez Karbala Health Directorate Alsafeer Surgical Hospital Kerbala City Iraq Department of Statistics Yeni Yuzyil University Istanbul Türkiye Al-Farah Specialized Center for Infertility and IVF Baghdad Iraq Department of Histology and Embryology Yeni Yuzyil University Istanbul Türkiye

Introduction: This study aimed to perform routine seminal fluid analysis, sperm DNA fragmentation, and sperm function tests at the chromatin maturation level and evaluate pregnancy in the patients passing intrauterine insemination before starting intrauterine insemination (IUI) method. Materials and Methods: In this prospective study, 111 couples who underwent intrauterine insemination (IUI) in unexplained infertility patients were admitted to Al-Farah IVF and assisted reproductive center in Baghdad, Iraq between November 2020 and February 2021 were evaluated. Semen fluid analysis was performed based on (WHO 4th) guiding rules. In addition, Sperm Chromatin Dispersion (halo test) and sperm maturation were performed with Aniline Blue Stain (ABS). Results: Sperm Chromatin Dispersion (SCD) groups were compared in terms of pregnancy outcome;the positive pregnancy rate was found to be above in the normal SCD groups (p = 0.0005). In addition, Aniline Blue Stain (ABS) groups were compared in the terms of pregnancy outcome;the positive pregnancy rate was found to be higher in the normal ABS group (p = 0.017). Conclusion: Our study showed that the use of DNA fragmentation (SCD) and sperm maturation tests (ABS) together with routine semen analysis in intrauterine insemination cases will make a significant contribution to the prediction of intrauterine insemination (IUI) increased results. So, these results indicate a defect in the effect of DNA fragmentation on the outcome of intrauterine insemination.

关键词： Sperm Chromatin Dispersion Aniline Blue Stain Sperm DNA Fragmentation intrauterine insemination

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intrauterine insemination—Our Results between the Years 2008-2012

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Advances in Reproductive Sciences 2015年第2期3卷 34-40页

作者： Vilma Lánská Blanka Koubková Jitka Rezácová Michal Krcmár Pavel Darebny Lucie Melicharová Katerina Dohnalová Alena Vaverková Jaroslav Feyereisl Institute for the Care of Mother and Child PragueCzech Republic

The purpose of this retrospective study was to determine whether or not there was a significant relationship between women’s age as a cause of sterility and pregnancy after IUI. Furthermore, we evaluated the effect of stimulation of antiestrogens and time of hCG administration on the success of IUI in relation to the age of women. During the period between 2008 and 2012, we performed a total number of 793 IUI. Patients were prepared for IUI in the natural cycle and stimulation with antiestrogens (clomiphene citrate-CC). Ovulation was induced by hCG (Ovitrelle) 40 hours before IUI or immediately after the procedure. Sperm was processed through density gradients. The average success rate of IUI was 10.2% of pregnant women per cycle. Significantly the highest number of pregnant women 16.3% was women with a diagnosis of anovulation. Significantly the lowest success rate of IUI was at the immunological cause of infertility and endometriosis. There was no evidence of age dependence for women on the success of IUI. Stimulation of CC did not significantly increase the chance of becoming pregnant. There was also no statistically significant difference in hCG before and after IUI pregnancy success. The most important group of women for whom IUI is a suitable form of assisted reproduction consists of patients of 35 years old with anovulation cause of sterility. Those patients with an immunological cause of infertility and endometriosis have significantly lower chances of conceiving after IUI and it is preferable for them to choose other techniques of assisted reproduction and embryo transfer.

关键词： intrauterine insemination Pregnancy Rate Woman’s Age Cause of Infertility Administration of Clomiphene Citrate and Ovitrelle

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