Volume 11, Issue 3 (5-2013)                   IJRM 2013, 11(3): 227-0 | Back to browse issues page

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Yavuz A, Demirci O, Sözen H, Uludoğan M. Predictive factors influencing pregnancy rates after intrauterine insemination. IJRM. 2013; 11 (3) :227-0
URL: http://journals.ssu.ac.ir/ijrmnew/article-1-394-en.html
1- Department of Obstetrics and Gynecology, Zeynep Kamil Gynecologic and Pediatric Training Research Hospital, 34668, İstanbul, Turkey , demircioya@gmail.com
2- Department of Obstetrics and Gynecology, Zeynep Kamil Gynecologic and Pediatric Training Research Hospital, 34668, İstanbul, Turkey
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Introduction
 
Intrauterine insemination (IUI) is an assisted reproduction procedure that places sperm directly into the uterus. Controlled ovarian hyperstimulation (COH) together with IUI is commonly offered to couples with subfertility factors not involving the fallopian tubes. IUI gained its popularity because it is simple, non-invasive, and a cost-effective technique (1). This method is indicated in cases of cervical infertility, relative male factor infertility, anovulation, endometriosis with a healthy fallopian tube, and unexplained infertility.
Pregnancy rate after IUI differ between studies according to patient selection criteria, the presence of various infertility factors, ovarian stimulation methods, number of cycles performed, different sperm parameters and preparation technique (2). Although many factors have been reported as influencing pregnancy rates after IUI, the various investigators have not agreed the predictive factors for successful ongoing pregnancy (3-10). The purpose of our study therefore was to help clinicians predict IUI outcomes based on factors that can be assessed patients evaluations.
 
Materials and methods
 
In this retrospective cohort study, we reviewed the medical records of women who underwent IUI at Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital between January 2006 and December 2009. In total 980 IUI cycles in 569 couples with unexplained and male-factor subfertility were analyzed. The institution’s ethics committee approved the study and informed consent was obtained from the participants.
The study couples had at least one year infertility and had undergone a basic infertility evaluation consisting of detailed anamnesis (age ,duration of infertility, type of infertility, medical history, previous surgical interventions, lifestyles, body mass index ), hormone concentrations at the third day of menstrual cycle (FSH, LH, estradiol-17, TSH and PRL) and semen analysis. Physical and gynecological examinations were performed on all the women subjects. Tubal patency was confirmed by hysterosalpingography or laparoscopy. Laparoscopy or hysteroscopy was done when there was a possibility of pelvic adhesions, endometriosis, intracavitary lesions in uterus of the hysterosalpingography or transvaginal ultrasound. Patients with stage 3-4 endometriosis, intracaviter lesion in uterus, previous surgery on ovaries, and at least one closed tube were excluded from the study.
Body mass index (BMI) was calculated by dividing weight (kg) by square of height (m²) and patients were categorized into two groups as follows <25 BMI, and ≥25 BMI. Regarding the age of women, patients were divided into three groups as follows: <30 years old, 30-35 years old, and >35 years old. Duration of infertility was categorized as <6 years and >6 years. Ovarian function was estimated in terms of the serum concentrations of FSH and E2 before beginning of the cycle. The generally admitted thresholds are 9,4IU/L and 80 pg/ml, respectively (3). Patients were divided into 2 groups according to each threshold of FSH and E2. At the hCG administration day, 8 mm of endometrial thickness was admitted as cut off value and patients were divided into two groups as the ones with length of endometrium below 8 mm and the ones with this above 8mm.
All women in the study underwent ovarian stimulation using gonadotrophin (Gonal-F Ares-Serono, Geneva, Switzerland; Puregon, Organon International Inc, Roseland, NJ or hMG Menopur, Ferring SAS, St. Prex, Switzerland). Ovarian stimulation was initiated on the third day of the cycle with a dose of 75 IU. Initial dose of gonadotrophin was modified according to previous treatment, the duration of infertility, the woman’s hormone profile, level of body mass index and age. Initial dose of gonadotrophin was maintained throughout the first five days of stimulation. Necessary dose of gonadotrophin was altered after the first five days of stimulation depending on ovarian responses.
Ovarian and endometrial responses were monitored by transvaginal ultrasonography on the sixth day of stimulation and repeated after 2 or 3 days, depending on the follicular growth. When at least one follicle reached to 16 mm, 5000-10000 IU of hCG (Pregnyl N.V Organon) or 250 µg of recombinant hCG (Ovitrelle, Ares-Serono) was administered. Standard IUI was performed 36 hours after administration of hCG. The administration of hCG was withheld, and IUI was canceled in the stimulation protocols when more than three follicles with a diameter of at least 16mm or more than four follicles with diameter of at least 14 mm were present.
All the semen samples were collected by masturbation in the laboratory after three days of sexual abstinence and prepared less than 2 hours before insemination. After complete liquefaction for 30 minutes at room temperature, each sample was analyzed using World Health Organization/ Kruger guidelines. Semen preparation for IUI was performed with the density gradient centrifugation technique (20 minutes at 1300 rpm) and a washing step (6 minutes at 2200 rpm) with 2-ml culture medium (Quinn’s R sperm washing medium HTF with 5.0 mg/ml human albumin In vitro fertilization, inc. U.S.A.).
Bivalve speculum was used to expose the cervix and the cervical mucus was cleaned. Insemination catheter (Ainseblue-R RI.MOS, Mirandola Italy) was placed into the uterus approximately 0.5 cm below the fundus, 0.5 ml sperm preparation was injected slowly. A two weeks course of daily treatment with 90 mg micronized progesterone vaginal gel (Crinone 8%; Serono) was prescribed for luteal support. After this time, the woman was allowed to perform a pregnancy test (a serum β-hCG assay). Clinical pregnancies were defined as gestational sac in uterus.
 
Statistical analysis
Results were given as mean±SD