A Study of Predictive Factors Affecting Outcome of IUI in Unexplained Infertility

Title: A Study of Predictive Factors Affecting Outcome of IUI in Unexplained Infertility

Authors: Dr Namita Shrivastava, Dr Neelesh Shrivastava, Dr Lila Vyas, Dr Anita Sharma

DOI: http://dx.doi.org/10.18535/jmscr/v4i2.41

Abstract

Introduction: Infertility is defined as the inability to conceive after 1 year of regular unprotected intercourse, without use of any contraceptive device or methods. Unexplained infertility means that, couple does not conceived after 1 year of unprotected vaginal sexual intercourse, with basic infertility evaluation shows no obvious abnormality (ASRM, 2006)¹. Incidence 15% to 30% of infertile couples (ASRM, 2006)¹.

Method: 50 cases of unexplained infertility underwent 93 cycles (max. 2 cycles per patient) of IUI both natural as well as stimulated between Feb 2013 -15. In stimulated cycle, COS was initiated and a single IUI performed after 36 hrs of hCG trigger.

Main Outcome Measures: The primary outcome measured was clinical pregnancy rate per cycle and cumulative pregnancy rate. Predictive factors evaluated were age, duration of infertility, type of infertility, stimulation protocol, AFC, ET, endometrial pattern, no. of preovulatory follicles and pre-post wash count and motility.

Results: The pregnancy rate in first and second cycle was 14% and 20.93%, respectively while cumulative pregnancy rate was 17.20%. Among the predictive factors age 24.69 yrs vs 30.51 yrs (P = <0.001), no. of preovulatory follicles 2.00 vs 1.56 (P = 0.046), endometrial pattern trilaminar vs diffuse PR 33.33% vs 8.12% (P = 0.04) and post wash sperm count (p< 0.001) significantly affected the IUI outcome.

Conclusion: Definitive prognostic factors for predicting success will help in counselling regarding treatment modality. Favourable prognostic factors where age, number of preovulatory follicles, motile sperm count and endometrial pattern. The most important factor of these by far is female age, because of its negative effect on ovarian reserve and oocyte quality. By modi modifying the predictive factors significant effect on outcome. When it comes to cost effectiveness, it has been demonstrated that three cycles of IUI offers the same CPR rate as IVF and remain more cost-effective for unexplained infertility. Finally we can say IUI is clearly an efficient treatment option for unexplained infertility.

Keywords: Clinical pregnancy rate, intrauterine insemination, predictive factors

References

1. Practice Committee of the American Society for Reproductive. Effectiveness and treatment for unexplained infertility. Medicine Fertil Steril, 2006 Nov; 86(5 Suppl 1) : S111-4.

2. Practice Committee of the American Society for Reproductive Medicine. Optimal evaluation of the infertile female. Fertil Steril, 2006 Nov; 86(5 Suppl 1) : S264-7.

3. ESHRE. Capri workshop. Intrauterine insemination. Hum Reprod Update, 2009; 15 : 265-277.

4. Grigoriou O, Pantos K, Makrakis E, Hassiakos D, Konidaris S, Creatsas G. Impact of isolated teratozoospermia on the outcome of intrauterine insemination. Fertil Steril, 2005; 83 : 773-775.

5. Merviel P, Heraud MH, Grenier N, Lourdel E, Sanguinet P, Copin H. Predictive factors for pregnancy after intrauterine insemination (IUI) : an analysis of 1038 cycles and a review of the literature. Fertil Steril, 2010; 93 : 79-88.

6. Nuojua-Huttunen S, Tomas C, Bloigu R, Tuomivaara L, Markainen H. Intrauterine insemination treatment in subfertility : An analysis of factors affecting outcome. Hum Reprod, 1999; 14 : 698-703.

7. Kamath MS, Bhave P, Aleyamma TK, Nair R, Chandy A. Predictive factors for pregnancy after IUI : A prospective study of factors affecting outcome. Journal of Human Reproductive Sciences, 2010 Sep-Dec; 3(3) : 129-134.

8. Ashrafi M, Rashidi M, Ghasemi A, Arabipoor A, Daghighi S, Pourasghari P, Zolfaghari Z. The role of infertility etiology in success rate of intrauterine insemination cycles: an evaluation of predictive factors for pregnancy rate. New Int J Fertil Steril, 2013 Jul; 7(2) : 100-7.

9. de Araújo LF, de Araújo Filho E, Fácio CL, Bossoni MC, Machado-Paula LA, Corrente JE, Cavagna M, Matheus PC, Pontes A. Efficacy of sperm motility after processing and incubation to predict pregnancy after intrauterine insemination in normospermic individuals. Reprod Biol Endocrinol, 2013 Oct 22; 11 : 101.

10. Dodson WC, Kunselman AR, Legro RS. Association of obesity with treatment outcomes in ovulatory infertile women undergoing superovulation and IUI. Fertility Sterility, Sep 2006; Vol. 86, Issue : pg 642-646.

11. Souter I, Baltagi LM, Kulata DK, Meeker JD, Petrozza JC. Women, weight and fertility : The effect of BMI on the outcome of superovulation / IUI cycles. Fertility Sterility, Mar 2011; Vol. 95, Issue 3 : pg 1042-1047.

12. Wolff EF, Vahidi N, Alford C, Richter K, Widra E. Influences on endometrial development during intrauterine insemination: clinical experience of 2,929 patients with unexplained infertility. Fertil Steril, 2013 Jul; 100(1) : 194-9.e1.

13. Azargoon A, Bahrami M, Alavy Toussy J. Comparing clomiphen citrate plus HMG with clomiphen citrate plus rFSH in IUI cycles in couples with unexplained or male factor infertility: A prospective randomized study. Iran J Reprod Med, 2013 Mar; 11(3) : 243-8.

14. Palatnik A, Strawn E, Szabo A, Robb P. What is the optimal follicular size before triggering ovulation in intrauterine insemination cycles with clomiphene citrate or letrozole? An analysis of 988 cycles. 56. Fertil Steril, 2012 May; 97(5) : 1089-94.e1-3.

15. Hock DL, Bohrer MK, Ananth CV, Kemnnann E. Sonographic assessment of endometrial pattern and thickness in patients treated with CC, hMG and IUI. Fertility Sterility, Aug 1997; Vol. 68, Issue 2 : pg 242.1

Corresponding Author

Dr Namita Shriastava

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