Effect of the total motile sperm count on the efficacy and cost-effectiveness of intrauterine insemination and in vitro fertilization

Introduction: The unrestricted use of intracytoplasmic sperm injection (ICSI) for non-male factor infertility is associated with adverse outcomes. Post-wash total motile sperm count (PW-TMSC) offers prognostic value to assess sperm quality and aid in the decision to perform in vitro fertilization (IVF) or ICSI. Objectives: The aim of this study was to identify the effect of PW-TMSC on fertilization rates in patients undergoing IVF cycles exclusively with non-male factor infertility. It also aimed to identify whether unnecessary ICSI could be avoided in such cases, thus maximizing optimal outcomes. Materials & Methods: We retrospectively analyzed age, semen volume, prewash TMSC, and PW-TMSC in 68 conventional IVF cycles of infertile couples with non-male factor infertility. Clinical characteristics including female age, number of follicles, level of estradiol on trigger day, mature cumulus-oocyte complexes (COCs) collected, were also included. Results: Incidence of <30% fertilization was significantly higher in the 4-<10 Million group compared with the ≥20 Million post-wash TMSC group (P<0.001). Furthermore, Receiver operating characteristics (ROC) analysis revealed post-wash TMSC as a significant predictor (P<0.05) of total failed fertilization (TFF) and of ≥30% fertilization (P<0.05) with area under curve (AUC) of 0. 79 and 0.77, respectively, with a deemed cutoff of 10.89 Million. Conclusion: Post-wash TMSC is a good predictor of fertilization; it can help in avoiding potentially low or even total fertilization failure (TFF). A cut-off point of 10.89 Million or less should warrant the use of ICSI.

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Time to improvement in semen parameters after microsurgical varicocelectomy in men with severe oligospermia

Canadian Urological Association Journal ◽

10.5489/cuaj.5408 ◽

2018 ◽

Vol 13 (3) ◽

Cited By ~ 4

Author(s):

Thomas A. Masterson ◽

Aubrey B. Greer ◽

Ranjith Ramasamy

Keyword(s):

Semen Quality ◽

Intrauterine Insemination ◽

Sperm Count ◽

Semen Analysis ◽

Semen Parameters ◽

Vitro Fertilization ◽

Minimal Improvement ◽

Quality Upgrading ◽

Total Motile Sperm Count

Introduction: We aimed to determine the time and predictive factors of semen quality improvement in men with severe oligospermia after microsurgical varicocelectomy. Methods: Men with total motile sperm count (TMSC) <5 million on two semen analyses were identified from May 2015 to August 2017. Postoperative semen analysis was collected at 3–6 months and >6 months. We evaluated preoperative factors for successful semen quality upgrading based on assisted reproductive technology (ART) eligibility: in vitro fertilization [IVF] (<5 million), intrauterine insemination (IUI) (5–9 million), and natural pregnancy (>9 million). We compared men with TMSC <5 million to those with TMSC 5–9 million. Data are reported as means and standard error of the mean (SEM). Pregnancy data was collected by phone interview at >6 months postoperatively. Results: A total of 33 men were included. TMSC improved from 1.5±0.2 to 7.3±1.8 million at 3–6 months (p<0.05) and 12.2±3.6 million at >6 months (p<0.05). There was no statistical difference in TMSC between 3–6 months and >6 months. Sixteen (48.5%) men upgraded semen quality into the range of natural pregnancy. Preoperative TMSC from 2–5 million was predictive of upgrading semen quality. Twenty-four couples were contacted by phone; 20 were attempting pregnancy in the postoperative period and five (25%) of them had achieved natural pregnancy. Conclusions: Men with TMSC <5 million can expect the largest improvement in TMSC from 3–6 months postoperatively with minimal improvement thereafter. Preoperative TMSC >2 million was most predictive of semen quality upgrading.

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A Comparison of the Cost-Effectiveness of In Vitro Fertilization Strategies and Stimulated Intrauterine Insemination in a Canadian Health Economic Model

Journal of Obstetrics and Gynaecology Canada ◽

10.1016/s1701-2163(16)32826-2 ◽

2008 ◽

Vol 30 (5) ◽

pp. 411-420 ◽

Cited By ~ 9

Author(s):

Taimur Bhatti ◽

Akerke Baibergenova

Keyword(s):

Health Economic ◽

Cost Effectiveness ◽

In Vitro Fertilization ◽

Economic Model ◽

Intrauterine Insemination ◽

Vitro Fertilization ◽

Canadian Health ◽

Health Economic Model ◽

The Cost

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Cost-effectiveness of assisted reproductive technologies in Saudi Arabia: Comparing in vitro fertilization with intrauterine insemination

SAGE Open Medicine ◽

10.1177/2050312120931988 ◽

2020 ◽

Vol 8 ◽

pp. 205031212093198

Author(s):

Faisal Almaslami ◽

Syed Mohamed Aljunid

Keyword(s):

Saudi Arabia ◽

Cost Effectiveness ◽

In Vitro Fertilization ◽

Live Birth ◽

Treatment Cycle ◽

Intrauterine Insemination ◽

Vitro Fertilization ◽

Effectiveness Analysis ◽

The Cost

Objectives: The aim of this study was to compare the cost-effectiveness of in vitro fertilization and intrauterine insemination for the management of unexplained, mild male and mild female factor infertility in Saudi Arabia. Methods: A cost-effectiveness analysis from a societal perspective was conducted for couples seeking assisted reproductive technology services between January and December 2016 in one of the largest private hospitals in Saudi Arabia. Activity-Based Costing and Step-Down Costing methodologies with expert interviews were used to compute the costs of in vitro fertilization and intrauterine insemination. A total of 710 assisted reproductive technology procedures were observed by the embryologist in charge. The costs calculated included direct and indirect costs. A cost-effectiveness analysis and a Monte Carlo simulation probabilistic sensitivity analysis were conducted. Results: The average cost per in vitro fertilization and intrauterine insemination cycle was SR 27,360 (range: SR 19,541–29,618) and SR 10,143 (range: SR 7568–11,976), respectively, and the live birth rate per initiated in vitro fertilization and intrauterine insemination cycle was 20.7% and 7.9%, respectively, resulting in an average cost per live birth per in vitro fertilization and intrauterine insemination treatment cycle of SR 132,174 (95% confidence interval: 120,802–143,546) and SR 128,392 (95% confidence interval: 124,468–132,316), respectively. The incremental cost-effectiveness ratio was SR 134,508 per extra live birth implicit in a decision to treat with in vitro fertilization. Probabilistic sensitivity analysis confirms the robustness of the cost-effectiveness results. Conclusion: This study found that from a societal perspective, one in vitro fertilization treatment cycle was more cost-effective than intrauterine insemination in Saudi Arabia.

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