scholarly journals Controlled ovarian stimulation should not be preferred for male infertility treated with intrauterine insemination: a retrospective study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yan Tang ◽  
Qian-Dong He ◽  
Ting-Ting Zhang ◽  
Jing-Jing Wang ◽  
Si-Chong Huang ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Pregnancy Rate ◽  
Ovarian Stimulation ◽  
Intrauterine Insemination ◽  
Multiple Pregnancy ◽  
Clinical Pregnancy ◽  
Male Factor Infertility ◽  
Male Factor ◽  
Ovulatory Follicles ◽  
Multiple Pregnancy Rate

Abstract Background Some studies have stated that intrauterine insemination (IUI) with controlled ovarian stimulation (COS) might increase the pregnancy rate, while others suggest that IUI in the natural cycle (NC) should be the first line of treatment. It remains unclear whether it is necessary to use COS at the same time when IUI is applied to treat isolated male factor infertility. Thus, we aimed to investigate efficacy of IUI with COS for isolated male factor infertility. Methods A total of 601 IUI cycles from 307 couples who sought medical care for isolated male factor infertility between January 2010 and February 2020 were divided into two groups: NC-IUI and COS-IUI. The COS-IUI group was further divided into two subgroups according to the number of pre-ovulatory follicles on the day of HCG: cycles with monofollicular development (one follicle group) and cycles with at least two pre-ovulatory follicles (≥ 2 follicles group). The IUI outcomes, including clinical pregnancy, live birth, spontaneous abortion, ectopic pregnancy, and multiple pregnancy rates were compared. Results The clinical pregnancy, live birth, spontaneous abortion, and ectopic pregnancy rates were comparable between the NC-IUI and COS-IUI group. Similar results were also observed among the NC-IUI, one follicle, and ≥ 2 follicles groups. However, with respect to the multiple pregnancy rate, a trend toward higher multiple pregnancy rate was observed in the COS-IUI group compared to the NC-IUI group (8.7% vs. 0, P = 0.091), and a significant difference was found between the NC-IUI and ≥ 2 follicles group (0 vs. 16.7%, P = 0.033). Conclusion In COS cycles, especially in those with at least two pre-ovulatory follicles, the multiple pregnancy rate increased without a substantial gain in overall pregnancy rate; thus, COS should not be preferred in IUI for isolated male factor infertility. If COS is required, one stimulated follicle and one healthy baby should be the goal considering the safety of both mothers and foetuses.

scholarly journals Controlled ovarian stimulation should not be preferred for male infertility treated with intrauterine insemination: a retrospective study

2021 ◽  
Author(s):  
Yan Tang ◽  
Qian-Dong He ◽  
Ting-Ting Zhang ◽  
Jing-Jing Wang ◽  
Si-Chong Huang ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Pregnancy Rate ◽  
Ovarian Stimulation ◽  
Intrauterine Insemination ◽  
Multiple Pregnancy ◽  
Clinical Pregnancy ◽  
Male Factor Infertility ◽  
Male Factor ◽  
Ovulatory Follicles ◽  
Multiple Pregnancy Rate

Abstract Background: Some studies have stated that intrauterine insemination (IUI) with controlled ovarian stimulation (COS) might increase the pregnancy rate, while others suggest that IUI in the natural cycle (NC) should be the first line of treatment. It remains unclear whether it is necessary to use COS at the same time when IUI is applied to treat isolated male factor infertility. Thus, we aimed to investigate efficacy of IUI with COS for isolated male factor infertility.Methods: A total of 601 IUI cycles from 307 couples who sought medical care for isolated male factor infertility between January 2010 and February 2020 were divided into two groups: NC-IUI and COS-IUI. The COS-IUI group was further divided into two subgroups according to the number of pre-ovulatory follicles on the day of HCG: cycles with monofollicular development (one follicle group) and cycles with at least two pre-ovulatory follicles (≥ 2 follicles group). The IUI outcomes, including clinical pregnancy, live birth, spontaneous abortion, ectopic pregnancy, and multiple pregnancy rates were compared.Results: The clinical pregnancy, live birth, spontaneous abortion, and ectopic pregnancy rates were comparable between the NC-IUI and COS-IUI group. Similar results were also observed among the NC-IUI, one follicle, and ≥ 2 follicles groups. However, with respect to the multiple pregnancy rate, a trend toward higher multiple pregnancy rate was observed in the COS-IUI group compared to the NC-IUI group (8.7% vs. 0, P=0.091), and a significant difference was found between the NC-IUI and ≥ 2 follicles group (0 vs. 16.7%, P=0.033).Conclusion: In COS cycles, especially in those with at least two pre-ovulatory follicles, the multiple pregnancy rate increased without a substantial gain in overall pregnancy rate; thus, COS should not be preferred in IUI for isolated male factor infertility. If COS is required, one stimulated follicle and one healthy baby should be the goal considering the safety of both mothers and foetuses.

scholarly journals Controlled Ovarian Stimulation Should Not Be Recommended for Male Infertility Treated With IUI

2020 ◽  
Author(s):  
Yan Tang ◽  
Qian-Dong He ◽  
Ting-Ting Zhang ◽  
Jing-Jing Wang ◽  
Si-Chong Huang ◽  
...  
Keyword(s):  
Male Infertility ◽  
Pregnancy Rate ◽  
Ovarian Stimulation ◽  
Birth Rate ◽  
Multiple Pregnancy ◽  
Live Birth Rate ◽  
Abortion Rate ◽  
Clinical Pregnancy ◽  
Ovulatory Follicles ◽  
Multiple Pregnancy Rate

Abstract Background: Some studies stated that intra-uterine insemination (IUI) with controlled ovarian stimulation (COS) might increase the chance of pregnancy, while others suggested that IUI in natural cycle (NC) should be the treatment of first choice. Whether it is necessary to use COS at the same time, when IUI is applied to treat male infertility solely? There is still no consensus.Objective: To investigate the efficacy of IUI with COS in male infertility solely?Methods: 544 IUI cycles from 280 couples who sought medical care for male infertility from January 2010 to February 2019 were divided into two groups: group NC-IUI and group COS-IUI. Besides, the COS-IUI group was further divided into two subgroups according to the number of pre-ovulatory follicles on the day of HCG: cycles with monofollicular development (1 follicle group) and cycles with at least two pre-ovulatory follicles (≥ 2 follicles group). The outcome of IUI, including clinical pregnancy rate, live birth rate, spontaneous abortion rate, ectopic pregnancy rate and multiple pregnancy rate were compared.Results: The clinical pregnancy rate, live birth rate, early spontaneous abortion rate, and ectopic pregnancy rate were comparable between NC-IUI group and COS-IUI group. Similar results were observed among NC-IUI group, 1 follicle group and ≥ 2 follicles group. However, when it comes to the multiple pregnancy rate, a trend toward higher multiple pregnancy rate was observed in the COS-IUI group compared that in the NC-IUI group (10.5% (2/19) vs. 0 (0/42), P=0.093), furthermore, a significant difference was found between NC-IUI group and ≥ 2 follicles group (0 vs. 20%, P =0.034).Conclusion: For male infertility, since in cycles with COS, especially in those with at least two pre-ovulatory follicles cycles, the multiple pregnancy rate increased without substantial gain in overall pregnancy rate, COS in IUI should not be recommended. If COS is required, one stimulated follicle and one health baby should be the goal considering the safety both for mothers and fetuses.

scholarly journals What is the optimal protocol for Intrauterine Insemination (IUI)? A Mini Review and A Retrospective Study to Evaluate Effective Factors Influencing Pregnancy after IUI

2019 ◽  
Author(s):  
Qing Li ◽  
Belén Herrero ◽  
Mao-Ling Zhu ◽  
Josée Lefebvre ◽  
William Buckett
Keyword(s):  
Logistic Regression ◽  
Pregnancy Rate ◽  
Ovarian Stimulation ◽  
Endometrial Thickness ◽  
Intrauterine Insemination ◽  
Multiple Pregnancy ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Effective Factors ◽  
Optimal Protocol

Abstract Background: Although it is well documented on the study of intrauterine insemination (IUI), the effectiveness of various factors on IUI treatment is inconsistent. The aim of this study is to investigate the various factors that influence IUI outcome and attempt to set up optimal protocol for IUI patients. Methods: This was a retrospective cohort study including1948 cycles (843 couples) that performed IUI between January 2012 and December 2013 in a single centre. Various factors that may affect IUI outcome were analyzed using chi-square. Moreover, we conducted multiple logistic regression to evaluate the main factors on the effects of IUI outcome. In addition, follicle growth and endometrial development relevant to conception were also assessed among protocols. Results: The clinical pregnancy rate (CPR) per cycle was 12.5% in the present study. Seven factors were identified to be associated significantly with CPR by multivariate logistic regression analysis: female age, type of infertility, ovarian stimulation protocol, preovulatory follicles, endometrial thickness, growing length of preovulatory follicle, post-washed total motile spermatozoa count (TMSC). Comparing with 11 days or less, more than 15 days for ovarian response and endometrial development before insemination induced a better success rate. Although ovarian stimulation with gonadotrophin or letrozole induced higher CPR when comparing to stimulation with clomiphene citrate or without stimulation, ovarian stimulation with letrozole was superior to gonadotrophin by its similar CPR to gonadotrophin but lower follicle number, without the risk of multiple pregnancy. Women younger than 41 years with elevated endometrial thickness inseminated with TMSC ≥ 4.0 million had better chance to obtain pregnancy. Number of treatment cycle was not a factor to affect CPR, with a stable CPR in the first four cycles. Conclusions: We conclude that women no more than 41 years old are suitable to perform at least 4 cycles of IUI before proceeding to IVF. The optimized IUI treatment requires ovarian stimulation with letrozole to induce one/two follicles and fertilize with four or more million motile spermatozoa and an elevated endometrium on day 15 or after in the cycle. Key words: infertility, intrauterine insemination, effective factors, clinical pregnancy rate.

scholarly journals Effect of blastocyst morphology and developmental speed on transfer strategy for grade “C” blastocyst in vitrified‐warmed cycles

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Yuxia He ◽  
Shiping Chen ◽  
Jianqiao Liu ◽  
Xiangjin Kang ◽  
Haiying Liu
Keyword(s):  
Pregnancy Rate ◽  
Live Birth ◽  
Pregnancy Outcomes ◽  
Multiple Pregnancy ◽  
Poor Quality ◽  
Clinical Pregnancy ◽  
Neonatal Outcomes ◽  
Blastocyst Transfer ◽  
Blastocyst Development ◽  
Multiple Pregnancy Rate

Abstract Background High-quality single blastocyst transfer (SBT) is increasingly recommended to patients because of its acceptable pregnancy outcomes and significantly reduced multiple pregnancy rate compared to double blastocyst transfer (DBT). However, there is no consensus on whether this transfer strategy is also suitable for poor-quality blastocysts. Moreover, the effect of the development speed of poor-quality blastocysts on pregnancy outcomes has been controversial. Therefore, this study aimed to explore the effects of blastocyst development speed and morphology on pregnancy and neonatal outcomes during the frozen embryo transfer (FET) cycle of poor-quality blastocysts and to ultimately provide references for clinical transfer strategies. Methods A total of 2,038 FET cycles of poor-quality blastocysts from patients 40 years old or less were included from January 2014 to December 2019 and divided based on the blastocyst development speed and number of embryos transferred: the D5-SBT (n = 476), D5-DBT (n = 365), D6-SBT (n = 730), and D6-DBT (n = 467) groups. The SBT group was further divided based on embryo morphology: D5-AC/BC (n = 407), D5-CA/CB (n = 69), D6-AC/BC (n = 580), and D6-CA /CB (n = 150). Results When blastocysts reach the same development speed, the live birth and multiple pregnancy rates of DBT were significantly higher than those of SBT. Moreover, there was no statistical difference in the rates of early miscarriage and live birth between the AC/BC and CA/CB groups. When patients in the SBT group were stratified by blastocyst development speed, the rates of clinical pregnancy (42.44 % vs. 20.82 %) and live birth (32.35 % vs. 14.25 %) of D5-SBT group were significantly higher than those of D6-SBT group. Furthermore, for blastocysts in the same morphology group (AC/BC or CA/CA group), the rates of clinical pregnancy and live birth in the D5 group were also significantly higher than those of D6 group. Conclusions For poor-quality D5 blastocysts, SBT can be recommended to patients because of acceptable pregnancy outcomes and significantly reduced multiple pregnancy rate compared with DBT. For poor-quality D6, the DBT strategy is recommended to patients to improve pregnancy outcomes. When blastocysts reach the same development speed, the transfer strategy of selecting blastocyst with inner cell mass “C” or blastocyst with trophectoderm “C” does not affect the pregnancy and neonatal outcomes.

scholarly journals Comparative Analysis of Effectiveness of Clomiphene Citrate and Letrozole Combined with Low Dose Human Menopausal Gonadotropin for Controlled Ovarian Stimulation in Intrauterine Insemination Cycles

2021 ◽  
Vol 73 (3) ◽  
pp. 198-203
Author(s):  
Padmalaya Thakur ◽  
Sujata Pradhan
Keyword(s):  
Pregnancy Rate ◽  
Ovarian Stimulation ◽  
Low Dose ◽  
Intrauterine Insemination ◽  
Clomiphene Citrate ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Controlled Ovarian Stimulation ◽  
Human Menopausal Gonadotropin ◽  
Group B

Objective: To compare the efficacy of clomiphene citrate and letrozole in combination with low dose human menopausal gonadotropin for controlled ovarian stimulation in intrauterine insemination (IUI) cycles.Methods: During January-2018 to December-2019 for intending 496 IUI cycles, controlled ovarian stimulation was performed with either clomiphene or letrozole combined with human menopausal gonadotropin (hMG), in two arms:  subjects in one arm (Group A) were with clomiphene and hMG in 222 cycles; those in the second arm (Group B) were with letrozole and hMG in 274 cycles. Pregnancy rate and clinical pregnancy rate of both groups were considered as the primary outcomes.Results: Patient characteristics like female age, indications for IUI, type of IUI, endometrial thickness and total motile fraction (TMF) of spermatozoa of male partners were seen similar in both groups. The letrozole-hMG group (Group B) had significantly higher numbers of cycles with single dominant follicle (P=0.01) and human chorionic gonadotropin (hCG) was more frequently used as the ovulation trigger (P=0.03). Pregnancy rate (18.5% vs. 15.3%, P=0.35) and clinical pregnancy rate (18.5% vs. 15.3%, P=0.35) were similar in groups A and B, respectively.Conclusion: Clomiphene citrate and letrozole combined with low dose human menopausal gonadotropin were equally effective for controlled ovarian stimulation in IUI cycles.

scholarly journals Predictive Factors for Pregnancy after Intrauterine Insemination: A Retrospective Study of Factors Affecting Outcome

2016 ◽  
Vol 8 (2) ◽  
pp. 140-144
Author(s):  
Azadeh Pravin Patel ◽  
Megha Snehal Patel ◽  
Sushma Rakesh Shah ◽  
Shashwat Kamal Jani
Keyword(s):  
Retrospective Study ◽  
Pregnancy Rate ◽  
Live Birth ◽  
Predictive Factors ◽  
Intrauterine Insemination ◽  
Multiple Pregnancy ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Female Age ◽  
Factors Affecting

ABSTRACT Objectives To determine the predictive factors for pregnancy after stimulated intrauterine insemination (IUI). Materials and methods A retrospective analysis of 136 patients undergoing 443 stimulated IUI cycles was done in an attempt to identify significant variables predictive of treatment success. The primary outcome measures were clinical pregnancy and live birth rates. Predictive factors evaluated were female age, duration of infertility, indication for IUI, number of preovulatory follicles, and postwash total motile fraction (TMF). Results The overall clinical pregnancy rate and live birth rate were 7.2% and 5.1 per cycle respectively. The mean number of IUI cycles per patient was 3.2, the miscarriage rate was 15%, and the multiple pregnancy rate was 3.1%. Among the predictive factors evaluated, female age (age > 37 years; p = 0.039), the duration of infertility (5.36 vs 6.71 years, p = 0.032), and the TMF (between 10 and 20 million, p = 0.003) significantly influenced the clinical pregnancy rate. Conclusion The clinical management of the selected infertile couple should be performed in an expedited manner taking into consideration the age of the woman, etiology, and duration of infertility and motile fraction of sperms. How to cite this article Patel AP, Patel MS, Shah SR, Jani SK. Predictive Factors for Pregnancy after Intrauterine Insemination: A Retrospective Study of Factors Affecting Outcome. J South Asian Feder Obst Gynae 2016;8(2):140-144.

Multiple pregnancy rate based on history of clinical pregnancy

2013 ◽  
Vol 100 (3) ◽  
pp. S287
Author(s):  
H. Kitasaka ◽  
N. Fukunaga ◽  
T. Yoshimura ◽  
E. Kojima ◽  
F. Tamura ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Multiple Pregnancy ◽  
Clinical Pregnancy ◽  
History Of ◽  
Multiple Pregnancy Rate

scholarly journals Is the cumulative live birth rate following in vitro fertilization (IVF) lower with government coverage than prior to coverage?

2018 ◽  
Vol 7 (12) ◽  
pp. 5150
Author(s):  
Adhwaa Khudhari ◽  
Chamile Sylvestre ◽  
Simon Phillips
Keyword(s):  
Pregnancy Rate ◽  
Live Birth ◽  
Multiple Pregnancy ◽  
Fertilization Rate ◽  
Good Prognosis ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Cumulative Pregnancy Rate ◽  
Frozen Embryos ◽  
Multiple Pregnancy Rate

Background: Most studies conclude that the cumulative pregnancy rate depends on embryo quality and quantity, which is directly related to patient’s age. In the best-case scenario, the cumulative pregnancy rate reaches 79% when the number of embryos reaches 15. Other studies reported 75% probability of live birth after 6 cycles of controlled ovarian stimulation and IVF.Methods: Retrospective cohort study comparing IVF cycles between January 2008 to December 2009 (before governmental coverage), and between January 2012 to December 2013. University-affiliated private IVF clinic. 298 good prognosis IVF patients from 2008-2009 and 610 patients from 2012-2013 were included. The cumulative LBR per IVF cycle was the main outcome measure; the secondary outcome measures were the type of protocol used, percentage of ICSI cycles, fertilization rate, proportion of day 3 versus (vs) day 5 embryo transfers, average number of embryos transferred, average number of frozen embryos, the clinical pregnancy rate and the multiple pregnancy.Results: no statistically significant difference in the cumulative LBR; it was 44.8% in 2008-2009 but 40.3% in 2012-2013. p: 0.134. The long agonist protocol was used the most 2008-2009 (75.5% of the cycles) compared to antagonist protocol in 2012-2013 (77.2%) p <0.01. There was no difference in the use of ICSI, but the fertilization rate in 2012-2013 (60.9% vs 65.9%, p=0.001). The proportion of day 3 embryos transferred in 2008-2009 (82.2%) and 2012-2013 (43.9%), p=0.005, and the proportion of day 5 embryos transferred is 3.7% in 2008-2009 but 54.9% in 2012-2013, p<0.001. The average number of embryos transferred in 2008-2009 was 1.96 vs 1.08 in 2012-2013. The average number of frozen embryos per cycle was not significantly different. The clinical pregnancy rate was not significantly different (56.8% vs 54.3%). The multiple pregnancy rate is 19.4% in 2008-2009 and 0.5% in 2012-2013.Conclusions: In good prognosis IVF patients, the cumulative LBR per cycle started was not significantly different after IVF provincial coverage and the move towards eSET on day 3 or day 5. No advantage of transferring multiple embryos in this group of patients, and that transferring one at a time reduces significantly the multiple pregnancy rate and its complications.

scholarly journals CARTR Plus: the creation of an ART registry in Canada

2020 ◽  
Vol 2020 (3) ◽  
Author(s):  
A Lanes ◽  
DB Fell ◽  
M Teitelbaum ◽  
AE Sprague ◽  
M Johnson ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Birth Outcomes ◽  
Birth Rate ◽  
Multiple Pregnancy ◽  
Pregnancy Rates ◽  
Clinical Pregnancy ◽  
Fertility Treatment ◽  
Live Births ◽  
Multiple Pregnancy Rate

Abstract STUDY QUESTION What is the status of fertility treatment and birth outcomes documented over the first 6 years of the Canadian Assisted Reproductive Technologies Register (CARTR) Plus registry? SUMMARY ANSWER The CARTR Plus registry is a robust database containing comprehensive Canadian fertility treatment data to assist with providing evidence-based rationale for clinical practice change. WHAT IS KNOWN ALREADY The rate of infertility is increasing globally and having data on fertility treatment cycles and outcomes at a population level is important for accurately documenting and effecting changes in clinical practice. STUDY DESIGN, SIZE, DURATION This is a descriptive manuscript of 183 739 fertility treatment cycles from 36 Canadian clinics over 6 years from the CARTR Plus registry. PARTICIPANTS/MATERIALS, SETTING, METHODS Canadian ART treatment cycles from 2013 through 2018 were included. This manuscript described trends in type of fertility treatment cycles, pregnancy rates, multiple pregnancy rates, primary transfer rates and birth outcomes. MAIN RESULTS AND THE ROLE OF CHANCE Over the 6 years of the CARTR Plus registry, the number of treatment cycles performed ranged from less than 200 to greater than 1000 per clinic. Patient age and the underlying cause of infertility were two of the most variable characteristics across clinics. Similar clinical pregnancy rates were found among IVF and frozen embryo transfer (FET) cycles with own oocytes (38.9 and 39.7% per embryo transfer cycle, respectively). Fertility treatment cycles that used donor oocytes had a higher clinical pregnancy rate among IVF cycles compared with FET cycles (54.9 and 39.8% per embryo transfer cycle, respectively). The multiple pregnancy rate was 7.4% per ongoing clinical pregnancy in 2018, which reflected a decreasing trend across the study period. Between 2013 and 2017, there were 31 811 pregnancies that had live births from all ART treatment cycles, which corresponded to a live birth rate of 21.4% per cycle start and 89.1% of these pregnancies were singleton live births. The low multiple pregnancy rate and high singleton birth rate are associated with the increase in single embryo transfers. LIMITATIONS, REASONS FOR CAUTION There is potential for misclassification of data, which is present in all administrative health databases. WIDER IMPLICATIONS OF THE FINDINGS The CARTR Plus registry is a robust resource for ART data in Canada. It provides easily accessible aggregated data for Canadian fertility clinics, and it contains data that are internationally comparable. STUDY FUNDING/COMPETING INTEREST(S) There was no funding provided for this study. The authors have no competing interests to declare.

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