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      Factors influencing the outcome of intrauterine insemination (IUI): Age, clinical variables and significant thresholds

      Author(s): , , , , , ,
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      Journal: Journal of Obstetrics and Gynaecology
      Publisher: Informa UK Limited

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          Abstract

          The aim was to investigate the influence of various biological factors upon the outcome of intrauterine insemination (IUI). The total IUI history (856 cycles) of 352 couples was studied. Live-birth showed a strong negative correlation with female age but no correlation with male age. Antimüllerian hormone (AMH) and antral follicle count (AFC) correlated negatively with female age, and follicle stimulating hormone (FSH) correlated positively. Significant thresholds were found for all three variables, and also for total motile count (TMC) in the prepared sperm. Calculating pregnancy losses per positive pregnancy showed a strong correlation with increasing female age. This was highly significant for biochemical losses but not for fetal heart miscarriages. Male age had no effect on rate of pregnancy loss. In conclusion, female age, FSH, AMH and TMC are good predictive factors for live-birth and therefore relate to essential in vivo steps in the reproductive process.

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          Cumulative live-birth rates after in vitro fertilization.

          Michele Hacker, Alan S Penzias, A A Malizia (2009)
          Outcomes of in vitro fertilization (IVF) treatment are traditionally reported as pregnancies per IVF cycle. However, a couple's primary concern is the chance of a live birth over an entire treatment course. We estimated cumulative live-birth rates among patients undergoing their first fresh-embryo, nondonor IVF cycle between 2000 and 2005 at one large center. Couples were followed until either discontinuation of treatment or delivery of a live-born infant. Analyses were stratified according to maternal age and performed with the use of both optimistic and conservative methods. Optimistic methods assumed that patients who did not return for subsequent IVF cycles would have the same chance of a pregnancy resulting in a live birth as patients who continued treatment; conservative methods assumed no live births among patients who did not return. Among 6164 patients undergoing 14,248 cycles, the cumulative live-birth rate after 6 cycles was 72% (95% confidence interval [CI], 70 to 74) with the optimistic analysis and 51% (95% CI, 49 to 52) with the conservative analysis. Among patients who were younger than 35 years of age, the corresponding rates after six cycles were 86% (95% CI, 83 to 88) and 65% (95% CI, 64 to 67). Among patients who were 40 years of age or older, the corresponding rates were 42% (95% CI, 37 to 47) and 23% (95% CI, 21 to 25). The cumulative live-birth rate decreased with increasing age, and the age-stratified curves ( or = 40 years) were significantly different from one another (P<0.001). Our results indicate that IVF may largely overcome infertility in younger women, but it does not reverse the age-dependent decline in fertility. 2009 Massachusetts Medical Society
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            Predictive factors for pregnancy after intrauterine insemination (IUI): an analysis of 1038 cycles and a review of the literature.

            Philippe Merviel, Marie Heraud, Nadège Grenier … (2010)
            To determine the predictive factors for pregnancy after IUI. Retrospective study. A single university medical center. One thousand thirty-eight IUI cycles in 353 couples were studied between 2002 and 2005. Ovarian stimulation via SC injection of FSH or hMG was performed daily; IUI was then performed 36 hours after triggering ovulation if at least one follicle measuring >16 mm and an endometrial thickness of >7 mm (with triple-line development) were obtained. Clinical pregnancy rates were analyzed according to the woman's age, the type of infertility, the spermogram characteristics, the total motile spermatozoa (TMS) count, the E(2) level before hCG injection, and the number of mature follicles. The couple with the best chance of pregnancy can be described as follows: an under 30 woman with cervical or anovulatory infertility and a man with a TMS >or=5 million spermatozoa. The "ideal" stimulation cycle enables the recruitment of two follicles measuring >16 mm with an E(2) concentration >500 pg/mL on the day of hCG administration. The best results are obtained when IUI is performed using a soft catheter. This study enabled the characterization of many prognostic factors for pregnancy and particularly those for women at risk of multiple pregnancies after IUI. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
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              Serum antimüllerian hormone/müllerian-inhibiting substance appears to be a more discriminatory marker of assisted reproductive technology outcome than follicle-stimulating hormone, inhibin B, or estradiol.

              David B Seifer, Paul Cohen, A M Junca … (2004)
              To test the hypothesis that the concentration of early follicular phase serum antimullerian hormone (AMH) or mullerian-inhibiting substance (MIS) is a useful marker of ovarian response and assisted reproductive technology (ART) outcome. Retrospective analysis of day 3 serum samples drawn before treatment. Private ART program. One hundred nine consecutive serum samples from women younger than 42 years of age who were undergoing ovulation induction for IVF. Follicular aspiration for IVF after ovarian stimulation with FSH in a down-regulated cycle using GnRH-a treatment. Correlations between day 3 serum AMH/MIS, E2, FSH, inhibin B levels, and IVF outcome (i.e., number of retrieved mature oocytes, number and quality of embryos obtained, ongoing clinical pregnancy rates). Multivariate regression analysis on categorical data was performed to describe a predictive model of clinical pregnancy outcome. Mean serum AMH/MIS value for clinical pregnancy (n = 38) was 2.4 ng/mL, in comparison to 1.1 ng/mL for those who did not become pregnant (n = 71). No differences were noted in mean values for day 3 FSH, inhibin B, or E2 between groups. Multivariate regression analysis demonstrated that day 3 serum AMH/MIS had the greatest independent contribution in predicting pregnancy outcomes. These data demonstrate a strong association between day 3 serum AMH/MIS level and IVF outcome in women younger than 42 years of age. Higher AMH/MIS concentrations are associated with a greater number of mature oocytes, a greater number of embryos, and ultimately a higher clinical pregnancy rate. Furthermore, AMH/MIS may offer greater prognostic value than other currently available serum markers of ART outcome.
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                Author and article information

                Journal
                Title: Journal of Obstetrics and Gynaecology
                Abbreviated Title: Journal of Obstetrics and Gynaecology
                Publisher: Informa UK Limited
                ISSN (Print): 0144-3615
                ISSN (Electronic): 1364-6893
                Publication date Created: October 15 2013
                Publication date Created: October 2013
                Publication date (Electronic): October 15 2013
                Publication date (Print): October 2013
                Volume: 33
                Issue: 7
                Pages: 697-700
                Article
                DOI: 10.3109/01443615.2013.810199
                PubMed ID: 24127958
                SO-VID: 213e98bc-dddb-49b0-9d84-3c4aba2baec8
                Copyright © © 2013
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