İntrauterin İnseminasyon Sikluslarında başarıyı etkileyen faktörler; tek merkezin iki yıllık deneyimi

Abstract

Amaç: Bu çalışmanın amacı; ovulatuar disfonksiyonu veya açıklanamayan infertilitesi olan hastalarda, klomifen sitrat ve gonadotropinler ile yapılan ovulasyon indüksiyonu ve intrauterin inseminasyon sikluslarının başarı oranlarını değerlendirmek ve başarıyı etkileyen faktörleri incelemektir. Gereç ve Yöntemler: Haziran 2017 ve Ekim 2019 yılları arasında ovulatuar disfonksiyon veya açıklanamayan infertilite tanısı konan 152 infertil çiftte yapılan 223 intrauterin inseminasyon siklusu kayıtları retrospektif olarak tarandı. Sonuç: Toplamda 33 pozitif gebelik test sonucu elde edildi ve gebelik başarı oranımız %14,8’di. Gonadotropin IUI sikluslarında gebelik başarı oranı %16,6 ve klomifen sitrat IUI sikluslarında gebelik başarı oranı %9,3’dü. Ovulatuar disfonksiyonu ve açıklanamayan infertilitesi olan infertil populasyonda sigara içmenin IUI başarısı üzerine olumsuz etkisi saptanırken (p=0,012); kadın yaşı, BMI, infertilite süresi, bazal FSH, LH, östradiol düzeyleri ve trigger günü endometiral kalınlık ile IUI başarısı arasında bir ilişki saptanmadı.

Keywords

• Ovulasyon indüksiyonu
• intrauterin inseminasyon
• prognostik faktörler
• gebelik oranı

Factors affecting success in intrauterine insemination cycles; 2-year single center experience

Abstract

Abstract Objective: The aim of this study is to evaluate the success rates of intrauterine insemination cycles due to ovulation induction with clomiphene citrate and gonadotropins, and to identify factors associated with successful outcomes in women with unexplained infertility and ovulatory dysfunction. Material and Methods: Between June 2017 and October 2019, 223 intrauterine insemination cycle records were scanned retrospectively in 152 infertile couples diagnosed with ovulatory dysfunction or unexplained infertility. Result: A total of 33 positive pregnancy test results were obtained, which had shown a pregnancy success rate of 14.8%. Pregnancy success rate in Gonadotropin IUI (Intrauterine Insemination) cycles was found as 16.6% and pregnancy success rate in CC (Clomiphene Citrate) IUI cycles was found as 9.3%. While it has been detected that smoking has had a negative effect on IUI success rate for the infertile population with ovulatory dysfunction and unexplained infertility (p=0.012); factors such as female age, BMI (Body mass index), infertility span, basal FSH (Follicle Stimulating Hormone), basal LH (Luteinizing Hormone), basal estradiol levels and trigger-day endometrial thickness were found to have no correlation with IUI success rate at all.

Keywords

• Ovulation induction
• intrauterine insemination
• prognostic factors
• pregnancy rate

References

1. 1: Lindsay TJ, Vitrikas KR. Evaluation and treatment of infertility. Am Fam Physician. 2015 Mar 1;91(5):308-14.
2. 2: B Gurlek, AS Batioglu, M Kanat-Pektas, I Kale, O Onal, N Yilmaz-Karakas. Success Rates of Clomiphene Citrate and Recombinant Gonadotropin Cycles: A Single-Center Experience. Gynecol Obstet Reprod Med 2019;25(0):000-000.
3. 3: Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, Piltonen T, Norman RJ; International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 2018 Sep 1;33(9):1602-1618. doi: 10.1093/humrep/dey256.
4. 4: Luco SM, Agbo C, Behr B, Dahan MH. The evaluation of pre and post processing semen analysis parameters at the time of intrauterine insemination in couples diagnosed with male factor infertility and pregnancy rates based on stimulation agent. A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol. 2014 Aug;179:159-62. doi: 10.1016/j.ejogrb.2014.05.003. Epub 2014 May 20.
5. 5:Allahbadia GN. Intrauterine Insemination: Fundamentals Revisited. J Obstet Gynaecol India. 2017 Dec;67(6):385-392. doi: 10.1007/s13224-017-1060-x. Epub 2017 Oct 25.
6. 6: Ejzenberg D, Gomes TJO, Monteleone PAA, Serafini PC, Soares-Jr JM, Baracat EC. Prognostic factors for pregnancy after intrauterine insemination. Int J Gynaecol Obstet. 2019 Oct;147(1):65-72. doi: 10.1002/ijgo.12898. Epub 2019 Jul 23.
7. 7: Farquhar CM, Liu E, Armstrong S, Arroll N, Lensen S, Brown J. Intrauterine insemination with ovarian stimulation versus expectant management for unexplained infertility (TUI): a pragmatic, open-label, randomised, controlled, two-centre trial. Lancet. 2018 Feb 3;391(10119):441-450. doi: 10.1016/S0140-6736(17)32406-6. Epub 2017 Nov 23.
8. 8: Steures P, van der Steeg JW, Hompes PG, Bossuyt PM, Habbema JD, Eijkemans MJ, Schöls WA, Burggraaff JM, van der Veen F, Mol BW. Effectiveness of intrauterine insemination in subfertile couples with an isolated cervical factor: a randomized clinical trial. Fertil Steril. 2007 Dec;88(6):1692-6. Epub 2007 May 7. Doi:10.1016/j.fertnstert.2007.01.124.

9. 9: van Eekelen R, van Geloven N, van Wely M, McLernon DJ, Mol F, Custers IM, Steures P, Bhattacharya S, Mol BW, van der Veen F, Eijkemans MJ. Is IUI with ovarian stimulation effective in couples with unexplained subfertility? Hum Reprod. 2019 Jan 1;34(1):84-91. doi: 10.1093/humrep/dey329.
10. 10: Cantineau AE, Cohlen BJ, Heineman MJ. Ovarian stimulation protocols (anti-estrogens, gonadotrophins with and without GnRH agonists/antagonists) for intrauterine insemination (IUI) in women with subfertility. Cochrane Database Syst Rev. 2007;(2):CD005356.
11. 11: Diamond MP, Legro RS, Coutifaris C, Alvero R, Robinson RD, Casson P, et al. Letrozole, Gonadotropin, or Clomiphene for Unexplained Infertility. N Engl J Med. 2015;373(13):1230-40.
12. 12: Danhof NA, van Wely M, Repping S, Koks C, Verhoeve HR, de Bruin JP, et al. Follicle stimulating hormone versus clomiphene citrate in intrauterine insemination for unexplained subfertility: a randomized controlled trial. Hum Reprod. 2018;33(10):1866-74.
13. 13: Huang S, Du X, Wang R, Li R, Wang H, Luo L, O'Leary S, Qiao J, Mol BWJ. Ovulation induction and intrauterine insemination in infertile women with polycystic ovary syndrome: A comparison of drugs. Eur J Obstet Gynecol Reprod Biol. 2018;231:117-21.
14. 14: van Rumste MM, Custers IM, van der Veen F, van Wely M, Evers JL, Mol BW. The influence of the number of follicles on pregnancy rates in intrauterine insemination with ovarian stimulation: a meta-analysis. Hum Reprod Update. 2008 Nov-Dec;14(6):563-70. doi: 10.1093/humupd/dmn034. Epub 2008 Aug 6.
15. 15: Ahinko-Hakamaa K, Huhtala H, Tinkanen H. Success in intrauterine insemination: the role of etiology. Acta Obstet Gynecol Scand. 2007;86(7):855-60.
16. 16: 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 Jan;93(1):79-88. doi: 10.1016/j.fertnstert.2008.09.058. Epub 2008 Nov 8.
17. 17: Bou Nemer L, Weitzman VN, Arheart KL, Barrionuevo MJ, Christie DR, Mouhayar Y, Hoffman DI, Maxson WS, Ory SJ. In Vitro Fertilization Versus Mild Stimulation Intrauterine Insemination in Women Aged 40 and Older. Reprod Sci. 2017 Apr;24(4):609-612. doi: 10.1177/1933719116667215. Epub 2016 Sep 27.
18. 18: Isa AM, Abu-Rafea B, Alasiri SA, Binsaleh S, Ismail KH, Vilos GA. Age, body mass index, and number of previous trials: are they prognosticators of intra-uterine-insemination for infertility treatment? Int J Fertil Steril. 2014 Oct;8(3):255-60. Epub 2014 Nov 1.
19. 19: Li HW, Van Esch M, De Vries J, Duncan WC, Anderson RA. Gonadotrophin ovulation induction is a successful treatment for World Health Organisation Group II anovulatory subfertility in women aged up to 40 and with body mass index up to 34. Hum Fertil (Camb). 2010 Mar;13(1):35-40. doi: 10.3109/14647270903490765.
20. 20: McKnight KK, Nodler JL, Cooper JJ Jr, Chapman VR, Cliver SP, Bates GW Jr. Body mass index-associated differences in response to ovulation induction with letrozole. Fertil Steril. 2011 Nov;96(5):1206-8. doi: 10.1016/j.fertnstert.2011.08.002. Epub 2011 Aug 24.
21. 21: Jeon YE, Jung JA, Kim HY, Seo SK, Cho S, Choi YS, Lee BS. Predictive factors for pregnancy during the first four intrauterine insemination cycles using gonadotropin. Gynecol Endocrinol. 2013 Sep;29(9):834-8. doi: 10.3109/09513590.2013.808324. Epub 2013 Jul 17.
22. 22: van der Steeg JW, Steures P, Eijkemans MJ, Habbema JD, Hompes PG, Broekmans FJ, Bouckaert PX, Bossuyt PM, van der Veen F, Mol BW. Predictive value and clinical impact of Basal follicle-stimulating hormone in subfertile, ovulatory women. J Clin Endocrinol Metab. 2007 Jun;92(6):2163-8. Epub 2007 Apr 3.
23. 23: Firns S, Cruzat VF, Keane KN, Joesbury KA, Lee AH, Newsholme P, Yovich JL.The effect of cigarette smoking, alcohol consumption and fruit and vegetable consumption on IVF outcomes: a review and presentation of original data. Reprod Biol Endocrinol. 2015 Dec 16;13:134. doi: 10.1186/s12958-015-0133-x.
24. 24: Freour T, Masson D, Dessolle L, Allaoua D, Dejoie T, Mirallie S, et al. Ovarian reserve and in vitro fertilization cycles outcome according to women smoking status and stimulation regimen. Arch Gynecol Obstet. 2012;285(4): 1177–82.
25. 25: Soares SR, Simon C, Remohí J, Pellicer A. Cigarette smoking affects uterine receptiveness. Hum Reprod. 2007 Feb;22(2):543-7. Epub 2006 Nov 9.
26. 26: Hansen KR, He AL, Styer AK, Wild RA, Butts S, Engmann L, et al. Predictors of pregnancy and live-birth in couples with unexplained infertility after ovarian stimulation-intrauterine insemination. Fertil Steril. 2016; 105(6):1575-83.e2.
27. 27:Farhi J, Orvieto R. Influence of smoking on outcome of COH and IUI in subfertile couples. J Assist Reprod Genet. 2009;26(7):421-4.
28. 28: Weiss NS, van Vliet MN, Limpens J, Hompes PGA, Lambalk CB, Mochtar MH, van der Veen F, Mol BWJ, van Wely M. Endometrial thickness in women undergoing IUI with ovarian stimulation. How thick is too thin? A systematic review and meta-analysis. Hum Reprod. 2017 May 1;32(5):1009-1018. doi: 10.1093/humrep/dex035.