The Effect of Semen Parameters and Insemination Preparation Period on Intrauterine Insemination Success

Yıl 2021, Cilt: 47 Sayı: 1, 55 - 61, 01.04.2021

Seda Işıklar , Kiper Aslan , Cihan Çakır , Işıl Kasapoğlu , Gürkan Uncu , Berrin Avcı

https://doi.org/10.32708/uutfd.808684

Öz

In intrauterine insemination (IUI), which is the first step in assisted reproductive techniques (ART), female age, body mass index (BMI), stimulation time, abstinence duration and semen parameters are among prognostic factors that affect success. Considering clinical success achieved by each ART center as a result of routine treatment approaches and laboratory practices, its prognostic factors should be established and management of the treatment process should be arranged in this perspective. In this retrospective study, 245 IUI cycles performed in our ART center between January 2019 and February 2020 were evaluated. Etiology, age, BMI, sperm parameters of ejaculate before and after washing, abstinence duration and time periods during ejaculate preparation were evaluated. While there was no difference between groups in terms of female and male age, female BMI, etiology, duration of infertility, number of cycles and abstinence duration, it was found that increased male BMI decreased pregnancy success. It was observed that semen volume, sperm concentration before and after washing and total motile sperm count did not have a determining effect on pregnancy success, and the percentage of motile sperm and immotile sperm after washing was determinant. It was determined that the time from sampling and washing to the time of IUI procedure did not affect clinical success, but the long incubation period before washing decreased the pregnancy rate. In this study conducted with a small sample group, it was concluded that pre-wash semen parameters do not have a determinant effect on clinical success in IUI treatment, and male obesity and sample preparation processes should be considered as prognostic factors.

Anahtar Kelimeler

Infertility, intrauterine insemination, prognostic factors, pregnancy rates, sperm parameters

Semen Parametrelerinin ve İnseminasyon Öncesi Hazırlık Periyodunun İntrauterin İnseminasyon Başarısına Etkisi

Öz

Üremeye yardımcı tedavi (ÜYT) uygulamalarında ilk basamak olan intrauterin inseminasyonda (IUI) kadın yaşı, vücut kitle indeksi (VKİ), stimülasyon süresi, abstinens süresi ve semen parametreleri başarıyı etkileyen prognostik faktörler arasındadır. Her ÜYT merkezinin rutin tedavi yaklaşımları ve laboratuvar uygulamaları sonucunda elde ettiği klinik başarı dikkate alınarak kendi prognostik faktörleri oluşturulmalı ve tedavi sürecinin yönetimi bu perspektifte düzenlenmelidir. Bu retrospektif çalışmada Ocak 2019-Şubat 2020 tarihleri arasında ÜYT merkezimizde gerçekleştirilen 245 IUI siklusu değerlendirilmiştir. IUI tedavisi uygulanan hastaların etiyoloji, yaş, VKİ, ejakülatın yıkama öncesi ve yıkama sonrası sperm parametreleri, abstinens süresi ve ejakulat yıkama işlemi boyunca geçen zaman periyotları değerlendirilmiştir. Kadın ve erkek yaşı, kadın VKİ, etiyoloji, infertilite süresi, siklus sayısı ve abstinens süresi bakımından gruplar arası farklılık saptanmaz iken, erkek VKİ artışının gebelik başarısını azalttığı saptandı. Semen volümü, yıkama öncesi ve sonrası sperm konsantrasyonu ve total motil sperm sayısının gebelik başarısı açısından belirleyici etkisinin olmadığı, yıkama sonrası motil sperm ve immotil sperm yüzdesinin belirleyici olduğu görüldü. Numune verilmesi ve yıkama sonrasından IUI işlemine kadar geçen sürelerin klinik başarıyı etkilemediği, fakat yıkama öncesi uzun inkübasyon süresinin gebelik şansını azalttığı saptandı. Küçük örneklem grubuyla yapılan bu çalışmada IUI tedavisinde klinik başarıda yıkama öncesi semen parametrelerinin belirleyici bir etkisinin olmadığı, erkek obezitesi ve numune hazırlama süreçlerinin prognostik faktörler olarak göz önünde bulundurulması gerektiği sonucuna varıldı.

Anahtar Kelimeler

İnfertilite, intrauterin inseminasyon, prognostik faktörler, gebelik oranları, sperm parametreleri

Kaynakça

• 1. Moghissi KS, Wallach EE. Unexplained infertility. Fertil Steril 1983;39(1):5-21.
• 2. Guzick DS, Grefenstette I, Baffone K et al. Infertility evaluation in fertile women:a model for assessing the efficacy of infertility testing. Hum Reprod. 1994 Dec;9(12):2306-10.
• 3. Abdelkader AM, Yeh J. The potential use of intrauterine insemination as a basic option for infertility: a review for technology-limited medical settings. Obstet Gynecol Int 2009;2009: 584837.
• 4. Bensdorp AJ, Tjon-Kon-Fat RI, Bossuyt PMM et al. Prevention of multiple pregnancies in couples with unexplained or mild male subfertility: randomised controlled trial of in vitro fertilisation with single embryo transfer or invitro fertilisation in modified natural cycle compared with intrauterine insemination with controlled ovarian hyperstimulation. BMJ. 2015 Jan 9;350:g7771.
• 5.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.
• 6.Nandi A, Bhide P, Hooper R et al. Intrauterine insemination-with gonadotropin stimulation or invitro fertilization for the treatment of unexplained sub-fertility: a randomized controlled trial. Fertil Steril. 2017 Jun;107(6):1329-1335.e2.
• 7.Huttunen SN, Tomas C,Bloigu R et al. Intrauterine insemination treatment in subfertility: an analysis of factors affecting outcome. Hum Reprod. 1999 Mar;14(3):698-703.
• 8.Ejzenberg D, Gomes TJO, Monteleone PAA et al. Prognostic factors for pregnancy after intrauterine insemination. Int J Gynaecol Obstet 2019 Oct;147(1):65-72.
• 9. World Health Organization Department of Reproductive Health and Research. WHO laboratory manual for the examination and processing of human semen, fifth edition. WHO 2010.
• 10. Wainer R, Merlet F. Indications des inseminations intra-uternes intraconjugales en casd’oligo-astenoterato-spermie. In Les Traitements Actuels de la Sterilite Masculine. John Libbey Eurotext, montrogue, France.1998.
• 11. Belloc S, Cohen-Bacrie P, Benkhalifa M et al. Effect of maternal and paternal age on pregnancy and miscarriage rate safter intrauterine insemination. Reprod Biomed Online. 2008 Sep;17(3):392-7.
• 12. Haebe J, Martin J, Tekepety F et al. Success of intrauterine insemination in women aged 40-42 years. Fertil Steril. 2002 Jul;78(1):29-33.
• 13. Merviel P, Heraud MH, Grenier N et al. Predictive factors for pregnancy after intrauterine insemination (IUI):an analysis of 1038 cyclesand a review of the literature. Fertil Steril. 2010 Jan;93(1):79-88.
• 14. Ahinko-Hakamaa K, Huhtala H, Tinkanen H. Success in intrauterine insemination: the role of etiology. Acta Obstet Gynecol Scand. 2007;86(7):855-60.
• 15. Ashrafi M, Rashidi M, Ghasemi A et al. The role of infertility etiology in success rate of intrauterine insemination cycles: an evaluation of predictive factors for pregnancy rate. Int J Fertil Steril. 2013 Jul;7(2):100-7.
• 16.Hansen KR,He ALW, Styer AK et al. Predictors of pregnancy and live-birth in couples with unexplained infertility after ovarian stimulation-intrauterine insemination. Fertil Steril. 2016 Jun; 105(6): 1575–1583.e2.
• 17.Tay PYS, Raj VRM, Kulenthran A et al. Prognostic factors influencing pregnancy rate after stimulated intrauterine insemination.Med J Malaysia. 2007 Oct;62(4):286-9.
• 18. Zainul MRR, Ong FB, Omar MH et al. Predictors of intrauterine insemination success. Med J Malaysia. 2006 Dec;61(5):599-607.
• 19. Campbell JM, Lane M, Owens JA et al. Paternal obesity negatively affects malefertility and assisted reproduction outcomes:a systematic review and meta-analysis. Reprod Biomed Online. 2015 Nov;31(5):593-604.
• 20. Fernández-Sánchez A, Madrigal-Santillán E, Bautista M et al. Inflammation, Oxidative Stress, and Obesity. Int J Mol Sci. 2011; 12(5): 3117–3132.
• 21.Durairajanayagam D, Agarwal A, Ong C. Causes, effects and molecular mechanisms of testicular heat stress. Reproductive BioMedicine Online (2015) 30, 14–27.
• 22. Durairajanayagam D. Lifestyle causes of male infertility. Arab Journal of Urology (2018) 16, 10–20.
• 23. Khalil MR, Rasmussen PE, Erb K et al. Homolog ous intrauterine insemination. An evaluation of prognostic factors based on a review of 2473 cycles. Acta Obstet Gynecol Scand. 2001 Jan;80(1):74-81.
• 24. Dickey RP, Pyrzak R, Lu PY et al. Comparison of the sperm quality necessary for successful intrauterine insemination with World Health Organization threshold values for normal sperm. Fertil Steril. 1999 Apr;71(4):684-9.
• 25. Hammoud AO, Gibson M, Peterson MC, Carrell DT. Effect of sperm preparation techniques by density gradient on intra-individual variation of sperm motility. Arch Androl. 2007 Nov-Dec;53(6):349-51. doi: 10.1080/01485010701730666. PMID: 18357965.
• 26.Song GJ, Herko R, Lewis V. Location of semen collection and time interval from collection to use for intrauterine insemination. Fertil Steril. 2007 Dec;88(6):1689-91.
• 27. Yavas Y, Selub MR. Intrauterine insemination (IUI) pregnancy outcome is enhanced by shorter intervals from semen collection to sperm wash, from sperm wash to IUI time, and from semen collection to IUI time. Fertil Steril. 2004 Dec;82(6):1638-47.