Evaluation of pregnancy rates in infertile women after application of ovulation induction and intrauterine insemination
Yıl 2020,
Cilt: 45 Sayı: 2, 621 - 628, 30.06.2020
Sabri Berkem Ökten
,
Zehra Nihal Dolgun
,
Vedat Ugurel
,
Koray Elter
Öz
Purpose: The aim of this studywas to investigate the effects of these factors on pregnancy rates in infertile patients following ovulation induction and intrauterine insemination.
Materials and Methods: The study was performed retrospectively that investigated examination reports and laboratory results of 201 infertile patients with unexplained infertility, male factor and anovulation. Women were subdivided into two groups according to the ovary-stimulating agent used as gonadotropin or clomiphene citrate. A semen sample was obtained from all men participants.
Results: There were 239 cycles of unexplained infertility (77.9%), 39 cycles in ovulatory dysfunction (12.7%) and 29 cycles in male factor (9.4%) groups. The clinical pregnancy rates per cycle according to infertility type were found as 18.4% (n:44) for unexplained infertility, 17.9% (n:7) for ovulatory dysfunction and 13.8% (n:4) for malefactor. In regression analyses, follicle (diameter>10mm) count on the day of hCG administration and inseminated total motile sperm count (ITMSC) were independently affected pregnancy rate. ITMSC area value under the curve (0.63) was significantly different from 0.5.
Conclusion: Follicle count on the day of hCG administration and ITMSC independently affect the pregnancy rate. Additionally, the intrauterine insemination method should be attempted in appropriate cases that have an acceptable successful pregnancy rate.
Teşekkür
We thank the Baskent University Administration for approving and supporting the study.
Kaynakça
- 1. Medicine PCoASfR. Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertility and Sterility. 2013;99(1):63.2. Demirel E. Effects of spermiogram parameters in patients who attempt intrauterine insemination. Journal of Clinical and Experimental Investigations. 2013;4(4):472-6.3. Khalil MR, Rasmussen PE, Erb K, Laursen SB, Rex S, Westergaard LG. Homologous intrauterine insemination. An evaluation of prognostic factors based on a review of 2473 cycles. Acta Obstetricia et Gynecologica Scandinavica. 2001;80(1):74-81.4. Miller DC, Hollenbeck BK, Smith GD, Randolph JF, Christman GM, Smith YR, et al. Processed total motile sperm count correlates with pregnancy outcome after intrauterine insemination. Urology. 2002;60(3):497-501.5. Papillon-Smith J, Baker SE, Agbo C, Dahan MH. Pregnancy rates with intrauterine insemination: comparing 1999 and 2010 World Health Organization semen analysis norms. Reproductive BioMedicine Online. 2015;30(4):392-400.6. Thijssen A, Creemers A, Van der Elst W, Creemers E, Vandormael E, Dhont N, et al. Predictive factors influencing pregnancy rates after intrauterine insemination with frozen donor semen: a prospective cohort study. Reproductive BioMedicine Online. 2017;34(6):590-7.7. Van Voorhis B. Effect of the total motile sperm count on the efficacy and cost-effectiveness of intrauterine insemination and in vitro fertilization. Fertility and Sterility. 2001;75(4):661-8.8. Yavuz A, Demirci O, Sözen H, Uludoğan M. Predictive factors influencing pregnancy rates after intrauterine insemination. Iranian Journal of Reproductive Medicine. 2013;11(3):227-34.9. Grigoriou O, Pantos K, Makrakis E, Hassiakos D, Konidaris S, Creatsas G. Impact of isolated teratozoospermia on the outcome of intrauterine insemination. Fertility and Sterility. 2005;83(3):773-5.10. 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. Fertility and Sterility. 2010;93(1):79-88.11. Wainer R. Influence of the number of motile spermatozoa inseminated and of their morphology on the success of intrauterine insemination. Human Reproduction. 2004;19(9):2060-5.12. Ibérico G, Vioque J, Ariza N, Lozano JM, Roca M, Llácer J, et al. Analysis of factors influencing pregnancy rates in homologous intrauterine insemination. Fertility and Sterility. 2004;81(5):1308-13.13. Steures P, van der Steeg JW, Mol BWJ, Eijkemans MJC, van der Veen F, Habbema JDF, et al. Prediction of an ongoing pregnancy after intrauterine insemination. Fertility and Sterility. 2004;82(1):45-51.14. van Rumste MME, Custers IM, van der Veen F, van Wely M, Evers JLH, Mol BWJ. The influence of the number of follicles on pregnancy rates in intrauterine insemination with ovarian stimulation: a meta-analysis. Human Reproduction Update. 2008;14(6):563-70.15. Nuojua-Huttunen S. Intrauterine insemination treatment in subfertility: an analysis of factors affecting outcome. Human Reproduction. 1999;14(3):698-703.16. Dickey RP, Olar TT, Taylor SN, Curole DN, Rye PH. Relationship of follicle number and other factors to fecundability and multiple pregnancy in clomiphene citrate-induced intrauterine insemination cycles. International Journal of Gynecology & Obstetrics. 1992;39(3):255-.17. Dickey RP, Taylor SN, Lu PY, Sartor BM, Rye PH, Pyrzak R. Effect of diagnosis, age, sperm quality, and number of preovulatory follicles on the outcome of multiple cycles of clomiphene citrate-intrauterine insemination. Fertility and Sterility. 2002;78(5):1088-95.18. Steures P, van der Steeg JW, Hompes PGA, Habbema JDF, Eijkemans MJC, Broekmans FJ, et al. Intrauterine insemination with controlled ovarian hyperstimulation versus expectant management for couples with unexplained subfertility and an intermediate prognosis: a randomised clinical trial. The Lancet. 2006;368(9531):216-21.19. Dinelli L, Courbière B, Achard V, Jouve E, Deveze C, Gnisci A, et al. Prognosis factors of pregnancy after intrauterine insemination with the husband's sperm: conclusions of an analysis of 2,019 cycles. Fertility and Sterility. 2014;101(4):994-1000.20. Cantineau AEP, Cohlen BJ, Heineman MJ. Ovarian stimulation protocols (anti-oestrogens, gonadotrophins with and without GnRH agonists/antagonists) for intrauterine insemination (IUI) in women with subfertility. Cochrane Database of Systematic Reviews: John Wiley & Sons, Ltd; 2005.21. Gomez R, Schorsch M, Steetskamp J, Hahn T, Heidner K, Seufert R, et al. The effect of ovarian stimulation on the outcome of intrauterine insemination. Archives of gynecology and obstetrics. 2013;289(1):181-5.22. 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. European journal of obstetrics, gynecology, and reproductive biology. 2014;179:159-62.23. Hassan N, Agbo C, Dahan MH. Pregnancy rates unaffected by sperm count in intrauterine insemination: a retrospective cohort study. Minerva ginecologica. 2017;69(1):6-12.24. Ruiter-Ligeti J, Agbo C, Dahan M. The impact of semen processing on sperm parameters and pregnancy rates after intrauterine insemination. Minerva ginecologica. 2017;69(3):218-24.25. Xiao CW, Agbo C, Dahan MH. Comparison of pregnancy rates in pre-treatment male infertility and low total motile sperm count at insemination. Archives of gynecology and obstetrics. 2016;293(1):211-7.26. Badawy A, Elnashar A, Eltotongy M. Effect of sperm morphology and number on success of intrauterine insemination. Fertility and Sterility. 2009;91(3):777-81.27. Francavilla F, Romano R, Santucci R, Poccia G. Effect of sperm morphology and motile sperm count on outcome of intrauterine insemination in oligozoospermia and/or asthenozoospermia**Supported by Ministero della Pubblica Istruzione, Rome, Italy.††Presented in part at the IVth International Congress of Andrology, Florence, Italy, May 14 to 18, 1989. Fertility and Sterility. 1990;53(5):892-7.28. Tomlinson MJ, Amissah-Arthur JB, Thompson KA, Kasraie JL, Bentick B. Infertility: Prognostic indicators for intrauterine insemination (IUI): statistical model for IUI success. Human Reproduction. 1996;11(9):1892-6.29. Mathieu C, Ecochard R, Bied V, Lornage J, Czyba JC. Andrology: Cumulative conception rate following intrauterine artificial insemination with husband's spermatozoa: influence of husband's age. Human Reproduction. 1995;10(5):1090-7.30. Brzechffa PR, Daneshmand S, Buyalos RP. Sequential clomiphene citrate and human menopausal gonadotrophin with intrauterine insemination: the effect of patient age on clinical outcome. Human Reproduction. 1998;13(8):2110-4.31. Kolibianakis EM, Zikopoulos KA, Fatemi HM, Osmanagaoglu K, Evenpoel J, Van Steirteghem A, et al. Endometrial thickness cannot predict ongoing pregnancy achievement in cycles stimulated with clomiphene citrate for intrauterine insemination. Reproductive BioMedicine Online. 2004;8(1):115-8.
Ovulasyon indüksiyonu ve intrauterin inseminasyon sonrası infertil kadınlarda gebelik hızlarının değerlendirilmesi
Yıl 2020,
Cilt: 45 Sayı: 2, 621 - 628, 30.06.2020
Sabri Berkem Ökten
,
Zehra Nihal Dolgun
,
Vedat Ugurel
,
Koray Elter
Öz
Amaç: Bu çalışmada ovulasyon indüksiyonu ve intrauterin inseminasyon sonrası infertil hastalarda bu faktörlerin gebelik oranlarına etkilerini araştırılması amaçlanmıştır.
Gereç ve Yöntem: Çalışma retrospektif olarak incelendi ve açıklanamayan infertilite, erkek faktörü ve anovülasyonu olan 201 infertil hastanın laboratuvar sonuçları ve raporları incelendi. Kadınlar gonadotropin veya klomifen sitrat olarak kullanılan ovulasyon uyarıcı maddeye göre iki gruba ayrıldı. Tüm katılımcılardan alınan semen örnekleri değerlendirildi.
Bulgular: Açıklanamayan infertilite 239 siklus (77.9%), ovulatör disfonksiyonda 39 (12.7%) ve erkek faktör (9.4%) gruplarında 29 siklus vardı. İnfertilite tipine göre siklus başına klinik gebelik oranları açıklanamayan infertilite için 18.4% (n:44), ovulasyon disfonksiyonu için 17.9% (n:7), erkek faktör için13.8% (n:4) olarak bulundu. Regresyon analizlerinde hCG uygulamasının yapıldığı gün folikül (çap>10 mm) sayısı ve insemine toplam hareketli sperm sayısı (ITHSS) gebelik oranını bağımsız olarak etkiledi. ITHSS eğrisi altındaki alan değeri (0.63) 0.5'ten anlamlı olarak farklıydı.
Sonuç: hCG uygulamasının yapıldığı gün folikül sayısının ve ITHSS'nin gebelik oranını bağımsız olarak etkilediğini göstermiştir. Ek olarak, kabul edilebilir başarılı bir gebelik oranına sahip uygun durumlarda intrauterin inseminasyon yöntemi denenmelidir.
Kaynakça
- 1. Medicine PCoASfR. Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertility and Sterility. 2013;99(1):63.2. Demirel E. Effects of spermiogram parameters in patients who attempt intrauterine insemination. Journal of Clinical and Experimental Investigations. 2013;4(4):472-6.3. Khalil MR, Rasmussen PE, Erb K, Laursen SB, Rex S, Westergaard LG. Homologous intrauterine insemination. An evaluation of prognostic factors based on a review of 2473 cycles. Acta Obstetricia et Gynecologica Scandinavica. 2001;80(1):74-81.4. Miller DC, Hollenbeck BK, Smith GD, Randolph JF, Christman GM, Smith YR, et al. Processed total motile sperm count correlates with pregnancy outcome after intrauterine insemination. Urology. 2002;60(3):497-501.5. Papillon-Smith J, Baker SE, Agbo C, Dahan MH. Pregnancy rates with intrauterine insemination: comparing 1999 and 2010 World Health Organization semen analysis norms. Reproductive BioMedicine Online. 2015;30(4):392-400.6. Thijssen A, Creemers A, Van der Elst W, Creemers E, Vandormael E, Dhont N, et al. Predictive factors influencing pregnancy rates after intrauterine insemination with frozen donor semen: a prospective cohort study. Reproductive BioMedicine Online. 2017;34(6):590-7.7. Van Voorhis B. Effect of the total motile sperm count on the efficacy and cost-effectiveness of intrauterine insemination and in vitro fertilization. Fertility and Sterility. 2001;75(4):661-8.8. Yavuz A, Demirci O, Sözen H, Uludoğan M. Predictive factors influencing pregnancy rates after intrauterine insemination. Iranian Journal of Reproductive Medicine. 2013;11(3):227-34.9. Grigoriou O, Pantos K, Makrakis E, Hassiakos D, Konidaris S, Creatsas G. Impact of isolated teratozoospermia on the outcome of intrauterine insemination. Fertility and Sterility. 2005;83(3):773-5.10. 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. Fertility and Sterility. 2010;93(1):79-88.11. Wainer R. Influence of the number of motile spermatozoa inseminated and of their morphology on the success of intrauterine insemination. Human Reproduction. 2004;19(9):2060-5.12. Ibérico G, Vioque J, Ariza N, Lozano JM, Roca M, Llácer J, et al. Analysis of factors influencing pregnancy rates in homologous intrauterine insemination. Fertility and Sterility. 2004;81(5):1308-13.13. Steures P, van der Steeg JW, Mol BWJ, Eijkemans MJC, van der Veen F, Habbema JDF, et al. Prediction of an ongoing pregnancy after intrauterine insemination. Fertility and Sterility. 2004;82(1):45-51.14. van Rumste MME, Custers IM, van der Veen F, van Wely M, Evers JLH, Mol BWJ. The influence of the number of follicles on pregnancy rates in intrauterine insemination with ovarian stimulation: a meta-analysis. Human Reproduction Update. 2008;14(6):563-70.15. Nuojua-Huttunen S. Intrauterine insemination treatment in subfertility: an analysis of factors affecting outcome. Human Reproduction. 1999;14(3):698-703.16. Dickey RP, Olar TT, Taylor SN, Curole DN, Rye PH. Relationship of follicle number and other factors to fecundability and multiple pregnancy in clomiphene citrate-induced intrauterine insemination cycles. International Journal of Gynecology & Obstetrics. 1992;39(3):255-.17. Dickey RP, Taylor SN, Lu PY, Sartor BM, Rye PH, Pyrzak R. Effect of diagnosis, age, sperm quality, and number of preovulatory follicles on the outcome of multiple cycles of clomiphene citrate-intrauterine insemination. Fertility and Sterility. 2002;78(5):1088-95.18. Steures P, van der Steeg JW, Hompes PGA, Habbema JDF, Eijkemans MJC, Broekmans FJ, et al. Intrauterine insemination with controlled ovarian hyperstimulation versus expectant management for couples with unexplained subfertility and an intermediate prognosis: a randomised clinical trial. The Lancet. 2006;368(9531):216-21.19. Dinelli L, Courbière B, Achard V, Jouve E, Deveze C, Gnisci A, et al. Prognosis factors of pregnancy after intrauterine insemination with the husband's sperm: conclusions of an analysis of 2,019 cycles. Fertility and Sterility. 2014;101(4):994-1000.20. Cantineau AEP, Cohlen BJ, Heineman MJ. Ovarian stimulation protocols (anti-oestrogens, gonadotrophins with and without GnRH agonists/antagonists) for intrauterine insemination (IUI) in women with subfertility. Cochrane Database of Systematic Reviews: John Wiley & Sons, Ltd; 2005.21. Gomez R, Schorsch M, Steetskamp J, Hahn T, Heidner K, Seufert R, et al. The effect of ovarian stimulation on the outcome of intrauterine insemination. Archives of gynecology and obstetrics. 2013;289(1):181-5.22. 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. European journal of obstetrics, gynecology, and reproductive biology. 2014;179:159-62.23. Hassan N, Agbo C, Dahan MH. Pregnancy rates unaffected by sperm count in intrauterine insemination: a retrospective cohort study. Minerva ginecologica. 2017;69(1):6-12.24. Ruiter-Ligeti J, Agbo C, Dahan M. The impact of semen processing on sperm parameters and pregnancy rates after intrauterine insemination. Minerva ginecologica. 2017;69(3):218-24.25. Xiao CW, Agbo C, Dahan MH. Comparison of pregnancy rates in pre-treatment male infertility and low total motile sperm count at insemination. Archives of gynecology and obstetrics. 2016;293(1):211-7.26. Badawy A, Elnashar A, Eltotongy M. Effect of sperm morphology and number on success of intrauterine insemination. Fertility and Sterility. 2009;91(3):777-81.27. Francavilla F, Romano R, Santucci R, Poccia G. Effect of sperm morphology and motile sperm count on outcome of intrauterine insemination in oligozoospermia and/or asthenozoospermia**Supported by Ministero della Pubblica Istruzione, Rome, Italy.††Presented in part at the IVth International Congress of Andrology, Florence, Italy, May 14 to 18, 1989. Fertility and Sterility. 1990;53(5):892-7.28. Tomlinson MJ, Amissah-Arthur JB, Thompson KA, Kasraie JL, Bentick B. Infertility: Prognostic indicators for intrauterine insemination (IUI): statistical model for IUI success. Human Reproduction. 1996;11(9):1892-6.29. Mathieu C, Ecochard R, Bied V, Lornage J, Czyba JC. Andrology: Cumulative conception rate following intrauterine artificial insemination with husband's spermatozoa: influence of husband's age. Human Reproduction. 1995;10(5):1090-7.30. Brzechffa PR, Daneshmand S, Buyalos RP. Sequential clomiphene citrate and human menopausal gonadotrophin with intrauterine insemination: the effect of patient age on clinical outcome. Human Reproduction. 1998;13(8):2110-4.31. Kolibianakis EM, Zikopoulos KA, Fatemi HM, Osmanagaoglu K, Evenpoel J, Van Steirteghem A, et al. Endometrial thickness cannot predict ongoing pregnancy achievement in cycles stimulated with clomiphene citrate for intrauterine insemination. Reproductive BioMedicine Online. 2004;8(1):115-8.