FACTORS INFLUENCING INTRAUTERINE INSEMINATION OUTCOMES IN BRUNEI FEMALES

Öz

Objective: To determine the effects of female age, body mass index (BMI), hormonal profile, infertility duration, and causes on pregnancy outcomes of females undergoing intrauterine insemination (IUI). Material and Method: This retrospective study included 199 infertile females who underwent IUI from 2015 to 2019 at Raja-Is teri-Pengiran-Anak-Saleha Hospital, Brunei Darussalam. Age, BMI, hormonal profile, duration of infertility, and causes of infer tility associated with pregnancy outcome during treatment were studied. Urine pregnancy test confirmed the pregnancy post-IUI. The statistical analysis tests for categorical variables were the Chi-Square test and Fisher’s exact test. One-way ANOVA was used to assess numerical variables. P-values <0.05 were deemed statistically significant. Result: The mean age of the pregnant females was 32.8±4.9 years, the mean BMI was 24.7 kg/m2 and 12.5% of the participants had normal weight, 5.5% were overweight, and 9% were obese. Overall, 18 females (9%) achieved successful outcomes. Despite the lack of a significant relationship between BMI and pregnancy outcome, 83% of females with positive outcomes were obese. Furthermore, 72.2% of the females who were infertile for <6 years had conceived. A decreasing trend of hormones was noticed with an increasing BMI (p<0.05). Overall hormonal values did not significantly determine IUI outcome (p>0.05). Conclusion: Successful outcomes after IUI were observed in fe males with unexplained or female-caused infertility. Male infer tility did not influence the positive pregnancy outcome. Females with an age range of 30-39 years, duration of infertility less than six years, and BMI index of >25 kg/m2 were able to conceive.

Anahtar Kelimeler

• Female infertility
• clinical characteristics
• intrauterine insemination
• pregnancy outcome

BRUNEİ KADINLARINDA İNTRAUTERİN İNSEMİNASYON SONUÇLARINI ETKİLEYEN FAKTÖRLER

Öz

Amaç: Bu çalışmanın amacı, intrauterin inseminasyon (IUI) uygulanan kadınlarda yaş, vücut kitle indeksi (BMI), hormonal profil, kısırlık süresi ve nedenlerinin gebelik sonuçları üzerine etkisinin araştırılmasıdır. Gereç ve Yöntem: Bu retrospektif çalışmaya, 2015-2019 yılları arasında Brunei Sultanlığı Raja-Isteri-Pengiran-Anak-Saleha Has tanesi'nde IUI uygulanan 199 infertil kadın dahil edildi. Yaş, BMI, hormonal profil, kısırlık süresi ve nedenleri ile tedavinin hamilelik sonucu ile ilişkisi incelendi. IUI sonrası gebelik, idrar gebelik testi ile doğrulandı. Kategorik değişkenler için istatistiksel analiz test leri Ki-Kare testi ve Fisher testi kullanıldı. Sayısal değişkenler için tek yönlü ANOVA testi uygulandı. P-değerleri <0,05 ise istatistik sel olarak anlamlı kabul edildi. Bulgular: Yaş ortalaması 32,8±4,9 ve ortalama BMI 24,7 kg/m2 olan çalışma grubunda gebe kalanlar arasında %12,5'i normal, %5,5'i fazla kilolu ve %9'u obez idi. Tüm grupta 18 kadında (%9) başarılı sonuçlar elde edildi. BMI ile gebelik sonucu arasında anlamlı bir ilişki olmamasına rağmen, pozitif sonucu olan kadın ların %83'ü obezdi. Ayrıca, altı yıldan düşük infertilite süresi olan kadınların %72,2'sinin gebe kaldığı görüldü. BMI arttıkça hor monal değerlerde azalma eğiliminin olduğu gözlendi (p<0,05). Hormonal değerlerin tümünün IUI sonucunun belirlenmesinde anlamlı olmadığı sonucuna varıldı (p>0,05). Sonuç: İnfertilite nedeni açıklanamayan veya kadın kaynaklı ol gularda IUI sonrası başarılı sonuçların alındığı gözlendi. Erkek infertilite faktörünün gebelik sonucunu etkilemediği gösterildi. Yaşları 30-39 aralığında, kısırlık süresi altı yıldan az ve BMI indeksi >25 kg/m2 olan kadınlarda gebelik elde edilebilmiştir.

Anahtar Kelimeler

• Kadın infertilitesi
• klinik özellikler
• intrauterin inseminasyon
• gebelik sonucu

Kaynakça

1. Zegers-Hochschild F, Adamson GD, Dyer S, Racowsky C, De Mouzon J, Sokol R, et al. The international glossary on infertility and fertility care. Hum Reprod 2017;1;32(9):1786-801. [CrossRef] google scholar
2. Vander Borght M, Wyns C. Fertility and infertility: Definition and epidemiology. Clin Biochem 2018;62:2-10. [CrossRef] google scholar
3. Starosta A, Gordon CE, Hornstein MD. Predictive factors for intrauterine insemination outcomes: a review. Fertil Res Pract 2020;23:6. [CrossRef] google scholar
4. Allahbadia GN. Intrauterine insemination: Fundamentals revisited. J Obstet Gynecol India 2017;67(6):385-92. [CrossRef] google scholar
5. Iberico G, Vioque J, Ariza N, Lozano JM, Roca M, Llâcer J, et al. Analysis of factors influencing pregnancy rates in homologous intrauterine insemination. Fertil Steril 2004;81(5):1308-13. [CrossRef] google scholar
6. Whelan III JG, Vlahos NF. The ovarian hyperstimulation syndrome. Fertil Steril 2000;73(5):883-96. [CrossRef] google scholar
7. Sicchieri F, Silva AB, de Sâ Rosa AC, Navarro PA, Ferriani RA, dos Reis RM. Prognostic factors in intrauterine insemination cycles. JBRA Assist Reprod 2018;22(1):2-7. [CrossRef] google scholar
8. Masood L, Alam F, Zahid N, Ayaz A, Hussain SS, Rehman R. Factors affecting Embryo Quality and Pregnancy Outcome in Intra-Cytoplasmic Sperm Injection using Decapeptyl and Cetrorelix-A retrospective study. Hum Reprod Arch 2021;36:e000820 [CrossRef] google scholar

9. Lemmens L, Kos S, Beijer C, Braat DD, Nelen WL, Wetzels AM. Section semen of the Dutch Foundation for Quality Assessment in Medical Laboratories. Techniques used for IUI: is it time for a change? Hum Reprod 2017;32(9):1835-45. [CrossRef] google scholar
10. Speyer BE, Abramov B, Saab W, Doshi A, Sarna U, Harper JC, et al. Factors influencing the outcome of intrauterine insemination (IUI): age, clinical variables and significant thresholds. J Obstet Gynaecol 2013;33(7):697-700. [CrossRef] google scholar
11. Osaikhuwuomwan J, Iribhogbe O, Aziken M, Orhue A. The Effect of Female Age on the Outcome of Intrauterine Insemination Treatment in a Public HospitalAssisted Reproduction Technology Unit. Niger J Clin Pract 2018;21(8):988-92. [CrossRef] google scholar
12. Vargas-Tominaga L, Alarcon F, Vargas A, Bernal G, Medina A, Polo Z. Associated factors to pregnancy in intrauterine insemination. JBRA Assist Reprod 2020;24(1):66-9. [CrossRef] google scholar
13. Nuojua-Huttunen S, Tomas C, Bloigu R, Tuomivaara L, Martikainen H. Intrauterine insemination treatment in subfertility: an analysis of factors affecting outcome. Hum Reprod 1999;14(3):698-703. [CrossRef] google scholar
14. Ashrafi M, Rashidi M, Ghasemi A, Arabipoor A, Daghighi S, Pourasghari P, et al. The role of infertility etiology in success rate of intrauterine insemination cycles: an evaluation of predictive factors for pregnancy rate. Int J Fert Steril 2013;7(2):100. google scholar
15. Eaton JL. Overweight and obesity among women undergoing intrauterine insemination: Does body mass index matter? Fertil Steril 2021;115(1):91. [CrossRef] google scholar
16. Wang JX, Warnes GW, Davies MJ, Norman RJ. Overweight infertile patients have a higher fecundity than normal-weight women undergoing controlled ovarian hyperstimulation with intrauterine insemination. Fertil Steril 2004;81(6):1710-2. [CrossRef] google scholar
17. Souter I, Baltagi LM, Kuleta D, Meeker JD, Petrozza JC. Women, weight, and fertility: the effect of body mass index on the outcome ofsuperovulation/intrauterine insemination cycles. Fertil Steril 2011;1;95(3):1042-7. [CrossRef] google scholar
18. Yu C, Bai L, Mei-Zhou J, Yu-Wang X, Chen L, Zhang J. Analysis of factors associated with IUI pregnancy outcomes in elderly and young patients. BMC Womens Health 2024;24(1):86. [CrossRef] google scholar
19. McKight KK, Nodler JL, Cooper Jr JJ, Chapman VR, Cliver SP, Bates GW. Body mass index-associated differences in response to ovulation induction with letrozole. Fertil Steril 2011;96:1206-8. [CrossRef] google scholar
20. Wang LT, Wang CX, Sun HL, Wang X, Li XF, Wang YL, et al. Effect of BMI on blood value of patients on HCG day with IUI treatment. BMC Womens Health 2020;20:1-8. [CrossRef] google scholar
21. Yavuz A, Demirci O, Sözen H, Uludoğan M. Predictive factors influencing pregnancy rates after intrauterine insemination. Iran J Reprod Med 2013;11(3):227. google scholar
22. Whynott RM, Summers KM, Van Voorhis BJ, Mejia RB. Effect of body mass index on intrauterine insemination cycle success. Fertil Steril 2021;115(1):221-8. [CrossRef] google scholar
23. 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;1;11(9):1892-6. [CrossRef] google scholar
24. Massarotti C, Fraire-Zamora JJ, Liperis G, Uraji J, Sharma K, Serdarogullari M, et al. Understanding and addressing unexplained infertility: from diagnosis to treatment. Hum Reprod 2024;26;39(5):1155-9. [CrossRef] google scholar