Journal of Human Reproductive Science
Home Ahead of Print Current Issue Archives
   Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size    Users online: 1166


 
   Table of Contents     
ORIGINAL ARTICLE  
Year : 2010  |  Volume : 3  |  Issue : 3  |  Page : 129-134
 

Predictive factors for pregnancy after intrauterine insemination: A prospective study of factors affecting outcome


1 Reproductive Medicine Unit, Christian Medical College, Vellore, India
2 Matha Assisted Reproductive Centre (MARC), Matha Hospital, Kottayam, Kerala, India

Date of Submission09-Jul-2010
Date of Decision23-Sep-2010
Date of Acceptance18-Oct-2010
Date of Web Publication23-Dec-2010

Correspondence Address:
Mohan S Kamath
Reproductive Medicine Unit, Christian Medical College, Vellore - 632 004
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-1208.74154

Rights and Permissions

 

   Abstract 

Objective : To determine the predictive factors for pregnancy after controlled ovarian hyperstimulation (COH)/intrauterine insemination (IUI). Design : Prospective observational study. Setting : University-level tertiary care center. Patients and Methods : 366 patients undergoing 480 stimulated IUI cycles between November 2007 and December 2008. Interventions : Ovarian stimulation with gonadotrophins was initiated and a single IUI was performed 36 h after triggering ovulation. Main Outcome Measures : The primary outcome measures were clinical pregnancy and live birth rates. Predictive factors evaluated were female age, duration of infertility, indication for IUI, number of preovulatory follicles, luteinizing hormone level on day of trigger and postwash total motile fraction (TMF). Results : The overall clinical pregnancy rate and live birth rate were 8.75% and 5.83%, respectively. Among the predictive factors evaluated, the duration of infertility (5.36 vs. 6.71 years, P = 0.032) and the TMF (between 10 and 20 million, P = 0.002) significantly influenced the clinical pregnancy rate. Conclusion : Our results indicate that COH/IUI is not an effective option in couples with infertility due to a male factor. Prolonged duration of infertility is also associated with decreased success, and should be considered when planning treatment.


Keywords: Clinical pregnancy rate, intrauterine insemination, predictive factors


How to cite this article:
Kamath MS, Bhave P, Aleyamma T K, Nair R, Chandy A, Mangalaraj AM, Muthukumar K, George K. Predictive factors for pregnancy after intrauterine insemination: A prospective study of factors affecting outcome. J Hum Reprod Sci 2010;3:129-34

How to cite this URL:
Kamath MS, Bhave P, Aleyamma T K, Nair R, Chandy A, Mangalaraj AM, Muthukumar K, George K. Predictive factors for pregnancy after intrauterine insemination: A prospective study of factors affecting outcome. J Hum Reprod Sci [serial online] 2010 [cited 2019 Nov 11];3:129-34. Available from: http://www.jhrsonline.org/text.asp?2010/3/3/129/74154



   Introduction Top


A combination of controlled ovarian hyperstimulation (COH) with intrauterine insemination (IUI) remains an important option available to an infertility specialist and is a widely used treatment modality for a broad range of indications. Common indications include cervical factor, mild endometriosis, mild to moderate male factor, ovulatory dysfunction and unexplained infertility. [1] The reported pregnancy rates per cycle range from 8 to 22%. [2],[3],[4] The pregnancy rates per IUI cycle are quite variable in the literature due to differences in cause and duration of infertility, concomitant usage or omission of ovarian stimulation, sperm preparation techniques, treatment cycles and number of times IUI is performed during a cycle (single or double). [1],[2],[3],[4]

The cumulative pregnancy rates for COH with IUI vary according to the indications, and are in the range of 20-33%. [4],[5] Generally, four cycles of COH/IUI are recommended depending on the female age prior to moving on to assisted reproductive technology (ART)-in vitro fertilization (IVF). [3],[6]

Several prognostic factors with regards to IUI treatment outcome have been identified, and include factors such as patient profile, duration of infertility, type of infertility, stimulation protocol, follicular response, endometrial thickness, timing of IUI and semen parameters, like postwash motility, morphology and total motile fraction (TMF). [4],[7],[8],[9],[10]

Even though COH/IUI is a less expensive and simpler form of treatment compared with ART-IVF, it still requires frequent monitoring and supervision under specialist care.

The knowledge that the per-cycle pregnancy rates are not very encouraging combined with the time, effort and financial implications of such treatment, attempting a COH/IUI cycle could be a challenging decision for the couple. Many couples would opt for one attempt of IVF rather than undergo three to four cycles of COH/IUI. This is especially true for couples travelling long distances seeking treatment in other cities/centers.

Since ours is a tertiary care center with couples coming from different cities/towns for treatment, we decided to analyze the variables that contribute to the success of stimulated intrauterine cycles. A prospective study was planned to determine prognostic factors for IUI in our setting that would provide important data for predicting the success of therapy and further help in planning subfertility treatment for the couples.


   Patients and Methods Top


This prospective, observational study was conducted at a university-level tertiary care center.

The study group comprised of couples with male factor infertility, unexplained infertility, minimum to mild endometriosis and anovulation. Patency of at least one tube, confirmed by diagnostic laparoscopy or hysterosalphingography (HSG), was obligatory.

Male factor infertility: defined as semen concentration <20 million sperms/ml, normal morphology <30% (WHO criteria) and progressive motility <50% (A + B) before sperm preparation as per the WHO (1992) guidelines.

Unexplained infertility: couples for whom the results of a standard infertility evaluation are normal (standard tests includes a normal semen analysis [WHO 1992], ovulatory cycles and a HSG or laparoscopy showing patent tubes).

Minimal endometriosis: score 1-5; mild endometriosis: score 6-15 by the revised AFS criteria.

Exclusion criteria included those patients with bilateral tubal blockage, moderate to severe endometriosis and severe male factor infertility, with TMF postwash of <1 million.

However, those patients with a lower sperm count after preparation on the day of IUI were included.

The protocol for ovulation induction included either gonadotrophin only (Menogon; Ferring Pharmaceutical, India) or a combination of clomiphene citrate (Fertomid; CIPLA, India) with gonadotrophin (hMG [human menopausal gonadotrophin]). In the clomiphene and hMG group, tablet clomiphene citrate 100 mg was started from day 2 of menstrual cycle for 5 days with inj. hMG 75 IU being administered on alternate days from day 5 (day 5, 7 and 9).

In cycles stimulated with gonadotrophin alone, inj. hMG 75 IU was administered on a daily basis from day 5 to day 9. On day 10 of stimulation, assessment of follicular development was performed using transvaginal ultrasound. Further stimulation with gonadotrophin was determined according to follicular response. The aim of stimulation was to achieve a monofollicular response. Once a follicle of >17 mm size was identified, a serum luteinizing hormone (LH) test was performed: if the LH level was <15 IU/ml, inj. human chorionic gonadotrophin 5000 IU (hCG) was given as an ovulation trigger and a single IUI was planned 36 h later. If the LH level was >15 IU/ml, hCG trigger was not given and an IUI was performed the next day.

If four or more mature follicles (>17mm) developed, the cycle was cancelled and the couples were advised to avoid intercourse for the next 2 weeks.

On the day of IUI, the husband was instructed to give a semen that was prepared by the double-density gradient method with Puresperm (Nidacon, International AB, Gothenburg, Sweden). The postwash sample parameters were assessed. Under aseptic precautions, IUI was carried out with a soft IUI catheter (Sunn Catheter; SAR Healthcare Ltd., India) with an insemination volume of 0.5ml. After the procedure, the patient was advised 20 mins of bed rest. All women were provided luteal phase support with natural micronized progesterone vaginal pessaries for 16 days.

If menstrual cycle was delayed, urine pregnancy test was carried out. When positive, a transvaginal ultrasound was performed 2 weeks later to confirm a clinical pregnancy.

Clinical pregnancy was defined as the presence of an intrauterine gestational sac, confirmed by ultrasound. Higher-order pregnancies were defined as three or more gestational sacs visualized at ultrasound.

Women were followed till delivery and the neonatal outcome was recorded. The primary end point was clinical pregnancy and live birth rate per cycle.

Statistical analysis

The variables selected were patient parameters like age of woman, duration of infertility, type of infertility and cause of infertility. Parameters related to ovulation induction, like number of dominant follicles, endometrial thickness, LH level on the day of trigger and duration between trigger and IUI were recorded. Laboratory parameters like days of abstinence, post-wash motility, morphology and TMF were recorded.

Of these parameters, age of the woman, duration of infertility and days of stimulation were recorded as continuous variables, and their means were compared using the independent t-test.

Other parameters were taken as categorical variables and were compared for significant differences using the

Chi-square test.

A P-value of <0.05 was considered to be significant.

Data were entered in SPSS version 11 (SPSS Inc., Chicago, IL, USA).


   Results Top


We evaluated 366 patients undergoing a total of 480 stimulated IUI cycles between November 2007 and December 2008.

Of the 480 homologous COH/IUI cycles analyzed, 346 were the first-treatment cycle, 102 were the second-treatment cycle, 28 were third-treatment cycle and four were fourth-treatment cycle during the study period.

The mean female age was 30.04 ± 4.295 years (range, 20-43 years).

Cause of infertility was anovulatory in 23.8%, male factor in 20.4%, endometriosis in 8.5% and unexplained in 47.3% of the patients.

The categorical variables were compared using the Chi-square test. Of all the categorical variables, the only significant variable affecting outcome was TMF (P = 0.002) [Table 1].
Table 1 :Factors affecting pregnancy rates in intrauterine insemination

Click here to view


The continuous variables were compared using the independent t-test. The duration of infertility was found to be significantly associated with the chances of success (5.36 vs. 6.71 years, P = 0.032) [Table 2].
Table 2 :Factors affecting the pregnancy rates in intrauterine insemination

Click here to view


The overall pregnancy rate per cycle was 8.75% (42/480). Of these, 41 pregnancies were clinical (8.54%), 7 resulted in abortions (17%) and two were ectopic pregnancies (4.7%). One pregnancy was biochemical in nature. There were no multiple pregnancies.

Of 7 abortions, 6 were first trimester and 1 was second trimester. Of 32 pregnancies that went on to term, 28 patients were followed-up while 4 patients could not be traced. 18 patients underwent Caesarean section and 10 had normal vaginal delivery. A total of 17 boys and 11 girls were delivered. No major congenital anomaly or neonatal mortality was recorded. The live birth rate/cycle was 5.83% (28/480) [Table 3].
Table 3 :Pregnancy outcome of the intrauterine insemination cycles

Click here to view


A multivariate analysis could not be carried out as the variables found to be significantly affecting outcome were only two.


   Discussion Top


In our study, we made an effort to determine the prognostic factors that would determine the success of COH/IUI. The variables selected were patient parameters like age of the woman, duration of infertility, type of infertility and cause of infertility. Parameters related to ovulation induction included number of dominant follicles, endometrial thickness, LH level on the day of trigger and time duration between trigger and IUI. Laboratory parameters like days of abstinence, postwash motility, morphology and TMF were recorded.

Among the patient parameters, female age is important as declining oocyte quality associated with increasing age is well documented. [11],[12] Even more-effective treatment options like ART-IVF cannot completely overcome the negative impact of age. [13] In our study, a trend toward reduction in success rate with COH/IUI was noted in women with age >35 years, although the difference was not statistically significant. However, many studies have documented a significant drop in the success rate beyond the age of 40 years, with reported live births being as low as 1.4%. [6],[14],[15] Put together, for women over 35, COH/IUI as a treatment option needs careful consideration, and for women over 40, IUI is a poor treatment option.

The success rate was significantly lower, with an increase in duration of infertility (5.36 vs. 6.71 years, P = 0.032). An earlier study also found a significant decline in the success of IUI therapy as the duration of infertility increased. [10] However, we were unable to determine any particular cut-off beyond which IUI could be discouraged. With increasing duration of infertility, IUI as an option appears to be less-effective.

No difference was noted in the success rate with regards to the type of infertility. Among indications for IUI, the success rate was higher in anovulatory and unexplained infertility patients as compared with endometriosis and male factor infertility, although the difference did not reach statistical significance. The trend toward lower pregnancy rates in endometriosis has been documented in an earlier meta-analysis, with the pregnancy rates reduced to half in comparison with other infertility indications. [7] The pregnancy rate in our study for male factor infertility was marginally lower than that in previously reported studies. [3],[9]

Our overall pregnancy rate with COH/IUI of 8.75% per cycle is low as compared with the results from other studies. [3],[9] Our policy of performing only homologous IUI could be one of the reasons for lower success rates as pregnancy rates of up to 22% per cycle are documented when donor insemination is carried out. [3],[10]

Another important reason for lower pregnancy rates in our setting could be our strategy of aiming for monofollicular development during COH. This, while leading to lower pregnancy rates, reduces both the multiple pregnancy and the hyperstimulation rates. With the current trend of limiting the number of embryos transferred in IVF cycles, ovulation induction is emerging as the prime cause for higher-order pregnancies. Earlier studies have reported an incidence of 20% twins and 39% higher-order multiple pregnancies as a result of ovulation induction, outside ART. [16],[17] All the recorded clinical pregnancies following COH/IUI in our center were singleton, and no case of hyperstimulation was documented during the study period. In our study, a monofollicular response was observed in 71.87% of the cycles. With an increase in the number of preovulatory follicles, a corresponding increase was observed in the pregnancy rates, as shown in [Table 1]. Studies have shown that the cycle fecundity rates are higher (20-33%) when superovulation protocols are used. [6],[8] However, multiple pregnancy rates, including higher-order pregnancies, also increase with superovulation protocols. Finally, each unit/center needs to decide regarding the stimulation protocols/policies and try to achieve a balance between the quest for a higher success rate and acceptable multiple pregnancy rates.

We found a trend toward a higher pregnancy rate with endometrial thickness >6 mm; however, the difference was not statistically significant.

The incidence of premature LH surge in COH/IUI is in the range of 24-36%, and negatively influences the outcome of the treatment cycle. [18] In our study, the incidence of premature LH surge (>15 miu/ml) was 15.83% (78/480). The pregnancy rates were lower in patients with premature LH surge (6.57%), which is in agreement with earlier studies. [19] Studies looking at the role of antagonist in the prevention of an LH surge in COH/IUI cycles have reported pregnancy rates of up to 20-35%, although the rise in the cost factor needs to be carefully considered. [18],[20] The role of clomiphene citrate as a cost-effective alternative in the prevention of an LH surge has been looked at in an earlier study, and promising results have been obtained. [21]

The duration of period of abstinence did not influence the pregnancy rates. Even though no pregnancies were recorded in the group with an abstinence period of <2 days, it is difficult to draw conclusions since the numbers in that group were small (n = 12). Even though studies have shown an increase in the ejaculated volume, sperm count and motility with longer periods of abstinence, this has not been shown to improve the IUI pregnancy rates. [22]

The TMF is an important prognostic factor for IUI success. We found a significantly higher pregnancy rate (18.29%) when the TMF was in the range of 10-20 million. The pregnancy rate was lower when the TMF was in the range of 5-10 million (5.63%), with disappointing rates (2.7%) when the TMF was <5 million. Unexpectedly, the pregnancy rates were also lower with high TMF (>20 million). In one of the earlier studies, the authors tried to arrive at a cut-off with regards to seminal parameters at which IUI would be of benefit in male factor infertility. [9] A TMF of <1 million was associated with poor pregnancy rates. When the TMF was <5 million, sperm morphology appeared to play an important role. A pregnancy rate of 5.43% was observed with morphology of <30% as compared with 18.42% with a normal morphology.

Combining the finding of our study and previous reports, we believe that in male factor infertility with a TMF <5 million, couples should be carefully counselled and the option of ART-IVF should be offered more liberally, especially if the female partner's age is advanced.

We obtained a pregnancy rate/cycle of 8.75% (42/480). The live birth rate/cycle was 5.83%, which is lower than that reported previously. [23],[24] No major congenital anomaly was recorded, nor was there any multiple pregnancy.

The purpose of our study was to determine prognostic factors for predicting IUI success. We found only two parameters significantly affecting success - duration of infertility and TMF. In an earlier study, the authors found five prognostic factors, namely number of treatment cycles, number of preovulatory follicles, age, etiology and duration of infertility. [3] A larger study on similar lines would help identify more predictors and also develop a prediction model for pregnancy following IUI cycles. [25] Once a prediction model is developed, validation studies could be carried out to prove its robustness. This could help formulate guidelines and make it easier for couples and clinicians to take important decisions regarding the all-important next step during the course of infertility treatment.


   Conclusion Top


COH/IUI is an important treatment option for varied indications, especially when female age is <35 years. Definitive prognostic factors for predicting success will help in counselling patients regarding the modality of treatment. Significantly higher pregnancy rates were observed when the duration of infertility was <5 years, and the TMF was between 10 and 20 million. Low pregnancy rates were associated with poor semen parameters, indicating that COH/IUI is not an effective option in these clinical situations. The overall pregnancy rate per cycle with COH/IUI in our study was 8.75% and live birth rate per cycle was 5.83%. Our policy of conducting only homologous IUI cycles together with a monofollicular ovulation induction approach are possibly responsible for the comparatively low pregnancy rates obtained. Avoiding twin and higher order pregnancies would be the advantage of such an approach. Many of the identified variables were not shown to significantly affect the outcome. Perhaps, a larger sample size may help in formulating a better predictive model for IUI success. The information could be used by couples and clinicians during counselling to arrive at a decision with regards to their treatment options.

 
   References Top

1.Duran HE, Morshedi M, Kruger T, Oehninger S. Intrauterine insemination: A systematic review on determinants of success. Hum Reprod Update 2002;8:373-84.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Bagis T, Haydardedeoglu B, Kilicdag EB, Cok T, Simsek E, Parlakgumus AH. Single versus double intrauterine insemination in multi-follicular ovarian hyperstimulation cycles: A randomized trial. Hum Reprod 2010;25:1684-90.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.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;14:698-703.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Guzick DS, Carson SA, Coutifaris C, Overstreet JW, Factor-Litvak P, Steinkampf MP, et al. Efficacy of superovulation and intrauterine insemination in the treatment of infertility. N Engl J Med 1999;340:177-83.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Dickey RP, Pyrzak R, Lu YP, Taylor SN, Rye PH. Comparison of the sperm quality necessary for successful intrauterine insemination with World Health Organization threshold values for normal semen. Fertil Steril 1999;71:684-9.  Back to cited text no. 5
    
6.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. Fertil Steril 2002;78:1088-95.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Hughes EG. Stimulated intra-uterine insemination is not a natural choice for the treatment of unexplained subfertility: 'Effective treatment' or 'not a natural choice'? Hum Reprod 2003;18:912-4.  Back to cited text no. 7
[PUBMED]  [FULLTEXT]  
8.Van Rumste M, Custers I, van der Veen F, van Wely M, Evers J, Mol B. The influence of the number of follicles on pregnancy rates in intrauterine insemination with ovarian stimulation: A meta-analysis. Hum Reprod Update 2008;14:563-70.  Back to cited text no. 8
    
9.Wainer R, Albert M, Dorion A, Bailly M, Bergere M, Lombroso R, et al. Influence of the number of motile spermatozoa inseminated and of their morphology on the success of intrauterine insemination. Hum Reprod 2004;19:2060-5.  Back to cited text no. 9
    
10.Tomlinson M, Amissah-Arthur J, Thompson K, Kasraie J, Bentick B. Infertility: Prognostic indicators for intrauterine insemination (IUI): Statistical model for IUI success. Hum Reprod 1996;11:1892-6.  Back to cited text no. 10
    
11.Baird DT, Collins J, Egozcue J, Evers LH, Gianaroli L, Leridon H, et al. Fertility and ageing. Hum Reprod Update 2005;11:261-76.  Back to cited text no. 11
[PUBMED]  [FULLTEXT]  
12.Grondahl M, Yding Andersen C, Bogstad J, Nielsen F, Meinertz H, Borup R. Gene expression profiles of single human mature oocytes in relation to age. Hum Reprod 2010;25:957-68.  Back to cited text no. 12
    
13.Leridon H. Can assisted reproduction technology compensate for the natural decline in fertility with age? A model assessment. Hum Reprod 2004;19:1548-53.  Back to cited text no. 13
[PUBMED]  [FULLTEXT]  
14.Agrawal SK, Buyalon RP. Clomiphene citrate with intrauterine insemination. Is it effective therapy in women above the age of 35years? Fertil Steril 1996;65:759-63.  Back to cited text no. 14
    
15.Frederick J, Denker M, Rojas A, Horta I, Stone S, Asch R, et al. Infertility: Is there a role for ovarian stimulation and intra-uterine insemination after age 40? Hum Reprod 1994;9:2284-6.  Back to cited text no. 15
    
16.Fauser BC, Devroey P, Macklon NS. Multiple birth resulting from ovarian stimulation for subfertility treatment. Lancet 2005;365:1807-16.  Back to cited text no. 16
[PUBMED]  [FULLTEXT]  
17.Reynolds MA, Schieve LA, Martin JA, Jeng G, Macaluso M. Trends in multiple births conceived using assisted reproductive technology, United States, 1997-2000. Pediatrics 2003;111:1159-62.  Back to cited text no. 17
[PUBMED]  [FULLTEXT]  
18.Allegra A, Marino A, Coffaro F, Scaglione P, Sammartano F, Rizza G, et al. GnRH antagonist-induced inhibition of the premature LH surge increases pregnancy rates in IUI-stimulated cycles. A prospective randomized trial. Hum Reprod 2007;22:101-8.  Back to cited text no. 18
    
19.Manzi DL, Dumez S, Scott LB, Nulsen JC. Selective use of leuprolide acetate in women undergoing superovulation with intrauterine insemination results in significant improvement in pregnancy outcome. Fertil Steril 1995;63:866-73.  Back to cited text no. 19
[PUBMED]    
20.Gomez-Palomares J, Julia B, Acevedo-Martin B, Martinez-Burgos M, Hernandez E, Ricciarelli E. Timing ovulation for intrauterine insemination with a GnRH antagonist. Hum Reprod 2005;20:368-72.  Back to cited text no. 20
    
21.Al Inany H, Azab H, El Khayat W, Nada A, El Khattan E, Abou-Setta AM. The effectiveness of clomiphene citrate in LH surge suppression in women undergoing IUI: A randomized controlled trial. Fertil Steril 2010 [In Press].  Back to cited text no. 21
    
22.Matilsky M, Battino S, Ben-Ami M, Geslevich Y, Eyali V, Shalev E. The effect of ejaculatory frequency on semen characteristics of normozoospermic and oligozoospermic men from an infertile population. Hum Reprod 1993;8:71-3.  Back to cited text no. 22
[PUBMED]  [FULLTEXT]  
23.Iberico G, Vioque J, Ariza N, Lozana JM, Roca M, Liacer J, et al. Analysis of factors influencing pregnancy rates in homologous intrauterine insemination. Fertil Steril 2004;81:1308-13.  Back to cited text no. 23
    
24.Ombelet W, Vandeput H, Van de Putte G, Cox A, Janssen M, Jacobs P, et al. Intrauterine insemination after ovarian stimulation with clomiphene citrate: Predictive potential of inseminating motile count and sperm morphology. Hum Reprod 1997;12:1458-63.  Back to cited text no. 24
[PUBMED]  [FULLTEXT]  
25.Steures P, van der Steeg JW, Mol BW, Eijkemans MJ, van der Veen F, Habbema JD, et al. Prediction of an ongoing pregnancy after intrauterine insemination. Fertil Steril 2004;82:45-51.  Back to cited text no. 25
[PUBMED]  [FULLTEXT]  



 
 
    Tables

  [Table 1], [Table 2], [Table 3]


This article has been cited by
1 Outcomes after intrauterine insemination are independent of provider type
Randi H. Goldman,Maria Batsis,Michele R. Hacker,Irene Souter,John C. Petrozza
American Journal of Obstetrics and Gynecology. 2014;
[Pubmed] | [DOI]
2 Patient-specific predictions of outcome after gonadotropin ovulation induction/intrauterine insemination
Randi H. Goldman,Maria Batsis,John C. Petrozza,Irene Souter
Fertility and Sterility. 2014;
[Pubmed] | [DOI]
3 The impact of thyroid function on intrauterine insemination outcome - a retrospective analysis
Birgit Jatzko,Elisabeth Vytiska-Bistorfer,Alexandra Pawlik,Regina Promberger,Klaus Mayerhofer,Johannes Ott
Reproductive Biology and Endocrinology. 2014; 12(1): 28
[Pubmed] | [DOI]
4 Prognosis factors of pregnancy after intrauterine insemination with the husbandęs sperm: conclusions of an analysis of 2,019 cycles
Laka Dinelli,Blandine Courbičre,Vincent Achard,Elisabeth Jouve,Carole Deveze,Audrey Gnisci,Jean-Marie Grillo,Odile Paulmyer-Lacroix
Fertility and Sterility. 2014; 101(4): 994
[Pubmed] | [DOI]
5 Re: Berker et al.: Absence of Rapid and Linear Progressive Motile Spermatozoa “Grade A” in Semen Specimens: Does It Change Intrauterine Insemination Outcomes? (Urology 2012;80:1262-1266)
Yogesh Garg,Jai Prakash,Satya Narayan Sankhwar
Urology. 2013; 81(5): 1110
[Pubmed] | [DOI]
6 Re: Berker et al.: Absence of rapid and linear progressive motile spermatozoa grade a in semen specimens: Does it change intrauterine insemination outcomes? (Urology 2012;80:1262-1266)
Garg, Y. and Prakash, J. and Sankhwar, S.N.
Urology. 2013; 81(5): 1110
[Pubmed]
7 Success in Pregnancy Through Intrauterine Insemination at First Cycle in 300 Infertile Couples: An Analysis
Babita Panda,Lita Mohapatra,Mahesh C. Sahu,Rabindra N. Padhy
The Journal of Obstetrics and Gynecology of India. 2013;
[Pubmed] | [DOI]
8 The use of ultrasound during intrauterine insemination in unexplained infertility may improve pregnancy outcomes
Oztekin, D. and Ozcinar, E. and Kose, C. and Gulhan, I. and Ozeren, M. and Tinar, S.
Medical Principles and Practice. 2013; 22(3): 291-294
[Pubmed]
9 Pregnancy predictors after intrauterine insemination: Analysis of 3012 cycles in 1201 couples
Soria, M. and Pradillo, G. and GarcĆ­a, J. and RamĆ³n, P. and Castillo, A. and Jordana, C. and Paricio, P.
Journal of Reproduction and Infertility. 2012; 13(3): 158-166
[Pubmed]
10 Intrauterine insemination: Our reality [InseminaĆ§Ć£o intrauterine: A nossa realidade]
Francisco, C. and Antunes, I. and SimƵes, T. and Pinto, S. and Silva, G. and Pinto, G.
Revista Iberoamericana de Fertilidad y Reproduccion Humana. 2011; 28(4): 4
[Pubmed]
11 Controlled ovarian stimulation and intrauterine insemination: An actual therapy? [EstimulaĆ§Ć£o ovariana controlada e inseminaĆ§Ć£o intrauterina: Uma terapia atual?]
Almeida, J.P.M. and Pinelo, S. and Serra, H. and Barbosa, A. and Felgueira, E. and Pires, I. and Tavares, A.
Revista Brasileira de Ginecologia e Obstetricia. 2011; 33(11): 341-347
[Pubmed]
12 Efficacy of the motile sperm organelle morphology examination (MSOME) in predicting pregnancy after intrauterine insemination
Akl, L.D., Oliveira, J.B.A., Petersen, C.G., Mauri, A.L., Silva, L.F.I., Massaro, F.C., Baruffi, R.L.R., (...), Franco Jr, J.G.
Reproductive Biology and Endocrinology. 2011; 9(art 120)
[Pubmed]
13 Efficacy of the motile sperm organelle morphology examination (MSOME) in predicting pregnancy after intrauterine insemination
Livia D Akl,Joao Batista A Oliveira,Claudia G Petersen,Ana L Mauri,Liliane FI Silva,Fabiana C Massaro,Ricardo LR Baruffi,Mario Cavagna,Jose G Franco
Reproductive Biology and Endocrinology. 2011; 9(1): 120
[Pubmed] | [DOI]



 

Top
Print this article  Email this article
             

    

 
   Search
 
  
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
    Article in PDF (907 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
    Introduction
    Patients and Methods
    Results
    Discussion
    Conclusion
    References
    Article Tables

 Article Access Statistics
    Viewed5633    
    Printed275    
    Emailed0    
    PDF Downloaded401    
    Comments [Add]    
    Cited by others 13    

Recommend this journal