Wadhwa Leena, Fauzdar Ashish, Wadhwa Sanjana Narula
IVF and Fertility Research Centre, ESIC-PGIMSR Model Hospital, New Delhi, India.
J Hum Reprod Sci. 2018 Jul-Sep;11(3):279-285. doi: 10.4103/jhrs.JHRS_34_18.
There are many variables that may influence the success rates of intrauterine insemination (IUI) treatment. Therefore, a regular audit program is needed for planning effective infertility treatment and improving pregnancy outcomes.
The main objective of this study was to identify the crucial predicting factors that can influence the IUI success.
A retrospective analysis of 800 IUI cycles done from January, 2013 to August, 2017 in 651 couples with various etiologies of infertility. The common etiologies included female factor of ovulatory dysfunction, tubal, endocrinal, male factor, male and female factors combined, and unexplained factors. Ovulation induction was done either by clomiphene citrate (CC) alone or in combination of CC with gonadotropins or pure gonadotropins only. Human chorionic gonadotropin trigger was given when at least one dominant follicle measuring ≥18 mm with an endometrial thickness of >7 mm was obtained. IUI was done post 36 h of trigger. The double-density gradient method was the preferred method of sperm preparation.
In 800 cycles in corresponding 651 couples, the total outcome was 113 pregnancies (14.1%) per cycle with overall pregnancy rate (PR) per couple of 17.3%. The highest PR was observed in the patient with ovulatory dysfunction (21.2%), followed by patients with combined factor (15.1%) and male factor (14.7%). In the study, a higher PR was achieved in the female ≤25 years (18.9%) < 0.04 with significant findings with duration of infertility ≤5 years (15.1%) having primary infertility (14.5%) with low body mass index <25 (14.1%). IUI success rate was highest in the first cycle (14.6%) followed by second cycle (14.0%) and third cycle (3.5%).
IUI audit enables the characterization of prognostic factors to achieve improved PR. This study identifies the factors that can predict improved pregnancy outcome in women age ≤25 years and endometrium thickness between 9 and 11 mm. We also recommend IUI as a first line of infertility treatment for couples in low-income setting provided the women age and duration of infertility are acceptably low.
有许多变量可能会影响宫腔内人工授精（IUI）治疗的成功率。因此，需要一个定期审计计划来规划有效的不孕症治疗并改善妊娠结局。
本研究的主要目的是确定可能影响IUI成功的关键预测因素。
对2013年1月至2017年8月期间651对因各种不孕症病因接受IUI治疗的夫妇的800个IUI周期进行回顾性分析。常见病因包括女性排卵功能障碍、输卵管、内分泌、男性因素、男女因素合并以及不明原因因素。排卵诱导采用单独使用枸橼酸氯米芬（CC）或CC与促性腺激素联合使用或仅使用纯促性腺激素。当获得至少一个直径≥18mm且子宫内膜厚度>7mm的优势卵泡时，给予人绒毛膜促性腺激素触发。IUI在触发后36小时进行。双密度梯度法是精子制备的首选方法。
在651对相应夫妇的800个周期中，每个周期的总妊娠结局为113例妊娠（14.1%），每对夫妇的总体妊娠率（PR）为17.3%。排卵功能障碍患者的PR最高（21.2%），其次是合并因素患者（15.1%）和男性因素患者（14.7%）。在该研究中，年龄≤25岁的女性（18.9%）、不孕持续时间≤5年（15.1%）、原发性不孕（14.5%）、体重指数<25（14.1%）的患者获得了较高的PR。IUI成功率在第一个周期最高（14.6%），其次是第二个周期（14.0%）和第三个周期（3.5%）。
IUI审计能够对预后因素进行特征化分析以提高PR。本研究确定了可预测年龄≤25岁且子宫内膜厚度在9至11mm之间的女性妊娠结局改善的因素。我们还建议，在低收入环境中，如果女性年龄和不孕持续时间可接受地低，IUI可作为夫妇不孕症治疗的一线方法。
