Dynamic Follicle Growth Rate Outperforms Traditional Ovarian Reserve Markers in Predicting Pregnancy in IUI Cycles

Dynamic Follicle Growth Rate Outperforms Traditional Ovarian Reserve Markers in Predicting Pregnancy in IUI Cycles | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Dynamic Follicle Growth Rate Outperforms Traditional Ovarian Reserve Markers in Predicting Pregnancy in IUI Cycles Evren Yeşildağer, Ufuk Yeşildağer, Fehmi Koray Altunay, Sefa Arlıer This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8938891/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Accurate prediction of pregnancy outcomes in intrauterine insemination (IUI) cycles remains challenging. While follicular size and hormonal parameters are commonly used, the clinical value of follicular growth dynamics has not been fully elucidated. This study aimed to evaluate the association between follicular growth rate and pregnancy outcomes and to determine an optimal growth-rate threshold using multivariable modeling and ROC analysis. Methods This retrospective cohort study included 411 IUI cycles. Cycles were categorized according to follicular growth rate as < 1.5 mm/day or ≥ 1.5 mm/day. Clinical pregnancy was defined by positive serum β-hCG. Multivariable logistic regression was performed adjusting for PCOS status, anti-Müllerian hormone (AMH), endometrial thickness on the hCG trigger day, and timing of hCG administration. Receiver operating characteristic (ROC) curve analysis was used to assess discriminative performance and validate the optimal cut-off value. Results Clinical pregnancy rates were significantly higher in cycles with a follicular growth rate ≥ 1.5 mm/day compared with slower-growing follicles (19.8% vs 10.5%). In multivariable logistic regression analysis, follicular growth rate ≥ 1.5 mm/day remained independently associated with a higher likelihood of clinical pregnancy (adjusted OR 2.94, 95% CI 1.48–5.82; p = 0.002). AMH was also independently associated with pregnancy outcome, whereas PCOS status, endometrial thickness, and hCG trigger day were not. ROC analysis demonstrated moderate predictive performance (AUC = 0.61), with an optimal cut-off of 1.5 mm/day, yielding a sensitivity of 80.6% and a specificity of 41.6%. Conclusions Follicular growth rate is a strong and independent predictor of clinical pregnancy in IUI cycles. A growth velocity ≥ 1.5 mm/day represents a simple, non-invasive, and clinically applicable marker that may aid in optimizing hCG timing and improving cycle prognostication. Prospective studies are warranted to confirm whether growth-rate–guided interventions can improve live birth outcomes. Intrauterine insemination (IUI) follicle growth rate ovarian stimulation AMH AFC PCOS. Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8938891","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":606558627,"identity":"de1455cb-cf11-428d-bcda-ad885aa6a3b4","order_by":0,"name":"Evren Yeşildağer","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYDCCAxCKsQFEfgBiNnZStDDOAGlhJkULMw+ISUgL3+3Dx6QrKu7I9vcvPvbZ5tc2eT5mBsYPH3Nwa5E8l5YmeebMM+MZN54lz87tu23YxszALDlzG24tBmd4jA0b2w4nNtw4Y8yc23ObEaiFjZkXrxb+z4aN/w4nzr9x/jOzZc9teyK08DA+bGw4nLjhfA8zM8OP24kEtUieYTN82HDssPHGG2zGjL0Nt5PbmBmb8fqF7wzzg4MNNYdl550//Jjhx5/btvPbmw9++IhHCwJIJABjpw3EgqQEIgD/ASDxh0jFo2AUjIJRMKIAABRtWSI19w2wAAAAAElFTkSuQmCC","orcid":"","institution":"Afyonkarahisar State Hospital","correspondingAuthor":true,"prefix":"","firstName":"Evren","middleName":"","lastName":"Yeşildağer","suffix":""},{"id":606558631,"identity":"b441ec25-371e-484f-bc48-ae1f0dd4fbfd","order_by":1,"name":"Ufuk Yeşildağer","email":"","orcid":"","institution":"Afyonkarahisar State Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ufuk","middleName":"","lastName":"Yeşildağer","suffix":""},{"id":606558632,"identity":"958c10bb-77b1-464a-94b5-577c9abe9e46","order_by":2,"name":"Fehmi Koray Altunay","email":"","orcid":"","institution":"Mozaik Hospital","correspondingAuthor":false,"prefix":"","firstName":"Fehmi","middleName":"Koray","lastName":"Altunay","suffix":""},{"id":606558633,"identity":"a76d6c1f-f390-4717-a641-27bb7a626743","order_by":3,"name":"Sefa Arlıer","email":"","orcid":"","institution":"University of Health Science, Adana City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sefa","middleName":"","lastName":"Arlıer","suffix":""}],"badges":[],"createdAt":"2026-02-22 11:53:52","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8938891/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8938891/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106093189,"identity":"fa30578f-3403-440e-9d0e-88a8916cf9d4","added_by":"auto","created_at":"2026-04-03 11:35:48","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":918710,"visible":true,"origin":"","legend":"","description":"","filename":"FoliklgrowthraterevisedV1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8938891/v1_covered_df07ad64-0d54-4c67-bb95-930082b2aa2e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Dynamic Follicle Growth Rate Outperforms Traditional Ovarian Reserve Markers in Predicting Pregnancy in IUI Cycles","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Intrauterine insemination (IUI), follicle growth rate, ovarian stimulation, AMH, AFC, PCOS.","lastPublishedDoi":"10.21203/rs.3.rs-8938891/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8938891/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAccurate prediction of pregnancy outcomes in intrauterine insemination (IUI) cycles remains challenging. While follicular size and hormonal parameters are commonly used, the clinical value of follicular growth dynamics has not been fully elucidated. This study aimed to evaluate the association between follicular growth rate and pregnancy outcomes and to determine an optimal growth-rate threshold using multivariable modeling and ROC analysis.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective cohort study included 411 IUI cycles. Cycles were categorized according to follicular growth rate as \u0026lt;\u0026thinsp;1.5 mm/day or \u0026ge;\u0026thinsp;1.5 mm/day. Clinical pregnancy was defined by positive serum β-hCG. Multivariable logistic regression was performed adjusting for PCOS status, anti-M\u0026uuml;llerian hormone (AMH), endometrial thickness on the hCG trigger day, and timing of hCG administration. Receiver operating characteristic (ROC) curve analysis was used to assess discriminative performance and validate the optimal cut-off value.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eClinical pregnancy rates were significantly higher in cycles with a follicular growth rate\u0026thinsp;\u0026ge;\u0026thinsp;1.5 mm/day compared with slower-growing follicles (19.8% vs 10.5%). In multivariable logistic regression analysis, follicular growth rate\u0026thinsp;\u0026ge;\u0026thinsp;1.5 mm/day remained independently associated with a higher likelihood of clinical pregnancy (adjusted OR 2.94, 95% CI 1.48\u0026ndash;5.82; p\u0026thinsp;=\u0026thinsp;0.002). AMH was also independently associated with pregnancy outcome, whereas PCOS status, endometrial thickness, and hCG trigger day were not. ROC analysis demonstrated moderate predictive performance (AUC\u0026thinsp;=\u0026thinsp;0.61), with an optimal cut-off of 1.5 mm/day, yielding a sensitivity of 80.6% and a specificity of 41.6%.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eFollicular growth rate is a strong and independent predictor of clinical pregnancy in IUI cycles. A growth velocity\u0026thinsp;\u0026ge;\u0026thinsp;1.5 mm/day represents a simple, non-invasive, and clinically applicable marker that may aid in optimizing hCG timing and improving cycle prognostication. Prospective studies are warranted to confirm whether growth-rate\u0026ndash;guided interventions can improve live birth outcomes.\u003c/p\u003e","manuscriptTitle":"Dynamic Follicle Growth Rate Outperforms Traditional Ovarian Reserve Markers in Predicting Pregnancy in IUI Cycles","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-17 16:50:48","doi":"10.21203/rs.3.rs-8938891/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bcac9ee8-d300-40af-872c-25956b8ed7eb","owner":[],"postedDate":"March 17th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-01T16:11:10+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-17 16:50:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8938891","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8938891","identity":"rs-8938891","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}