Effect of diagnosis, age, sperm quality, and number of preovulatory follicles on the outcome of multiple cycles of clomiphene citrate-intrauterine insemination

Richard P. Dickey, Dickey Rp, Taylor SN, Steven N. Taylor, Peter Y. Lu, Lu PY, Sartor BM, Belinda M. Sartor, Rye PH, Phillip H. Rye, Roman Pyrzak, Pyrzak R
Fertility and Sterility · 2002 · vol. 78(5) , pp. 1088–1095 · doi:10.1016/s0015-0282(02)04212-7 · PMID:12413999 · W2089743711
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This study examined how diagnosis, age, sperm quality, and follicle count influenced the success of multiple clomiphene citrate-intrauterine insemination cycles.

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Abstract

ObjectiveTo determine how diagnosis, age, sperm quality, and number of preovulatory follicles affect pregnancy rates when multiple cycles of clomiphene citrate (CC)-IUI are performed.DesignFifteen-year prospective observational study.SettingPrivate infertility clinic.Patient(s)Three thousand, three hundred eighty-one cycles of husband or donor IUI.Intervention(s)Ovulation induction with CC and IUI.Main outcome measure(s)Per-cycle pregnancy rate (PR), cumulative pregnancy rate (CPR).Result(s)Pregnancy rates remained constant through four cycles, then fell significantly for diagnoses other than ovulatory dysfunction. Mean PRs for cycles 1-4 were significantly lower for patients with the following characteristics: age >/=43 years, poor semen quality, single preovulatory follicles, and diagnoses other than ovulatory dysfunction. Additional cycles of CC-IUI compensated for low PRs because of age, semen quality, or number of follicles. After four cycles, CPRs were 46% for ovulatory dysfunction; 38% for cervical factor, male factor, and unexplained infertility; 34% for endometriosis; and 26% for tubal factor. After six cycles, CPRs were 65% for ovulation dysfunction, 35% for endometriosis, and unchanged for other diagnoses.Conclusion(s)Clomiphene citrate-intrauterine insemination should be performed for a minimum of four cycles. Additional cycles of CC-IUI can compensate for low pregnancy rates due to age, semen quality, or follicle number in patients with ovulation dysfunction.

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MeSH descriptors

Clomiphene Infertility, Female Infertility, Male Insemination, Artificial, Heterologous Insemination, Artificial, Homologous Aging Aging Clomiphene Female Follicular Phase Humans Infertility, Female Infertility, Female Infertility, Male Infertility, Male Male Ovarian Follicle Ovarian Follicle Pregnancy Pregnancy Rate

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