Predictive factors for pregnancy after controlled ovarian stimulation and intrauterine insemination: A retrospective analysis of 4146 cycles

Michau A, Adélie Michau, Hady El Hachem, El Hachem H, Galey J, Julie Galey, Sergio Parco, Soizic Le Parco, Le Parco S, Simone Perdigao, Perdigao S, Bruno Guthauser, Guthauser B, Agathe Rousseau, Rousseau A, Mehdi Dahoun, Dahoun M, Guillaume C, Cindy Guillaume, Tabchouri N, Nicolas Tabchouri, Ibrahim Hammoud, Hammoud I
Journal of gynecology obstetrics and human reproduction · 2019 · vol. 48(10) , pp. 811–815 · doi:10.1016/j.jogoh.2019.05.006 · PMID:31059860 · W2943716035
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This retrospective analysis of 4146 cycles found that cycle rank ≤3, age <38, ≥2 follicles, and sperm count ≥5 million were associated with pregnancy after ovarian stimulation and IUI.

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Abstract

BackgroundThe variability in indications and low rate of pregnancy compared to IVF have led many authors to dismiss IUI and offer IVF first-line instead.ObjectivesTo determine what are the predictive factors for clinical pregnancy (CP) and live birth (LB) in intrauterine insemination (IUI) cycles following controlled ovarian stimulation (COS).MethodsRetrospective unicentric study, between January 2009 and December 2016. Patients aged 18 to <43 years who had an IUI following COS with gonadotropins. Statistical analysis was performed using Chi square and logistic regression.Results4146 cycles (1312 couples) included. Mean age was 34.7 +/- 4years. LBR per couple was 39% for anovulatory infertility compared to (p < 0.05) unex-plained infertility (28.6%), mixed (23.4%), male factor (20.1%), unilateral tubal (14.2%), low ovarian reserve (13.2%), and endometriosis (stage I and II) (11.1%). Multivariate analysis showed the following factors were associated with CP: Cycle rank ≤3 (Odds ratio (OR) = 1.5, 95% CI: 1.2-1.9, p < 0.001), age <38 years (OR = 1.5, 95% CI: 1.2-2, p < 0.001), ≥2 preovulatory follicles (OR = 1.4, 95% CI: 1.1-1.8, p = 0.004), TMSC ≥ 5 millions (OR = 1.8, 95% CI: 1.3-2.4, p < 0.001). Endometriosis, low ovarian reserve, unilateral tubal and male factor had a negative impact on CPR (OR = 0.3, 95% CI: 0.1-0.5, p < 0.001; OR = 0.4, 95% CI: 0.3-0.7, p < 0.001; OR = 0.5 95% CI: 0.3-0.9, p = 0.01; OR = 0.6, 95% CI: 0.4-0.8, p = 0.002 respectively) compared to anovulatory infertility.ConclusionWe confirm that IUI can be an efficient treatment in selected indications. Young patients with anovulatory infertility seem to be the ideal candidates, with a 39% LBR per couple.

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Condition tags

endometriosis

MeSH descriptors

Infertility, Female Insemination, Artificial Ovulation Induction Pregnancy Rate Adult Age Factors Anovulation Anovulation Chi-Square Distribution Endometriosis Endometriosis Female Humans Infertility, Female Infertility, Female Infertility, Male Insemination, Artificial Insemination, Artificial Live Birth Logistic Models

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