Achieved Gestation Rates After Conjugal Artificial Insemination Depending On The Physician's Technique Experience

Objective: Intrauterine conjugal artificial insemination (IUAI) has been used as first-line treatment in infertile couples for 50 years, enhancing a relatively easy-to-perform procedure. Several factors are known to influence IUAI’s success: woman's age, infertility evolution, sperm quality, sampling-until-insemination time, etc. The aim of this retrospective cohort study is to analyze whether the physician’s technique experience may also affect pregnancy rates after IUAI. Methods: 979 infertile patients undergoing IUAI were recruited in Hospital del Mar (Barcelona) Jan2009- Dec2012, including couples with mild male factor, GI-II endometriosis and unilateral tubal factor. Same ovarian stimulation protocols were used among them: recFSH 75-150IU daily from cycle day 3, dosage adjusted on day 5 and every 48h based on observed follicular growth by ultrasound until 18 mm, +Rec-hCG 250ug for final oocyte maduration. IUAI was performed 36hs later by specialist senior physician (709 patients) or junior (270 patients), all with equally-prepared semen and ultrasound-guided. Data collected and checked to be comparable in both groups included age, parity, BMI, infertility time and cause, motile sperm count, antral follicle count, basal-FSH, number of follicles >16mm, serum-FSH and E2 levels on day 3, and follicle number on hCG-day. Main outcome measures after IUAI were: biochemical gestation rate (positive hCG after 3 weeks), pregnancy rate (visible gestational sac by ultrasound at 6 weeks), and at-term pregnancy (delivery >37 weeks); assessed between groups using Pearson Chi-square test.Results: From 133/979 diagnosed biochemical pregnancies; 112 (84.2%) had been inseminated by senior and 21 (15.8%) by junior practitioners. Biochemical gestation rate was 15.8% for seniors vs. 7.8% for juniors (p=0.001). Among them 125/979 patients got clinically pregnant; 104(83.2%) from senior IUAI and 21 (16.8%) from juniors’. Pregnancy rate was 14.7% for seniors vs. 7.8% for juniors (p=0.002). Finally 91/979 cases achieved term pregnancies; 79 (86.8%) from senior IUAI and 12 (13.2%) from juniors’. At-term pregnancy rate was 11.2% for seniors vs. 4.4% for juniors (p=0.001).As secondary findings, no differences either in miscarriage rates or multiple gestation rates were found between groups.Conclusion: Practitioners’ technique experience seems to affect pregnancy rates resulting from IUAI, which stands out the relevance of its performance learning curve.