• Vol. 43 No. 4, 225–231
  • 15 April 2014

Younger Women with Ovulation Disorders and Unexplained Infertility Predict a Higher Success Rate in Superovulation (SO) Intrauterine Insemination (IUI)

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ABSTRACT

Introduction: Superovulation-intrauterine insemination (SO-IUI) is the most common assisted reproductive technique (ART) in the world, with good evidence of efficacy and cost-effectiveness. However, parameters affecting its success have not been consistently reported. So in this study, we aim at determining the parameters influencing the success rate of SO-IUI.

Materials and Methods: We conducted a retrospective cohort study of 797 SO-IUI cycles from 606 patients, performed between 2007 and 2009 in a single centre. These women received clomiphene citrate (CC), recombinant FSH (rFSH) or both.

Results: There were 127 clinical pregnancies with a pregnancy rate (PR) of 15.9% (127/797) per treatment cycle. Factors associated with higher PR included maternal age <38 (P = 0.02), subfertility diagnoses of ovulatory disorders, unexplained infertility, sexual dysfunction and unilateral tubal obstruction (P = 0.02), an endometrial thickness ≥8 mm (P = 0.03), total number motile spermatozoa (TNMS) of ≥1 million (P = 0.03), and spermatozoa normal forms (NF) ≥4% (P <0.01) on bivariate analysis. When CC is used, the endometrial thickness is more likely to be suboptimal (<8 mm). All the above parameters remained significant except the subfertility diagnoses on multivariate analysis.

Conclusion: Patients’ selection with women <38 years old and preferably with ovulation disorders and unexplained infertility is associated with the highest PR in SO-IUI. Cycle parameters such as the use of rFSH alone, with the avoidance of CC, TNMS ≥1 million and NF ≥4% is likely to result in the best outcomes and reduce the high order multiple pregnancy risk.


Intrauterine insemination (IUI) with or without stimulation is the most common assisted reproductive technique (ART) in the world. Currently, IUI is widely used for treating infertility as a cheaper, simpler and less invasive method compared to in vitro fertilisation (IVF) techniques. While there is good evidence of the efficacy and cost-effectiveness of stimulated IUI (SO-IUI), the pregnancy rates (PR) of an unselected infertile population following homologous SO-IUI can vary from 8.2% to 16.9%. Accordingly, the ESHRE Capri Workshop Group attempted, to clarify the role of individual parameters such as maternal age, aetiology of infertility, the ovulation induction drug utilised, number of preovulatory follicles available and semen parameters. However, the results were either conflicting or non-informative. Thus, we conducted a retrospective study in a cohort of Southeast Asian patients undergoing SO-IUI in our centre with the aim of examining factors that influence the PR.

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