Abstract
Purpose
The objective of our study is to investigate the optimum number of stimulated intrauterine insemination (SIUI) or donor insemination (DI) cycles that can be offered to the couples prior to in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) in a tertiary referral unit for assisted reproduction.
Methods
This is a retrospective analysis of 408 SIUI and 704 DI cycles performed in a tertiary referral unit for assisted reproduction. SIUI’s were performed by controlled ovarian hyperstimulation and ovulation induction followed by insemination 36 h later. DI’s were performed in natural or stimulated cycles after thawing frozen donor sperm. The main outcome measured was cumulative live birth rate (CLBR) per couple.
Results
A maximum CLBR of 26.1% was achieved after the fourth cycle of SIUI. The CLBR of DI increased to 60.1% in the sixth cycle.
Conclusions
This study, in line with a number of other studies, is unable to demonstrate unequivocally whether increasing numbers of IUI or DI cycles are justified clinically or financially. There is a need for larger datasets from multiple centres along with rigorous randomised trials to compare treatment pathways. Until then, the resources spent on the provision of extra SIUI cycles may be better utilized by early referral to IVF.
Similar content being viewed by others
References
Plosker SM, Jacobson W, Amato P. Predicting and optimizing success in an intra-uterine insemination programme. Hum Reprod. 1994;9:2014–21.
Agrawal SK, Buyalos RP. Clomiphene citrate with intrauterine insemination: Is it effective therapy in women above the age of 35 years? Fertil Steril. 1996;65:759–63.
Yang JH, Wu MY, Chao KH, Chen SU, Ho HN, Yang YS. Controlled ovarian hyperstimulation and intrauterine insemination in subfertility. How many treatment cycles are sufficient? J Reprod Med. 1998;43:903–8.
Shulman A, Hauser R, Lipitz S, Frenkel Y, Dor J, Bider D. Sperm motility is a major determinant of pregnancy outcome following intrauterine insemination. J Assist Reprod Genet. 1998;15:381–5. doi:10.1023/A:1022585000740.
Sahakyan M, Harlow BL, Hornstein MD. Influence of age, diagnosis, and cycle number on pregnancy rates with gonadotropin-induced controlled ovarian hyperstimulation and intrauterine insemination. Fertil Steril. 1999;72:500–4. doi:10.1016/S0015-0282(99)00300-3.
Nuojua-Huttunen S, Tomas C, Bloigu R, Tuomivaara L, Martikainen H. Intrauterine insemination treatment subfertility: an analysis of factors affecting outcome. Hum Reprod. 1999;14:698–703. doi:10.1093/humrep/14.3.698.
Khalil MR, Rasmussen PE, Erb K, Laursen SB, Rex S, Westergaard LG. Homologous intrauterine insemination. An evaluation of prognostic factors based on a review of 2473 cycles. Acta Obstet Gynecol Scand. 2001;80:74–81.
Papageorgiou TC, Guibert J, Savale M, Goffinet F, Fournier C, Merlet F, et al. Low dose recombinant FSH treatment may reduce multiple gestations caused by controlled ovarian hyperstimulation and intrauterine insemination. BJOG. 2004;111:1277–82. doi:10.1111/j.1471-0528.2004.00439.x.
Lalich RA, Marut EL, Prins GS, Scommegna A. Life table analysis of intrauterine insemination pregnancy rates. Am J Obstet Gynecol. 1988;158:980–4.
Campana A, Sakkas D, Stalberg A, Bianchi PG, Comte I, Pache T, et al. Intrauterine insemination: evaluation of the results according to the woman’s age, sperm quality, total sperm count per insemination and life table analysis. Hum Reprod. 1996;11:732–6.
Friedman AJ, Juneau-Norcross M, Sedensky B, Andrews N, Dorfman J, Cramer DW. Life table analysis of intrauterine insemination pregnancy rates for couples with cervical factor, male factor, and idiopathic infertility. Fertil Steril. 1991;55:1005–7.
Aboulghar MA, Mansour RT, Serour GI, Abdrazek A, Amin Y, Rhodes C. Controlled ovarian hyperstimulation and intrauterine insemination for treatment of unexplained infertility should be limited to a number of 3 cycles. Fertil Steril. 2001;75:88–91. doi:10.1016/S0015-0282(00)01641-1.
National Institute for Clinical Excellence. Fertility: assessment and treatment for people with fertility problems. In: National Collaborating Centre for Women’s and Children’s Health. NICE UK: RCOG press; 2004.
Pandian Z, Bhattacharya S, Nikolaou D, Vale L, Templeton A. In vitro fertilisation for unexplained subfertility. Cochrane Database Syst Rev 2, 2002CD 003357.
Goverde AJ, McDonnell J, Vermeiden JP, Schats R, Rutten FF, Schoemaker J. Intrauterine insemination or in vitro fertilisation in idiopathic subfertility and male subfertility: a randomised trial and cost-effectiveness analysis. Lancet. 2000;355:13–8. doi:10.1016/S0140-6736(99)04002-7.
Pashayan N, Lyratzopoulos G, Mathur R. Cost-effectiveness of primary offer of IVF vs. primary offer of IUI followed by IVF (for IUI failures) in couples with unexplained or mild male factor sub fertility. BMC Health Serv Res. 2006;6:80. doi:10.1186/1472-6963-6-80.
Agresti A, Coull BA. Approximate is better than “exact” for interval estimation of binomial proportions. Am Stat. 1998;52:119–26. doi:10.2307/2685469.
Weinberg CR, Gladen BC. The beta-geometric distribution applied to comparative fecundability studies. Biometrics. 1986;42:547–60. doi:10.2307/2531205.
Anderson AN, Goossens V, Ferraretti AP, Bhattacharya S, Felberbaum R, de Mouzon J, et al. Assisted Reproductive technology in Europe, 2004: results generated from European registers by ESHRE. Hum Reprod. 2008;23:756–71. doi:10.1093/humrep/den014.
Burr RW, Siegberg R, Flaherty SP, Wang XJ, Matthews CD. The influence of sperm morphology and the number of motile sperm inseminated on the outcome of intrauterine insemination combined with mild ovarian stimulation. Fertil Steril. 1996;65:127–32.
Ombelet W, Vandeput H, Van de Putte G, Cox A, Janssen M, Jacobs P, et al. Intrauterine insemination after ovarian stimulation with clomiphene citrate: predictive potential of inseminating motile count and sperm morphology. Hum Reprod. 1997;12:1458–63. doi:10.1093/humrep/12.7.1458.
Dickey RP, Taylor SN, Lu PY, Sartor BM, Rye PH, Pyrzak R. Effect of diagnosis, age, sperm quality, and number of preovulatory follicles on the outcome of multiple cycles of clomiphene citrate-intrauterine insemination. Fertil Steril. 2002;78:1088–95. doi:10.1016/S0015-0282(02)04212-7.
Barros Delgadillo JC, Rojas Ruiz JC, Molina Munguía AC, Villalobos Acosta S, Sánchez Solís V, Barroso Villa G. Prognostic factors of pregnancy in intrauterine insemination. Ginecol Obstet Mex. 2006;74:611–25.
Tomlinson MJ, Amissah-Arthur JB, Thompson KA, Kasraie JL, Bentick B. Prognostic indicators for intrauterine insemination (IUI): statistical model for IUI success. Hum Reprod. 1996;11:1892–6.
Dankert T, Kremer JA, Cohlen BJ, Hamilton CJ, Pasker-de Jong PC, Straatman H, et al. A randomized clinical trial of clomiphene citrate versus low dose recombinant FSH for ovarian hyperstimulation in intrauterine insemination cycles for unexplained and male subfertility. Hum Reprod. 2006;22:792–7. doi:10.1093/humrep/del441.
Werbrouck E, Spiessens C, Meuleman C, D’Hooghe T. No difference in cycle pregnancy rate and in cumulative live-birth rate between women with surgically treated minimal to mild endometriosis and women with unexplained infertility after controlled ovarian hyperstimulation and intrauterine insemination. Fertil Steril. 2006;86:566–71. doi:10.1016/j.fertnstert.2006.01.044.
Custers IM, Steures P, Hompes P, Flierman P, van Kasteren Y, van Dop PA, et al. Intrauterine insemination: how many cycles should we perform? Hum Reprod. 2008;23:885–8. doi:10.1093/humrep/den008.
Achard V, Perrin J, Saias-Magnan J, Noizet A, Grillo JM, Paulmyer-Lacroix O. Optimization of artificial inseminations with donor semen: a four-year experience. Gynecol Obstet Fertil. 2005;33:877–83. doi:10.1016/j.gyobfe.2005.07.040.
Ferrara I, Balet R, Grudzinskas JG. Intrauterine insemination with frozen donor sperm. Pregnancy outcome in relation to age and ovarian stimulation regime. Hum Reprod. 2002;17:2320–4. doi:10.1093/humrep/17.9.2320.
Jurema MW, Vieira AD, Bankowski B, Petrella C, Zhao Y, Wallach E, et al. Effect of ejaculatory abstinence period on the pregnancy rate after intrauterine insemination. Fertil Steril. 2005;84:678–81. doi:10.1016/j.fertnstert.2005.03.044.
Khalil MR, Rasmussen PE, Erb K, Laursen SB, Rex S, Westergaard LG. Intrauterine insemination with donor semen. An evaluation of prognostic factors based on a review of 1131 cycles. Acta Obstet Gynecol Scand 2001;80:342–8.
Philips Z, Barraza-Llorens M, Posnett J. Evaluation of the relative cost-effectiveness of treatments for infertility in the UK. Hum Reprod. 2000;15:95–106. doi:10.1093/humrep/15.1.95.
van Weert JM, Van den Broek J, Van der Steeg JW. ven Der veen F, Flierman PA, Mol BW, Steures P: Patients preferences for intrauterine insemination or IVF. RBM Online. 2007;15:422–7.
Reindollar RH, Regan MM, Neumann PJ, Thornton KL, Alper MM, Goldman MB. A Randomized Controlled trial of 503 couples assigned to conventional infertility treatment or an accelerated track to IVF: Preliminary results of the fast track and standard treatment (FASTT) trial. Fertil Steril. 2007;88(Suppl. 1):S41. doi:10.1016/j.fertnstert.2007.07.145.
Author information
Authors and Affiliations
Corresponding author
Additional information
Capsule Compared to donor insemination cycles, higher order stimulated intrauterine insemination (SIUI) cycles do not increase the cumulative pregnancy rates.
Rights and permissions
About this article
Cite this article
Vitthala, S., Gelbaya, T.A., Hunter, H. et al. Stimulated intrauterine insemination (SIUI) and donor insemination (DI) as first line management for a selected subfertile population: the Manchester experience. J Assist Reprod Genet 25, 431–436 (2008). https://doi.org/10.1007/s10815-008-9251-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10815-008-9251-0