Intrauterine insemination cycles: prediction of success and thresholds for poor prognosis and futile care
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ASSISTED REPRODUCTION TECHNOLOGIES
Intrauterine insemination cycles: prediction of success and thresholds for poor prognosis and futile care Alessandra J. Ainsworth 1 & Emily P. Barnard 2 & Sarah C. Baumgarten 1 & Amy L. Weaver 3 & Zaraq Khan 1 Received: 26 March 2020 / Accepted: 6 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose We aimed to define intrauterine insemination (IUI) cycle characteristics associated with viable birth, identify thresholds below which IUI treatments are consistent with very poor prognosis and futile care, and develop a nomogram for individualized application. Methods This retrospective cohort study evaluated couples using fresh partner ejaculate for IUI from January 2005 to September 2017. Variables included female age, semen characteristics, and ovarian stimulation type. Using cycle-level data, we evaluated the association of these characteristics with the probability of viable birth by fitting generalized regression models for a binary outcome with a logit link function, using generalized estimating equation methodology to account for the correlation between cycles involving the same patient. Results The cohort consisted of 1117 women with 2912 IUI cycles; viable birth was achieved in 275 (9.4%) cycles. Futile care (viable birth rate < 1%) was identified for women age > 43, regardless of stimulation type or inseminate motility (IM). Very poor prognosis (viable birth rate < 5%) was identified for women using oral medications or Clomid plus gonadotropins who were (1) age < 35 with IM < 49%, (2) age 35–37 with IM < 56%, or (3) age ≥ 38, and (4) women age ≥ 38 using gonadotropins only with IM < 60%. A clinical prediction model and nomogram was developed with an optimism-corrected c-statistic of 0.611. Conclusions The present study highlights the impact of multiple clinical factors on IUI success, identifies criteria consistent with very poor prognosis and futile care, and provides a nomogram to individualize counseling regarding the probability of a viable birth. Keywords Intrauterine insemination . Poor prognosis care . Futile care . Nomogram
Introduction Intrauterine insemination (IUI) is a common approach for many women presenting for fertility treatment. It is the recommended
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10815-020-01918-z) contains supplementary material, which is available to authorized users. * Zaraq Khan [email protected] 1
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
2
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Pittsburgh, Pittsburg, PA, USA
3
Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
first-line approach for couples with unexplained infertility and for women without male partners using donor sperm for
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