Acceptable pregnancy rate of unstimulated intrauterine insemination: a retrospective analysis of 17,830 cycles
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ORIGINAL ARTICLE
Acceptable pregnancy rate of unstimulated intrauterine insemination: a retrospective analysis of 17,830 cycles Tetsuro Honda • Mai Tsutsumi • Fumio Komoda Kenichi Tatsumi
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Received: 17 June 2014 / Accepted: 6 August 2014 / Published online: 21 August 2014 Ó The Author(s) 2014. This article is published with open access at Springerlink.com
Abstract Purpose To evaluate the pregnancy rate (PR) of unstimulated intrauterine insemination (IUI). Methods This was a retrospective study in a private fertility clinic. Between 2004 and 2013, a total of 4,045 women underwent 17,830 cycles of unstimulated IUI. The etiologies of subfertility in the couples were unexplained (51 %), male factor (36 %), coital problems (9.5 %), and cervical factor (3.5 %). Results The PRs/cycle, between the 1st and 9th trials, in women \35, 35–37, 38–40, 41–42, and [42 years of age were 8.2, 7.3, 5.5, 3.6, and 0.9 %, respectively. In 10,076 cycles in which the male partner had a total motile sperm count C5 million, the PRs in the respective age groups were 9.9, 8.6, 6.1, 4.8, and 1.2 %. The largest-sized reported PRs for clomiphene citrate (CC)/IUI in the respective age groups were 11.5, 9.2, 7.3 4.3, and 1.0 % (4,199 cycles in total, Dovey et al., FertilSteril, 2008;90:2281–2286). There were no significant differences in PRs between unstimulated IUI and CC/IUI. Conclusion PR for unstimulated IUI was similar to the reported PR for CC/IUI. Although this was a retrospective study without a control group, to reduce multiple pregnancy rate, we believe that unstimulated IUI is a reasonable treatment. Keywords Controlled ovarian hyperstimulation Intrauterine insemination Multiple pregnancy Pregnancy rate Unstimulated
T. Honda (&) M. Tsutsumi F. Komoda K. Tatsumi Umegaoka Women’s Clinic, 1-33-3, Umegaoka, Setagaya, Tokyo 154-0022, Japan e-mail: [email protected]
Introduction Intrauterine insemination (IUI) is a common treatment for cervical factor, male factor, coital problems, and unexplained subfertility. In a previous review, the pregnancy rate (PR) per cycle for unexplained subfertility was reported to be 1.3–4.1 % with expectant management, 3.8 % with unstimulated IUI, 5.6 % with clomiphene citrate (CC), 8.3 % with CC/IUI, 7.7 % with gonadotropin (GT) administration, 17.1 % with GT/IUI, and 20.7 % with assisted reproductive technology (ART) [1]. With regard to male factor subfertility, PR of GT/IUI is superior to that of unstimulated IUI [2, 3]. Consequently, IUI has been performed generally combined with controlled ovarian hyperstimulation (COH), i.e., with CC and/or GT. The European Society of Human Reproduction and Embryology (ESHRE) Capri Workshop Group reported that PR was 12.4 % in 98,388 cycles of IUI performed in 2004, and that the incidence of multiple births with IUI was 11.8 %, suggesting that most cycles were combined with COH [4]. Since a potential complication of COH/IUI is the increased risk of multiple pregnancies, it was regarded as questionable whether Grade-A evidence for the efficacy of
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