Effect of clinical and semen characteristics on efficacy of ovulatory stimulation in patients undergoing intrauterine insemination

Purpose: We measured the effect of ovulatory stimulation (OS) upon intraute rine insemination (IUI) success rates, particularly among patients with ris k factors for IUI failure. Methods: Retrospective review of medical and laboratory results from 512 pa tients who underwent 1576 cycles of IUI with partner's sperm over a 3 year period. Data were collected on 3 risk factors for IUI failure (advanced fem ale age >37.7 years, prior corrective pelvic surgery, and poor post-wash sp erm motility), and on method of OS (none, clomiphene citrate, or gonadotrop in). Results: Patients who underwent OS had significantly higher pregnancy rates (7.6%) than those who did not (4.7%, p = 0.02). However where patients wer e stratified by their risk factors, OS made a significant difference only f or patients without risk factors. These patients had a 15.5% per cycle preg nancy rate with OS, compared to 7.9% in unstimulated IUI cycles (p = 0.04). Conclusions: Ovulatory stimulation doubles IUI pregnancy rates among young patients without a prior pelvic surgery and with good post-wash semen quali ty. The benefit of OS for patients with risk factors for IUI failure is unc lear. These patients should be counseled that their chances for success wit h IUI are limited, with or without OS.