Homologous intrauterine insemination. An evaluation of prognostic factors based on a review of 2473 cycles

Objective. To identify prognostic factors influencing the outcome of infert ility treatment using homologous intrauterine inseminations (IUI-H). Design. Retrospective study of all patients undergoing IUI-H at the Fertili ty Clinic, Odense University Hospital from August Ist, 1990 to July 31st, 1 998. Setting. University-affiliate infertility clinic. Patients. Eight hundred and ninety-three couples undergoing 2473 IUI-H trea tment cycles. Main outcome measures. Infertility diagnosis, female age, number of follicl es, type of hormonal treatment, length of follicular phase, endometrial pat tern, and semen quality related to clinical pregnancy rate, cumulative birt h rate and multiple gestations. Results. Throughout the nine year period the overall clinical pregnancy rat e per IUI-H cycle was 11.9% with a significant increase from 8.7% in 1990 t o 14.8% in 1998. The multiple birth rate was 18.1%. The birth rate per coup le was 27.2% after a mean of 2.8 treatment cycles. The pregnancy rate was h ighest in the first treatment cycle and the cumulative birth rate rose only slightly after the fourth treatment cycle. Of the main outcome measures th e following were positively and significantly related to a successful outco me of IUI: i) The first treatment cycle - compared to the following up to s ix treatment cycles; ii) number of mature follicles - up to five - at the t ime of insemination, however, with an unacceptable high rate of multiple pr egnancies with more than 4 mature follicles; iii) use of CC/hMG-FSH as comp ared to CC only for ovarian stimulation; iv) number of motile sperms insemi nated exceeding 5 million; v) time of insemination between the 13th and the 16th day in the cycle and vi) anovulatory or idiopathic infertility: Conclusions. IUI-H is a simple and inexpensive treatment giving acceptable pregnancy rates for up to four treatment cycles providing that at least 3 t o 4 mature follicles have developed at the time of insemination, which impl ies that hormonal ovarian stimulation and induction of ovulation is used, t hat insemination occurs between cycle day 13 and 16 and that at least 5 mil lion motile sperms are available for insemination. Our results indicate tha t in the presence of tubal pathology or less than 5 million motile sperms, the couples should be referred directly to IVF-treatment.