RESULTS OF 78 INTRAUTERINE INSEMINATION (IUI) CYCLES WITH HUSBAND SPERM IN INFERTILITY AND FACTORS AFFECTING IUI SUCCESS: A RETROSPECTIVE STUDY

Abstract

Abstract

Introduction: Intrauterine insemination (IUI) with or without controlled ovarian hyperstimulation is a

widely used therapeutic option for a variety of causes of infertility. Compared to in vitro fertilization (IVF)

and intracytoplasmic sperm injection (ICSI), IUI is efficient and more cost-effective than the others for the

treatment of unexplained and nonsevere male factor infertility. In this retrospective study, we aimed to

determine our IUI outcomes and the variables influencing IUI success.

Materials and Methods: To determine the influence of several parameters (age, duration and type of

infertility, semen parameters, presence of varicocele, varicocelectomy and smoking histories) on the outcome

of IUI in 35 women undergoing ovarian stimulation with clomiphen citrat, a retrospective review of 78 IUI

cycles, which were done for the treatment of infertility using fresh husband sperm, was performed for

approximately 1 year on data from the IUI program. Results of Pre-IUI evaluations were normal in all women

and all men had normal semen analyses results. Discontinuous gradient centrifugation (DGC) with Sil-Select

Plus was used for sperm preparation. Maximum number of IUI cycles per couple was three. In statistical

analysis, χ2, Fisher’s exact and Mann-Whitney U tests for in- and between-group comparisons and Pearson

and Spearman tests for correlation analyses were used.

Results: Primary and secondary infertility were determined in 25 and 10 couples, respectively. Fourteen

men had varicocelectomy history. Ten men were smoking cigarette. Seven men had left varicocele at physical

examination. Means of man and woman age and infertility duration were 29.94±4.72 (23-46) years, 27.46±4.55

(20-38) years and 63.23±30.88 (15-123) months, respectively. The pregnancy rate was 8.97% (7/78) per

treatment cycle, 20% (7/35) per patient, 5.71% (2/35) for first cycle, 10.34% (3/29) for second cycle and 14.3%

(2/14) for third cycle. All pregnancies were normal. No miscarriage, tubal pregnancy, birth defect and

prematurity were observed. Difference between the pregnancy rates of each cycle was statistically insignificant

(p=0.697). There were statistically significant negative correlations between the pregnancy rate and mean ages

of the men and especially women (p=0.041, p=0.009, respectively). However, no correlation was found between

pregnancy rate and infertility duration (p=0.108). DGC procedure increased percents of the sperms moving

with a slow, meandering forward progression (grade 2) and in a straight line with high speed (grade 4) and

decreased percent of sperms with no movement (grade 0) very significantly, without changing the percent of

those with sluggish or nonprogressive movement (grade 1). However no-one of the pre and post-DGC semen

analysis parameter was found to have influence on pregnancy rate. Pregnancy rates in the primary and

secondary infertile couples were statistically indifferent. Pregnancy rates achieved in patients without

varicocele or with a history of successful varicocelectomy were higher than those with untreated varicocele and

with a history of unsuccessful varicocelectomy. There was not any statistically significant difference between

the pregnancy rates in the patients with and without smoking history.

Conclusion: The most significant predictors of success of IUI with fresh husband sperm in infertile

couples were age of the woman and man. Absence of varicocele and treatment of it seemed to have affirmative

effect on pregnancy rate.