Determinants of the outcome of intrauterine insemination: Analysis of outcomes of 9963 consecutive cycles

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• 作者：Bronte A. Stone ; Joyce M. Vargyas ; Guy E. Ringler ; Andrea L. Stein ; Richard P. Marrs
• 关键词：Determinants of outcome of intrauterine insemination ; sperm processing ; patient stimulation ; patient age
• 刊名：American Journal of Obstetrics and Gynecology
• 出版年：1999
• 出版时间：June 1999
• 年：1999
• 卷：180
• 期：6
• 页码：1522-1534
• 全文大小：143 K

文摘

Objective: Our aim was to determine which factors influence the effectiveness of intrauterine insemination. Study Design: This article is a retrospective statistical analysis of outcomes of 9963 consecutive intrauterine insemination cycles. Results: Patient age was the main determinant of pregnancy outcome (analysis of variance F ratio = 29, P < .0001), followed by the number of follicles at the time of intrauterine insemination (analysis of variance F ratio = 9, P < .0001) and sperm motility in the inseminate (analysis of variance F ratio = 4, P = .002). A total of 18.9 % of all patients <26 years old conceived, compared with 13.9 % of those 26-30 years old, 12.4 % of those 31-35 years old, 11.1 % of those 36-40 years old, 4.7 % of those 41-45 years old, and 0.5 % of patients >45 years old (P < .001). When analyzed by single years, ongoing pregnancy rates after intrauterine insemination remained high through age 32 years. Across all ages and causes of infertility, 7.6 % of patients with 1 follicle at the time of intrauterine insemination conceived, compared with 10.1 % with 2, 14.0 % with 4, and 16.9 % with 6 follicles (P < .01). When ovulation occurred before intrauterine insemination (ie, no visible follicular structures), 4.6 % of patients conceived. The likelihood of pregnancy was maximized when motile sperm numbers were ≥4 million and sperm motility was ≥60 % . Differences in pregnancy outcomes between sperm processing options were related to differences in sperm motility after processing; use of methods incorporating motility enhancement with pentoxifylline and motile sperm concentration through silica gradients yielded the highest overall pregnancy rates. Conclusion: When the results of ongoing retrospective analysis of intrauterine insemination outcomes are applied, overall intrauterine insemination pregnancy rates have increased from 5.8 % per cycle in 1991 to 13.4 % per cycle in 1996, during which time the average age of patients undergoing intrauterine insemination has increased from 36.1 (±0.2) to 39.2 (±0.1) years. (Am J Obstet Gynecol 1999;180:1522-34.)