Predictive factors for pregnancy after controlled ovarian stimulation and intrauterine insemination: A retrospective analysis of 4146 cycles - 11/05/19

Doi : 10.1016/j.jogoh.2019.05.006

Adélie Michau ^a,^⁎ , Hady El Hachem ^b , Julie Galey ^a , Soizic Le Parco ^a , Simone Perdigao ^a , Bruno Guthauser ^a , Agathe Rousseau ^a , Mehdi Dahoun ^a , Cindy Guillaume ^a , Nicolas Tabchouri ^c , Ibrahim Hammoud ^a
^a ART Center, Institut Mutualiste Montsouris (IMM), 42 Boulevard Jourdan, 75014 Paris, France
^b Department of Obstetrics and Gynecology, Clemenceau Medical Center, Beirut, Lebanon
^c Department of Digestive Diseases, Institut Mutualiste Montsouris (IMM), 42 Boulevard Jourdan, 75014 Paris, France

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 11 May 2019
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Abstract

Background

The variability in indications and low rate of pregnancy compared to IVF have led many authors to dismiss IUI and offer IVF first-line instead.

Objectives

To determine what are the predictive factors for clinical pregnancy (CP) and live birth (LB) in intrauterine insemination (IUI) cycles following controlled ovarian stimulation (COS).

Methods

Retrospective unicentric study, between January 2009 and December 2016. Patients aged 18 to <43 years who had an IUI following COS with gonadotropins. Statistical analysis was performed using Chi square and logistic regression.

Results

4146 cycles (1312 couples) included. Mean age was 34.7 +/− 4years. LBR per couple was 39% for anovulatory infertility compared to (p < 0.05) unex-plained infertility (28.6%), mixed (23.4%), male factor (20.1%), unilateral tubal (14.2%), low ovarian reserve (13.2%), and endometriosis (stage I and II) (11.1%). Multivariate analysis showed the following factors were associated with CP: Cycle rank ≤3 (Odds ratio (OR) = 1.5, 95% CI: 1.2–1.9, p < 0.001), age <38 years (OR = 1.5, 95% CI: 1.2–2, p < 0.001), ≥2 preovulatory follicles (OR = 1.4, 95% CI: 1.1–1.8, p = 0.004), TMSC ≥ 5 millions (OR = 1.8, 95% CI: 1.3–2.4, p < 0.001). Endometriosis, low ovarian reserve, unilateral tubal and male factor had a negative impact on CPR (OR = 0.3, 95% CI: 0.1−0.5, p < 0.001; OR = 0.4, 95% CI: 0.3−0.7, p < 0.001; OR = 0.5 95% CI: 0.3−0.9, p = 0.01; OR = 0.6, 95% CI: 0.4−0.8, p = 0.002 respectively) compared to anovulatory infertility.

Conclusion

We confirm that IUI can be an efficient treatment in selected indications. Young patients with anovulatory infertility seem to be the ideal candidates, with a 39% LBR per couple.

Le texte complet de cet article est disponible en PDF.

Keywords : Intra uterine insemination, Predictive factors, Pregnancy, Controlled ovarian stimulation