Improving pregnancy rates in IUI procedure

NMUH Staff Publications

EMBASE

30

<span style="font-size: 10pt;">Study question: Which contributing factors will help improve rates for an IUI program using husbands sperm? Summary answer: Multiple factors associated with a successful pregnancy were: age of woman, having >= 5 million TPMS (Total Progressive Motile Sperm), insemination with at least 50% Grade A sperm, a mean of 1.7 follicles as in 45.8% of successful cohort, while.using hMG protocol with IUI at 29 hour hCG trigger. What is known already: IUI is universally practiced but the pregnancy rates are not well understood, with diverse protocols and practices, sometimes with higher order multiple births. Based on poor outcomes of about 6%/cycle pregnancy rates using clomid stimulation one RCT labelled IUI as ineffective despite the existence of a much larger HFEA database yielding on average 13%/ cycle success rates. IUI has also been blamed for higher order multiples births, and to erroneously recommend IVF instead. Study design, size, duration: The retrospective cohort study from a large teaching hospital charts the increasing pregnancy rates from 2009 to 2014. Improved outcomes were associated with a shift away from clomid to hMG stimulated cycles, and adding a 'consecutive ejaculate' to the first ejaculate in the sperm preparation procedure, and this unique approach has not been reported in clinical application before. The IUI outcomes for 2014 relating to 117 IUI cycles and 73 women will be discussed in detail. Participants/materials, setting, methods: A qualitative analyses from 2009- 2014 charted improving pregnancy outcomes, followed by detailed retrospective analyses from January-September 2014 included 117 cycles, 73 women and 24 clinical pregnancies. The unique clinical use of a 'consecutive ejaculate' to enhance the TPMS with a realistic hMG protocol made IUI a viable procedure. Main results and the role of chance: After IUI the pregnancy rates were 20.5%/cycle and 32.9% of the women became pregnant. The result exceeded the UK average of 13%/cycle, which in turn exceeded the the 6%/cycle from the only published RCT to condemn IUI procedure as ineffective. Our result is probably the best available data, robust, maintainable, and follows the improving trend over the years. The unique use of 'consecutive ejaculates' has contributed towards allowing 87.5% of the inseminations reach a threshold of >= 5 million TMPS, which has been quoted as a threshold for IUI to be realistic, and 54% of the pregnancies were associated with the 'consecutive ejaculate.' Insemination after 29 hour post hCG trigger seems to be positively associated with pregnancies. Limitations, reason for caution: This is a retrospective study needing to be scaled up and preferably entered in a prospective RCT. Patients serve as their own control. Wider implications of the findings: This is the best available data for IUI pregnancy rates, which if replicated on a large scale would challenge some IVF results, while allowing for a significant reduction of multiple birth rates. The multiple births and OHSS were none existent in our cohort and inseminating with 2-3 follicles may not present a significant risk as transferring 2-3 embryos as in IVF cycles. Consecutive ejaculate application is unique and will prove beneficial globally. [Conference abstract]</span>