There was no interaction between female age and indication. Results of the Cox regression analysis after adjusting for factors influencing ongoing pregnancy outcome from Cycle 1 to 6. Spline: age in relation to OPR. The HR is the black line, and the CI is the grey area around the line. One clinic performed two inseminations per ICI treatment. An increasing female age from 32 years onward was the only factor influencing OPR negatively for both treatments.
This cohort is unique since it is the largest cohort study on this topic and compares IUI and ICI in the natural cycle. Furthermore, it describes heterosexual, lesbian couples and single women, while all previous studies were limited to heterosexual couples and single women Besselink et al.
One of the limitations of this retrospective cohort is that there was considerable practice variation in semen processing, single or double insemination and timing of insemination between the participating centres. For ICI, sperm processing was never used. For IUI, five sperm banks froze the donor sperm and performed processing after thawing and one sperm bank performed processing before freezing.
Therefore, it was not feasible to evaluate the confounding or modifying effect of semen processing on the ongoing pregnancy chances following IUI and ICI. The only evidence that semen processing does not affect pregnancy chances comes from a study that combined retrospective data from women and prospective data from 39 women Wolf et al.
In the case of ICI, one clinic performed two inseminations per cycle. Also the timing of insemination was performed in different ways; some clinics used urine LH tests and some ovulation induction by human chorionic gonadotrophin Pregnyl. Guidelines do not report on timing of insemination in the case of AID. A second limitation is that data on the medical history including previous pregnancies and duration of subfertility were not obtained. These factors may influence pregnancy rates van der Steeg et al.
Nevertheless, the main prognostic factor to predict conception, e. From a theoretical point of view, we do not expect that duration of infertility and previous obstetric history results will add any additional information, since most women who opt for AID are not subfertile at all. Evidence of whether medical history does influence pregnancy outcome in this population is lacking. Thirdly, in heterosexual couples, it is known that partners of azoospermic men conceive more quickly with AID than partners of men with spermatozoa in their ejaculates, suggesting that in the latter, unknown female factors also contribute to the subfertility of the couples NICE, In this cohort, we did not differentiate between the indications for AID in heterosexual couples, because the data were not available.
This could have resulted in lower OPRs in heterosexual women. Finally, the number of women who started inseminations dropped after the first cycle, which makes calculation of OPRs less reliable. OPRs dropped after the first cycle, but cycles up to the sixth cycle still gave ongoing pregnancies. Several findings in our study warrant further discussion. First, in our cohort, the cumulative OPRs were lower compared than expected for a normal fertile population.
We assume that the lower OPR in this cohort is due to the use of cryopreserved donor sperm. Second, after every cycle, there were non-pregnant women who stopped treatment before the six cycles were completed. Dropout rates were higher in the ICI group. Fear of failure is a well-known and important factor in fertility treatment from the point of view of the patient, but also from the perspective of the doctor, and this may have led to the number of dropouts Campana et al.
Reasons for discontinuing inseminations are numerous; for a couple with repeated failed attempts, continuing AID may become a frustrating experience; from the clinician's perspective, repeating AID cycles can be time-consuming and it may seem easier to offer alternative options than to motivate patients who have lost confidence.
In view of this, we have to realize that women applying for AID are not proven to be subfertile. Furthermore, our data show that continuation of treatment after several failed attempts may be rewarding.
Appropriate counselling should help the couples to understand the principle of the treatment without ovarian stimulation and their pregnancy chances. Our study provides for the first time data questioning the use of IUI and at the same time underpinning the recommendation to inseminate in the natural cycle and thus not to add ovarian stimulation.
The costs for IUI have been estimated to be four times higher than ICI, mostly because of the additional sperm preparation required. Assuming pregnancy rates of In the absence of a significant difference, ICI should therefore be the preferred treatment.
Even if IUI would be 2. In conclusion, this retrospective cohort study showed no substantial benefit of IUI in the natural cycle above ICI in the natural cycle for insemination with cryopreserved donor sperm.
An RCT with an economic analysis alongside it is highly recommended to provide definitive evidence on the most cost-effective insemination technique. She also drafted the manuscript. Holiday Hours - The Holidays are upon us! Please review and accept our updated Privacy Policy.
Privacy Policy Accept. Privacy Policy. Close Privacy Overview This website uses cookies to improve your experience while you navigate through the website. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website.
We also use third-party cookies that help us analyze and understand how you use this website. These cookies will be stored in your browser only with your consent. You also have the option to opt-out of these cookies. Contact an Expert Inquire now and start a confidential conversation regarding your fertility care.
Subscribe to Blog Newsletter Get the latest from our blog directly in your inbox once a month, and learn more about your fertility options. Subscribe to the blog below. Turn Your Dreams of Parenthood into a Reality. Insemination may be used in cases of male factor infertility, cervical factor infertility, unexplained infertility, or when donor sperm is being used.
Donor sperm may be an option when male factor infertility is involved, or it may be chosen when a single woman or lesbian couple want to have a baby. Many fertility clinic doctors suggest IUI, or intrauterine insemination, by default. This is what they are most used to offering in an infertility setting.
Get diet and wellness tips to help your kids stay healthy and happy. Allahbadia GN. Intrauterine Insemination: Fundamentals Revisited. J Obstet Gynaecol India. Banerjee K, Singla B. J Hum Reprod Sci. Intrauterine insemination versus intracervical insemination in donor sperm treatment. Cochrane Database Syst Rev. Intrauterine insemination versus fallopian tube sperm perfusion for non-tubal infertility. American Pregnancy Association. Intrauterine Insemination: IUI.
Merck Manual Professional Version. Updated April Your Privacy Rights. To change or withdraw your consent choices for VerywellFamily.
0コメント